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ePaper created 2016-03-24, 17:16:09 | version 1.38.0
| research 28 implants 1 2016 In addition to the axial, panoramic, and three- dimensional reconstructed volume, the importance of the cross-sectional image is critical to fully ap- preciate the relationship between the implant posi- tion within the bone, and the emergence through the tooth. One area that has not been emphasized however, is the ability to determine the prosthetic space required for the abutment as it relates to the thickness of soft tissue supporting the overdenture (Fig. 15a). The realistic ball abutment can be clearly visualized sitting on the coronal aspect of the im- plant (red line), and the tissue cuff height of the abutment (green line). One component that is not easy to determine is the metal housing that will be processed within the denture. This component part is not yet available within the software libraries to the author’s present knowledge. Therefore an ap- proximation was digitally represented (gold), so that the extra height can be visualized (yellow line), revealing the thin palatal aspect of the overdenture (Fig. 15b). Once the virtual plan has been estab- lished a surgical template can be designed by the software and then fabricated through 3-D printing, stereolithography, or a CAD/CAM process to assist in the placement of the implants within the antici- pated restorative needs of the patient (Fig. 16). 3-D Planning Concepts: Full Arch Maxillary Fixed Prosthesis There are few differences between 3-D planning concepts for an overdenture prosthetic design, or a fixed prosthetic rehabilitation supported by implants. All aspects of the patient’s bone and soft tissue anatomy must be carefully evaluated. After a proper assessment of the available bone, key im- plant positions are identified, and simulated within the 3-D reconstructed volume as seen in Figure 17a. However, it is important to once again evalu- ate the potential implant receptor sites based upon the envelope of the occlusion (Fig. 17b). Using “se- lective transparency” helps to provide an enhanced perspective of how the implant abutment projec- tions (yellow) are spaced within the desired resto- ration (Fig. 17c). The frontal view clearly illustrates the importance of the implant abutment projec- tions, revealing for this example a nearly parallel placement of the implants (Figs. 18a & b). “Selec- tive transparency” can be applied to multiple struc- tures, to help visualize the entire complex of the implant, abutment projection, radiopaque tem- plate, and the underlying bone (Fig. 18c). By rotat- ing the 3-D reconstructed volumes, it is apparent Figs. 17a–c: Eight implants positioned to support a fixed restoration (a) to fit within the framework of the desired tooth position (b); using “selective transparency” the underlying bone can be visualized (c). Figs. 18a–c: Frontal view of the scanning template with yellow abutment projections seen above the occlusal plane (a); semi-transparent scanning template (b); and all three objects translucent to visualize the position of the implants within the bone (c). Fig. 19a & b: Another 3-D view showing the emergence of the abutment projections through the scanning template. Fig. 17a Fig. 18a Fig. 19a Fig. 19b Fig. 17b Fig. 18b Fig. 17c Fig. 18c 12016