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ePaper created 2017-04-05, 10:39:28 | version 1.38.0
I case study_ flapless implant placement Flapless implant placement with an internal sinus lift using dynamic guided navigation Author_Naheed Mohamed, DMD _Today, implant surgery is fo- cused on being minimally invasive with an emphasis on prostheti- cally guided implant placement.1 Implants that are not placed in a prosthetically favorable position are at risk for future complications involving the prosthetic compo- nents or peri-implant tissues.2 Successful implant placement is not only judged by osseointegra- tion but also the esthetics. In a climate where implant therapy is held to the highest of standards, using advanced tools to simplify surgical dental implant placement is a requisite for success. real-time three-dimensional drill guidance during implant surgery. One of the main advantages of this Navident system is that dynamic navigation allows intra-operative changes to implant position in real time if any errors or anatomical complexities are noted during the surgery.5 The flexibility of having a guided implant placement in a digitally planned ideal location without the need for a static surgical stent and having the osteotomies live navigated on CBCT data using optical tracking is a game changer for im- plant dentistry. This open system also has the flexibil- ity of using any implant system and any drill to guide placement. The case presented below showcases the flexibility of real-time navigation where Straumann implant drills are used for placement of an implant with a simultaneous internal sinus lift using the Hios- sen CAS-KIT drills with the Navident system. Currently computer-guided surgery involves the use of a CBCT (cone-beam com- puter tomography) scan and possibly an intra-oral scan to allow personalized digital surgical planning. This plan is then transferred to the patient in the form of surgical guides to aid in accurate implant placement. These guides, however, are static and do have some drawbacks. They are not always stable depending on whether they are supported by teeth, mucosa or bone. Limited mouth opening does be- come an issue when surgical guides are used to place implants for posterior dentition.3 And, lastly, if there is any error in the digital planning, segmentation of the anatomy or data transfer to the guide fabrication, the error is passed down onto the guide’s implant position.4 If errors are noted during surgery, then the guide essentially becomes useless. The next evolution in guided dental implant sur- gery comes from neurosurgery and orthopedic spine surgery, where it has been used for quite some time. ClaroNav Inc., has developed a live navigation system using optical tracking cameras (Fig. 1) during implant surgery to provide the surgeon with CBCT-based _Case report The patient was a 57-year-old healthy female who was referred to our clinic to replace the missing maxillary second premolar at the 2.5(13) site with a dental implant. The Navident workflow consists of four main sequential steps: stent fabrication, CT (computer-tomography) scan with the stent and affixed CT marker in the patient’s mouth, digitally planning the implant surgery in the Navident soft- ware and, lastly, completing the live guided implant surgery. One of the biggest advantages of the Navident system is that these four sequential steps can all be completed in one appointment, provided the clinic has an available CBCT scanner. The NaviStent functions as a retainer onto which the CT marker is affixed to while the patient under- goes her CBCT scan. The NaviStent is a custom single- use retainer made of a thermoplastic material called Naviplast then can be heated in hot water and molded to the patient’s dentition. The stent was trimmed, and the planned implant site was cut open to expose Fig. 1_The Navident system is shown here with the Micron Tracker and laptop loaded with the Navident software. (Photos/Provided by Dr. Naheed Mohamed and ClaroNav Inc.) 10 I implants 1_2017