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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
special _ 3-D planning for implants I I 33cone beam3_2014 implantsinthemandibleandeightinthemaxilla,and tooth-by-tooth reconstruction up to the first molar. Themultitudeofplanninginformationandtreatment possibilities requires a great deal of planning, which is always justified because of its significant conse- quences.Planningbasedondigitalcastsisnotappro- priate in these cases, since the support of the cheeks and lips by the prosthesis is important and this can only be determined with the help of and for each patient. Here, the advantages of prosthetic planning are particularly evident. Edentulous jaws often require a special approach (see Figs. 4a & b for an example). Extensive aug- mentationisfrequentlynecessary(Figs.5a–f).There- quiredlengthoftheteeth,however,hastobeclarified withthepatientbeforetreatmentanddependsonthe amount of tooth displayed during lip repose (Fig. 5e). Quite frequently, implants are placed inter-forami- nally in the mandible, often because extensive aug- mentation is still problematic in the lateral mandible. Figures6aandbshowapatientwithsiximplantsand an extension bridge. Even in cases of seemingly simple implantation for removable dentures in an edentulous jaw, 3-D planning and a planning cast are needed to verify functional reconstruction and soft-tissue support. In addition, they can aid determination of the posi- tions of the implants in consultation with the dental technician and planning for adequate space for the attachment box. _Discussion Three-dimensional planning for implants holds theadvantageofhigherqualityowingto(a)riskiden- tification; (b) planning reliability; (c) production of near-natural structures; (d) targeted and fast work; (e) patient compliance; and (f) cost transparency. These advantages are largely due to the greater amount and quality of information gained. Three- dimensional diagnostics enable us to obtain reliable information about the condition of the alveolar process and important anatomical structures. With the additional planning cast, information about the restoration of function and aesthetics is obtained. Combiningbothinformationsourceswillresultinop- timal treatment planning. In addition, an experienced surgeoncanaddresssurprisesifthepatientisflexible. Intra-operative decisions may also need to be made if unexpected situations arise. Knowledge of 3-D data permits planning, which entails devising a well-con- sideredprocedureandobtainingthenecessarytoolsand substitutematerial,forexamplesuitableimplantsand bonesubstitutes.Owingtothetraceabilityofdiagno- sis and treatment, as well as the resulting safety, pa- tientswillregardtheprocedureparticularlypositively. A disadvantage is the higher initial outlay, but this is balanced by increasing use owing to a targeted and quicker workflow and thus less reworking. Implan- tation always requires a 3-D radiograph. These new techniques have greater logistical requirements than conventional dental procedures do and require ex- tensive involvement of the teams involved in order to achieve treatment success. It should be borne in mind that every surgery is accompanied by a certain risk in spite of the safety precautionstaken.Inaddition,toomuchconfidencein methodologies may lead to carelessness. Errors may evenarisewith3-Dplanning,whichmayholdnegative consequencesfortreatment.Therefore,itisimportant to be familiar with each step and error source and thusexperttrainingiscrucial.Inaddition,maintaining a critical attitude throughout treatment is necessary to avoid errors. The advantages of 3-D planning are sosignificantthatithasbecomeindispensable._ Editorial note: A list of references is available from the publisher. Fig. 7b Fig. 7cFig. 7a Figs. 7a–c_X-ray after implantation with mucosa-born drilling template in situ (a). Surgical site with lingual position of the medial implants (b). After exposure (c). Dr Peter A.Ehrl andepend Berlin,Germany peter.ehrl@andepend.com cone beam_contact CBE0314_29-33_Ehrl 30.09.14 14:16 Seite 5