Page 42 - Dental Practice August 2022

42-45-RAMIT LAMBA-Q8:18-22-Lanka Mahesh.qxd 8/23/2022 2:09 PM Page 1

implantology section

DIGITAL DENTAL IMPLANTOLOGY

RAMIT LAMBA AND ETI LAMBA

Implant dentistry has a long history and dates back to the year 1965 l Difficult to perform in reduced mouth opening.
when Dr. Branemark placed the first implant without significant l More heat generation during osteotomy.
adverse reactions to hard and soft tissues, but the root form implant
history dates back to 4000 years ago when the Chinese carved bam- GUIDED SURGERY CAN BE BROADLY DIVIDED INTO:
boo sticks in the form of pegs and drove them into the bone for • Tooth Supported Guide.
fixed tooth replacement. • Tissue Supported Guide.
The goal of modern dentistry is to restore the patient to normal • Bone Level/Supported Guide.
contour, function, comfort, esthetics, speech and health whether
replacing a single tooth or multiple teeth. TOOTH SUPPORTED GUIDE
Earlier implants were placed according to the availability of the A single tooth Central Incisor implant was planned with a tooth sup-
bone and prosthesis was designed later, which in some cases may ported surgical guide. 3D Planning was carried out in the planning
lead to compromised prosthesis. One must not forget that the software. Waxup was done in the software to check the position of
patient visits for the missing teeth and not actually for implant final prosthesis. The outline of prosthesis can be seen in the cross
placement. Now the concept is completely reversed, as it is said section showing the palatal access hole (Figures 1 and 2).
“Begin with the end in mind”. Patient was advised for tissue augmentation procedure, but he
Digital implant dentistry gives an advantage of planning the type was not willing to get it done (Figure 3).
of final prosthesis before hand. Doctor and patient, both have an Tooth supported guide was 3D printed. Seating of guide is con-
idea of whether the final prosthesis will be fixed or removable and firmed with the windows showing in fitting. It is very important for
even the type of prosthesis. the guide to seat properly otherwise the virtually planned implant
Even the information about screw access holes and selection of position will not be transferred to the patient (Figure 4).
abutments can be done by virtually placing the implants using plan- The drilling protocol as per the manufacturer is carried out. In
ning software’s and patients CBCT. Guided surgery helps position- this patient Implant size 3.5-13 was selected. To achieve the primary
ing the dental implant accurately to achieve best functional and stability, 3-13 final drill was used to create osteotomy (Figure 5).
aesthetic result. Accurate 3D position as desired and planned in the software
was achieved (Figure 6). Screw retained final prosthesis with
ADVANTAGES OF GUIDED SURGERY palatal access hole was delivered to the patient post initial healing
l Prosthetic driven implant surgery (Figure 7).
Guided implant surgery can transfer the plan as exactly as the doc-
l
tor plans on the software. TISSUE LEVEL GUIDE
Allows for the placement of multiple implants that are precisely As the name suggests, guide seats on the tissue. It can be fabricated
l
parallel. in edentulous patient or full arch immediate implant placement.
If the implant needs to be placed at an angle, the angle can easily The guide is secured with the anchor stabilizer that is incorporated
l
be determined and abutment be selected even before the surgery. in the guide (Figure 10).
Guides allow for the ability to avoid vital structure (nerves, sinus All on six implant planning was done in planning software. Two
l
cavities). tilted and four straight implants were planned (Figure 8).
The angulations of implant were calculated in the software as per
DISADVANTAGES OF GUIDED SURGERY the availability of Angled multiunit abutments available for the sys-
Extra Expense of surgical guide and CBCT. tem. The type of prosthesis was also be determined as FP2 in this
l
l Radiation exposure. case even before the surgical placement of implant.
When doing a flapless surgery, the patient’s bone situation cannot
l
be assessed. BONE LEVEL GUIDE
The user must learn the planning software. Bone level guide seats on the bone. A full thickness flap is raised and
l
l Surgical kits and surgical sleeves must be purchased. guide is seated on the alveolar ridge. After the intra-oral scanning
and checkup, it was realized that the post extraction, tissue will col-
lapse and there will be insufficient tissue support for Surgical guide.
Article Citation For this case bone level guide was fabricated.
Lamba, R. Lamba, E. (2022). Digital dental implontology. By calculating the height of prosthesis from the crestal part of
Dental Practice, 18(4), 42-45 implant, final prosthesis type can be determined. In this case, FP1
prosthesis was determined and delivered as final restoration, post
healing phase. (Figure 17)

42 Dental Practice // July-August 2022 // Vol 18 No 4