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cone beam international magazine of cone beam dentistry

special _ 3-D planning for implants I I 29cone beam3_2014 _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-tissue situation, possible requiring partial re- construction. The ideal number of implants for large superstructures 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 con- ditions, one has to ascertain whether this is valid for single-tooth and multiple-tooth replacement for each case. Reasons for suboptimal solutions are manifold, ranging from poor initial conditions asso- ciatedwithahighertreatmentrisktosocio-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This is hardly surprising, since various methods are used, of which many have limited ap - plication and quickly become out of date.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 the quality of the treatment. Three-dimensional planning, however, always means considering the prosthetic 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 desired treatment result is helpful in achieving the result. Here too, we initially applied backward plan- ning to cases requiring extensive treatment at first, until we learned that planning is useful for single- tooth replacement too. Each of these techniques— conventional casts and CBCT scans—can be helpful, contributing to a distinct improvement in the treat- ment results in the hands of the experienced im- plantologist. The next step would therefore be to connect these two techniques. After purely digitally controlled navigation was found to be inaccurate, surgical guide systems, based on planning software, became available. Advantagesof 3-Dplanningforimplants Authors_Drs Andrea Grandoch & Peter A. Ehrl, Germany Fig. 1a Fig. 1dFig. 1cFig. 1b Fig. 1e Fig. 1f 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). CBE0314_29-33_Ehrl 30.09.14 14:16 Seite 1

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