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implants_international magazine of oral implantology No. 1, 2016

research | 291 2016 implants how powerful these interactive software tools can be (Figs. 19a & b). Once the final positions of the implants are confirmed for the edentulous presen­ tation, a mucosal-supported template can be ­designed and fabricated through 3-D printing, ­stereolithography, or a CAD/CAM process. The ­mucosal-supported template should be fixated to the bone, to insure accuracy of the drilling se- quence. The template with the blue screws can be visualized in Figures 20a–c. Conclusion The advent of complete denture fabrication evolved into the adoption of over-denture con- cepts for both natural and implant supported res- torations. Conventional prosthodontic protocols were developed to aid in the diagnosis, treatment planning, and laboratory phase of the reconstruc- tion. These included conventional periapical radio- graphs, panoramic radiographs, oral exam­ination, and mounted, articulated study casts. The clinician was then expected to assess several important as- pects of the patient’s anatomical presentation in- cluding vertical dimension of occlusion, lip sup- port, phonetics, smile line, overjet, overbite, ridge contours, and a basic understanding of the under- lying bone structures. The accumulation of prelim- inary data afforded by conventional diagnostics provided a foundation to prepare a course of ­treatment for the patient. However, the conven- tional review of findings was based upon a two-­ dimensional assessment of the actual patient’s bone anatomy. To fully understand each individual patient’s presentation, this article provided clini- cians with an appreciation of various innovative virtual, three-dimensional tools based upon the use of advanced three dimensional imaging mo- dalities for both removable and fixed prosthetic treatment alternatives. The application of CBCT and interactive treat- ment planning software, empowers clinicians with an accurate understanding of the three-dimen- sional anatomic reality for our patients as an aid in providing state-of-the-art treatment. Implants will be better positioned, with fewer surgical and restorative complications, and reduced laboratory remakes based upon these improved diagnostic tools. The benefits will enable clinicians to better understand the relationship between patient anat- omy and the desired restorative outcomes, in the process of achieving true restorative driven im- plant reconstruction. The ability to utilize digital imaging and treatment planning technology is now within the reach of most clinicians through the ­various software products that are on the market. In addition there are many third party outlets through internet portals that enable clinicians to upload their DICOM data for evaluation, process- ing, treatment planning, and even surgical tem- plate fabrication without actually owning the ­planning software. New paradigms have been es- tablished that in the author’s opinion will continue to redefine the process of diagnosis and treatment planning dental implant procedures, both remov- able and fixed alternatives for years to come. Please remember though that the “template is only as good as the plan”._ About the author Dr Scott D. Ganz maintains a private practice for prosthodontics, maxil- lofacial prosthetics and implant dentistry in Fort Lee, New Jersey, USA. He has served as President of the NJ Section of the American College of Prosthodontists and the Computer Aided Implantology Academy (CAI). He has served as President of the New Jersey Section of the American College of Prosthodontists and of the Computer Aided Implantology Academy. Dr Ganz delivers presentations worldwide on both the surgical and restorative phases of implant dentistry, and has published extensively on these topics. He is consi- dered one of America’s leading experts in the evolution of computer utilisation and interactive software for diag- nostic and treatment planning applications using CT and newer-generation CBCT imaging modalities. Figs. 20a–c: The template design revealing the guide tubes (a); three blue fixation pins (b); and the entire complex on the 3-D reconstructed volume (c). Fig. 20a Fig. 20b Fig. 20c 2912016

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