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Table of Contents
TECHNICAL PROCEDURE
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 60-63

Computed tomography guided mock up driven designing of implant surgical guide: A novel technique


1 Department of Prosthodontics, KLE VK Institute of Dental Science, KAHE (KLE University), Belgaum, Karnataka, India
2 Department of Prosthodontics, KIMS, Bellary, Karnataka, India

Date of Submission09-Nov-2020
Date of Decision04-Mar-2021
Date of Acceptance07-May-2021
Date of Web Publication10-Jun-2021

Correspondence Address:
Dr. Santosh Nelogi
House #1, 1.I.G. Phase III, Adarsh Nagar, Gulbarga, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_30_20

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   Abstract 

Prosthodontic implant rehabilitation remains one of the most complex restorative challenges because of the most usual troubles with regard to the lack of adequate treatment planning. Position, angulation, implant diameter, and length of an implant need to be determined before the surgical procedure is planned. This article briefs about the novel technique of presurgical mock up of implant site and evaluation of implants – Position, angulation, and complexity of procedure on the study model.

Keywords: Implant mock-up, implant surgical guide, implants


How to cite this article:
Nelogi S, Nelogi M, Rachana K B. Computed tomography guided mock up driven designing of implant surgical guide: A novel technique. J Dent Implant 2021;11:60-3

How to cite this URL:
Nelogi S, Nelogi M, Rachana K B. Computed tomography guided mock up driven designing of implant surgical guide: A novel technique. J Dent Implant [serial online] 2021 [cited 2021 Jun 13];11:60-3. Available from: https://www.jdionline.org/text.asp?2021/11/1/60/318070




   Introduction Top


Prosthodontic implant rehabilitation remains one of the most complex restorative challenges because of the most usual troubles with regard to the lack of adequate treatment planning. Position, angulation, implant diameter, and length of an implant need to be determined before the surgical procedure is planned.

A review through the literature[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] reveals several implant surgical guide for the placement of an implant, but the techniques mentioned do not guide the surgeon to perform presurgical mock-up evaluation with drill to the full depth of an implant site at determined angulation. They only mention about the placement of the implant and provide little or no information about the diameter of implant and abutment angulation required at proposed implant site.

Surgical guides made-up with the data obtained from panoramic or peri apical images to a degree based on two-dimensional imaging, which offer little or no information about the diameter of implant and abutment angulation required at proposed implant site.[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26]

Computed tomography (CT) has frequently been used as an imaging system for presurgical assessment for implant positioning.[17],[27],[28],[29],[30],[31],[32] The evaluation of available bone offers improved determination of the bone density and the localization of anatomical structures, it provides information about the trajectory of implant placement.[19]

With the progression of implant, imaging system software-guided implant position is frequently employed to direct the surgeon in placing the implant in the planned position with the proper angulation.

Even though useful, CT-guided surgical guide turns to be expensive and not feasible for all patients.

The next coherent step is to construct a surgical guide that in blend with a CT. This would illustrate the tangible implant site and the path of the implant position. The purpose of this article is to describe novel surgical guide fabricated by with the help of a CT as an alternative.


   Materials and Methods Top


  1. Make maxillary and mandibular over extended impressions with elastomeric impression material (Aquasil Ultra Soft Putty; Aquasil Ultra LV Wash; Dentsply International, Milford, Del) and pour casts with Type III dental stone. (Kalastone; Kalabahi ltd, Mumbai, India)
  2. The diagnostic CT scans of the patient are subjected for dolphin implant planer (or any implant planner), precise and appropriate placement of a dental implant with proper angulation is planned.


Preparation of mock up model

  1. Using the pin index system, removable die of the proposed implant site is prepared [Figure 1]
  2. The trajectory of the planned implant cross-sectional image of proposed implant site print out is taken on clear cellophane sheet without any magnification error [Figure 2] and is then delineated on to the respective removable dies of the proposed implant site through a conversion procedure [Figure 3]
  3. The central line delineated on to the respective removable dies of the proposed implant site at the time of planning of implant to determine the correct implant angulation. For every implant site, the vertical configuration of line presents the original spot, close to which position and angulation of implant is planned
  4. Mockup osteotomy done on die according to marked bony architecture
  5. Analyzing rods are aligned with the long axis of the marked bony architecture, which centered over the outline representing the location, diameter of implant, and angulation for implant placement [Figure 4]
  6. The vertical alliance of analyzing rod presents the original position of implant at that particular situation [Figure 3] and [Figure 4]
  7. At this angulation of analyzing rod, the round stainless steel tube of length 6 mm and with inner diameter of 2 mm is positioned over the analyzing rod, lightly contacting the cast [Figure 5]. When tube position and required abutment angulation is conformed, autopolymerizing acrylic is added incrementally to stabilize the tube
  8. When resin is polymerized, the surgical guide is recovered carefully from the mold to evade any damage or alteration of angulation of the stainless steel tube and sterilized by using cold sterilization [Figure 6].
Figure 1: Die with mock up osteotomy site for implants

