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cone beam – international magazine of cone beam dentistry

I case report _ guided implant surgery _Although osseointegration of dental implants is predictable, thorough preoperative planning is a prerequisite for a successful treatment outcome.1, 2 Anatomiclimitationsandprostheticconsiderations encourage the surgeon to obtain a very precise positioning of the implants. Historically, standard radiographic imaging techniques (intra-oral and panoramic) were available for investigation of po- tential implant sites. Nowadays, it is well known that 3-D CT scans allow for more reliable treatment planning than whenonly2-Ddataisavailable.3 TransformingtheCT scanimagesintoa3-Dvirtualimagecanbeachieved using computer software packages, allowing for a 3-D view using CAD technology.3 For years, stereo- lithographic guided surgery appeared to be the goldstandardincomputer-guidedimplantsurgery. This technique has been well developed in recent years and several scientific reports have been pub- lished regarding accuracy, complications, survival and success.4 However, stereolithographic guided surgery has some major disadvantages compared with conventional implant surgery. The surgeon has to rely on a predesigned trajectory planned in the software, without being able to make intra-op- erative adjustments. In addition, the loss of tactile feeling during preparation and implant placement is a major drawback. Real-time navigation appears to be a valuable al- ternativetostereolithographic(static)guidedsurgery, asitoffersthecliniciansomeadvantagesoverthefor- mertechnique.Usingreal-time(dynamic)navigation, one can avoid the fabrication of a stereolithographic template, resulting in a less expensive treatment. As navigation is considered a dynamic guided surgery system, changes to the treatment planning (location andsizeofimplants,numberofimplants,flaporflap- less, etc.) can easily be made intra-operatively. Also, thetactilefeelingduringthedrillingprocedure,aswell as manual control over the implant stability, is still presentwhenusingnavigationsurgery. Over the last decade, there has been a shift in surgicalandprostheticprotocols,resultinginsignif- icant reduction in the integration time of a dental implant. This is a logical consequence of the con- stant improvement of implant characteristics and components simplifying dental implant treatment. Guided surgery using implant simulation software can contribute to better treatment planning, as it provides a preoperative view of the anatomical structures related to the future prosthodontics.5 Thisfactcouldmakeimmediateloadingprocedures easier, and allows the clinician to know in advance the potential location and dimension of the future restoration(s). Many guided surgery procedures re- sult in the absence of a flap design. Minimising the surgical flap can have advantages for soft-tissue healing and patient comfort.6 However, it has been shownthatflaplessfree-handsurgery,regardlessof surgical experience, leads to malpositioning of im- plants and consequently to bone perforations and dehisences.7 This finding suggests that when using free-handflaplesssurgeryadditionalguidancedur- ing preparation of the implant bed and during im- plantplacementisrequired.Forthisreason,naviga- tion surgery can become an important tool in den- tal implantology, as it benefits from the advantages Figs. 1a & b_The NaviStent surgical stent. Fig. 2_Pre-op panoramic image. Immediate loading with dynamic navigation implant surgery Authors_Dr Jan D’haese, Dr Johan Ackhurst & Prof. Hugo De Bruyn, Belgium 18 I cone beam4_2015 Fig. 1a Fig. 1b Fig. 2

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