implants - international magazine of oral implantology

I overview Figs. 1a-f_Single-tooth replacement with 3-D planning pre- and post-augmentation: Massive defects in the buccal lamella, regions 11 and 21 (a). The dimensions of the defects are visible in the sagittal plane (b). After horizontal bone grafting (c). Three-dimensional planning post-augmentation (d). Post-implantation (e). Patient with crowns (f). _Introduction Implantology is predominantly a surgical and prostheticsubjectarea.Itsaimisbothfunctionaland aestheticrestoration.Today,onecanplaceanimplant in the jawbone with a high probability of success if there is good bone support. There are, however, con- cernswithregardtobonedefects,optimumaesthetic and functional positioning of the implant and the soft-tissuesituation,possiblerequiringpartialrecon- struction. The ideal number of implants for large su- perstructures is still a matter of debate. Functionality, durability and aesthetics are aims that should, in general, be achieved as simply as pos- sible using favourable and conditionally reversible techniques with minimal damage, even in problem- aticcases.Restoringteethtodayhasbecomeeasierto achieve but whether the cost–benefit ratio is satis- factorymustbeestablishedforeachcase.Thereisstill no consensus on these aims and perhaps success can be defined only individually. Expectations regarding implantological solutions have increased owing to significant technological advances. One may distin- guishbetweengeneralsuccesscriteriavalidforallim- plantsandcriteriaforspecialindications.Whilesome scientific societies recommend replacing lost teeth with implants as the optimal treatment, and bearing in mind that the goal is restoration of natural condi- tions,onehastoascertainwhetherthisisvalidforsin- gle-tooth and multiple-tooth replacement for each case. Reasons for suboptimal solutions are manifold, rangingfrompoorinitialconditionsassociatedwitha higher treatment risk to socio-economic limitations. Onecannotwriteaboutimplanttreatmentingen- eral, as too many parameters play a role, particularly because each case differs from another. Moreover, therearenogeneralrecommendationswithregardto methodology. This is hardly surprising, since various methods are used, of which many have limited appli- cation and quickly become out of date. There is no widely agreed upon gold standard.1 _Methods In 2000, CBCT was introduced to our clinic with hesitation initially and limited to more extensive problems and progressive diseases. It was used in- creasingly and has been used for almost all implant surgeries since 2008. Three-dimensional diagnostics undisputedly offer greater insight, thus increasing thequalityofthetreatment.Three-dimensionalplan- ning, however, always means considering the pros- thetic planning and the anatomical substratum. This is done digitally or via conventional casts. Even before the introduction of 3-D technologies, backward planning2 demonstrated that viewing the desiredtreatmentresultishelpfulinachievingthere- sult. Here too, we initially applied backward planning to cases requiring extensive treatment at first, until welearnedthatplanningisusefulforsingle-toothre- placement too. Each of these techniques—conven- tional casts and CBCT scans—can be helpful, con- tributing to a distinct improvement in the treatment results in the hands of the experienced implantolo- gist. The next step would therefore be to connect thesetwotechniques.Afterpurelydigitallycontrolled navigationwasfoundtobeinaccurate,surgicalguide systems, based on planning software, became avail- able. Advantagesof 3-Dplanningforimplants Authors_Drs A. Grandoch & P. Ehrl, Germany 26 I implants2_2013 Fig. 1a Fig. 1dFig. 1cFig. 1b Fig. 1e Fig. 1f