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Figure 2: The trajectory of the planned implant cross-sectional image of the proposed implant

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Figure 3: Proposed implant delineated on to the respective removable dies

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Figure 4: Analysing rod in position along the long axis of predicted implant location

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Figure 5: Analysing rod with a tube of inner diameter 2 mm

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Figure 6: Implant surgical guide

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   Discussion Top


A prosthetically guided implant placement often takes the help of radiography and surgical guides for implant placement.[33],[34] Some surgical guide provides data regarding the mesiodistal location of the implant, but no data on its angulation, others provide data on the location and angulation but not the depth. With the progression of computer engineering and software-guided implant placement is frequently employed to guide the surgeon in positioning the implant in the planned spot, at the proper depth, and with the proper angulation, which is not workable for most of the patient.

Surgical guides based on the practical planning information assures of precise guidance for implant positioning. Petersson et al.[35] and Weinberg[36] documented that preoperative CT was necessary in approximately two-thirds of patients for proper implant orientation even after panographic evaluation.

The surgical stent mentioned in this article helps the surgeon to perform presurgical mock up on the model and shows detailed three-dimensional relationships with the proposed implant site, also guides the surgeon to maintain predetermined angulation at the proposed implant site preventing any fenestration during surgery and ensures that the implant is correctly oriented with respect to the planned restoration.

The surgical guide with detailed three-dimensional position of stainless steel tube functions as a precise surgical osteotomy guide. The osteotomy prepared in the bone with surgical guide has the same orientation as the mock-up osteotomy in the mold and is coherent with the planned prosthetic angulations.

The stent also allows the pilot drill to be placed up to the required length along one specific path, avoiding the risk of change in angulations in subsequent drilling and thereby reducing the inadvertent eccentric enlargement of the implant site. The novel technique consists of mock up osteotomy on cast, which helps the restorative dentist to know the desired abutment angulation required for the placement of esthetic restorations.

The above-mentioned technique can be used for single or multiple implant placements. In multiple implant placements, this technique helps the operator to ensure parallelism between the implants and achieves the desired inclination of implant in accordance to the bony architecture.

During the cross-sectional imaging, if a variance is established between the premeditated prosthetic angulation and the residual bone, angulation, the analyzing rod is changed and the stainless steel tube is reoriented.

The implant placement planned in concurrence with CT imaging is a comparatively economical way to assess bone quality and at the same time, provides data about the trajectory for the placement of the dental implant in three dimensions.

The advantage of this technique is that it is simple and easy to fabricate and uses the material that are inexpensive and readily available. When the surgeon uses this surgical guide for placement of implant, the implant is placed as per the predetermined position and hence helps the restorative dentist in planning the restoration. Since the implant location and the desired abutment angulation are known, a provisional restoration can be fabricated and then that it can be cemented at the time of surgical operation if an immediate provisional restoration is preferred.


   Conclusion Top


The assembly of surgical guides in concurrence with a CT scan makes the provision of dental implant placement a more exact and reliable routine, provides information involving the trajectory for the location of the dental implant. The novel surgical guide mentioned in the article allows for evaluation not only of available bone height and width, but also the angulation and would describe the actual implant site and angulation on removable die and provide data about the trajectory of the position of the dental implants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chang YM, Shen YF. A newly simplified surgical implant stent design. J Prosthet Dent 1994;72:217-8.  Back to cited text no. 1
    
2.
Plummer KD, Nahon M. Use of a reline jig to fabricate a complete denture implant surgical guide from an existing complete denture. J Prosthet Dent 2004;92:598-9.  Back to cited text no. 2
    
3.
Burns DR, Crabtree DG, Bell DH. Template for positioning and angulation of intraosseous implants. J Prosthet Dent 1988;60:479-83.  Back to cited text no. 3
    
4.
Johnson CM, Lewandowski JA, McKinney JF. A surgical template for aligned placement of the osseointegrated implant. J Prosthet Dent 1988;59:684-8.  Back to cited text no. 4
    
5.
Edge MJ. Surgical placement guide for use with osseointegrated implants. J Prosthet Dent 1987;57:719-22.  Back to cited text no. 5
    
6.
Becker CM, Kaiser DA. Surgical guide for dental implant placement. J Prosthet Dent 2000;83:248-51.  Back to cited text no. 6
    
