cone beam international magazine of cone beam dentistry

overview _ implant planning I I 13cone beam2_2014 Fig. 8a_STL mesh of the situation model of Figure 6 with designed drilling sleeve guides, even under existing dentures (regio 36, 44/45). Fig. 8b_ Replication model resulting from Figure 8a with drill sleeve guides. Fig. 8c_Model replica with attached surgical drilling guides (Steco) in preparation of the production of surgical drilling template. Fig. 9a_Matching: situation model (red), wax-up (green), the opposing jaw (yellow) and DICOM dataset using virtual articulator; planned implant positions (orange line: gingiva). Fig. 9b_Hidden situation model; situation as seen in Figure 9a. Fig. 9c_Situation of Figure 9a: orthogonal slice with planned implant to planned full-guided drilling sleeve; gingiva line (orange); wax-up contour (green). Fig. 9d_Situation model (red) with the opposing jaw (yellow) in the virtual articulator and the planned implant positions and parallelised abutments. Fig. 9e_Situation in Fig. 9d, posterior view. Fig. 9f_Situation model (red) with the opposing jaw (yellow) in the virtual articulator with the planned implant positions, parallelised abutments and position for drilling sleeves (full-guided). Fig. 9g_STL mesh with drilling sleeves for the production of the replica model (surgical template). DICOM and STL data are used. Virtual models can be designed with exactly positioned sleeves for full- guidedsystemsandorwithlaboratoryanaloguesof the planned implants. This range can be extended, providedthattheSTLdatasetsofcomponentstobe designed are available, such as implant abutments. The thus created virtual model is transferred by milling, printing, sintering, etc. back to reality and can then be used e.g. in the laboratory for the pro- duction of temporary dentures or surgical guides. The more accurate the replications process the bet- ter the models (Figs. 4a & b, 5a-c). Safeimplant-planning It is also possible to safe implant-planning make with still incorporated metal structures, even if the X-ray image at these locations with radiation arti- fact areas is insufficiently evaluable. In the de- scribed case, the usage of a non-optimal DVT had been assumed, due to extensive metal restorations. Alternatively, the structures would have to be re- moved. Because of many opportunities in the CTV system, a virtual planning for minimally invasive, navigatedimplantationisalmostunrestricted.(Figs. 6–8c) Complexplanning For complex planning, even when there is not an optimal bone situation and accompanying surgical services (e.g. sinus lift) are needed, the matching processes of the CTV system support the surgeon. By virtual articulation of the scanned models and matching with the X-ray data, a position and axial direction of the planned implants and their subse- quent supra structure in relation to the remaining dentures or natural teeth are determined and other accompanying, necessary surgical procedures can be pre-planned (Figs. 9a–g). Comprehensivematchingprocess Lastbutnotleast,qualitycontrols,suchasofthe finished surgical drilling template, are carried out with these comprehensive matching processes. In order to achive this, the template is scanned and matched as best as possible with the planning im- ages for covering. Ideally, there are no deviations. If differences occur, the implantologist must decide whether he can use this template or a new prepara- tion will be necessary. In this way, failures in im- plantation and subsequent prosthetic treatment are avoided (Figs. 10a–e, 11a–c). Fig. 8a Fig. 8b Fig. 8c Fig. 9a Fig. 9b Fig. 9d Fig. 9e Fig. 9f Fig. 9g Fig. 9c