7.
Kennedy BD, Collins TA Jr., Kline PC. Simplified guide for precise implant placement: A technical note. Int J Oral Maxillofac Implants 1998;13:684-8.  Back to cited text no. 7
    
8.
Balsh TJ, Garver DG. Surgical guide stents for placement of implants. J Oral Maxillofac Surg 1987;45:463-5.  Back to cited text no. 8
    
9.
Parl SM, Sullivan DY. Esthetics and Ossiointegration. University of Texas Health Science: Osi Publication; 1989. p. 24-41.  Back to cited text no. 9
    
10.
Hobo S, Ichida E, Garcia LT. Ossointegration and Occlusal Rehabilitation. Tokyo: Quintessence Pub Co Ltd.; 1989. p. 120-1.  Back to cited text no. 10
    
11.
Engelman MJ, Sorensen JA, Moy P. Optimum placement of ossiointegrated implant. J Prosthet Dent 1988;59:467-73.  Back to cited text no. 11
    
12.
Basten CH. The use of radiographic template for predictable implant placement. Quintessence Int 1995;26:609-12.  Back to cited text no. 12
    
13.
Pesun IJ, Gardner FM. Fabrication of a guide for radiographic evaluation and surgical placement of implants. J Prosthet Dent 1995;73:548-52.  Back to cited text no. 13
    
14.
Basten CH, Kois JC. The use of barium sulfate for implant templates. J Prosthet Dent 1996;76:451-4.  Back to cited text no. 14
    
15.
Zahran HM, Fenton A. A radioopaque implant template for partially edentulous patients. J Prosthet Dent 2010;103:390-92.  Back to cited text no. 15
    
16.
Reiskin AB. Implant imaging. Status, controversies, and new developments. Dent Clin North Am 1998;42:47-56.  Back to cited text no. 16
    
17.
Klinge B, Petersson A, Maly P. Location of the mandibular canal: Comparison of macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants 1989;4:327-32.  Back to cited text no. 17
    
18.
Laney WR. Selecting edentulous patients for tissue-integrated prostheses. Int J Oral Maxillofac Implants 1986;1:129-38.  Back to cited text no. 18
    
19.
Kraut RA. Utilization of 3D/Dental software for precise implant site selection: Clinical reports. Implant Dent 1992;1:134-9.  Back to cited text no. 19
    
20.
Lindh C, Petersson A. Radiologic examination for location of the mandibular canal: A comparison between panoramic radiography and conventional tomography. Int J Oral Maxillofac Implants 1989;4:249-53.  Back to cited text no. 20
    
21.
Lindh C, Petersson A, Klinge B. Visualisation of the mandibular canal by different radiographic techniques. Clin Oral Implants Res 1992;3:90-7.  Back to cited text no. 21
    
22.
Sonick M, Abrahams J, Faiella RA. A comparison of the accuracy of periapical, panoramic, and computerized tomographic radiographs in locating the mandibular canal. Int J Oral Maxillofac Implants 1994;9:455-60.  Back to cited text no. 22
    
23.
Takeshita F, Tokoshima T, Suetsugu T. A stent for presurgical evaluation of implant placement. J Prosthet Dent 1997;77:36-8.  Back to cited text no. 23
    
24.
Cehreli MC, Aslan Y, Sahin S. Bilaminar dual-purpose stent for placement of dental implants. J Prosthet Dent 2000;84:55-8.  Back to cited text no. 24
    
25.
Sethi A. Precise site location for implants using CT scans: A technical note. Int J Oral Maxillofac Implants 1993;8:433-8.  Back to cited text no. 25
    
26.
Stellino G, Morgano SM, Imbelloni A. A dual-purpose, implant stent made from a provisional fixed partial denture. J Prosthet Dent 1995;74:212-4.  Back to cited text no. 26
    
27.
Urquiola J, Toothaker RW. Using lead foil as a radiopaque marker for computerized tomography imaging when implant treatment planning. J Prosthet Dent 1997;77:227-8.  Back to cited text no. 27
    
28.
Modica F, Fava C, Benech A, Preti G. Radiologic-prosthetic planning of the surgical phase of the treatment of edentulism by osseointegrated implants: An in vitro study. J Prosthet Dent 1991;65:541-6.  Back to cited text no. 28
    
29.
Schwarz MS, Rothman SL, Chafetz N, Rhodes M. Computed tomography in dental implantation surgery. Dent Clin North Am 1989;33:555-97.  Back to cited text no. 29
    
30.
Schwarz MS, Rothman SL, Rhodes ML, Chafetz N. Computed tomography: Part I. Preoperative assessment of the mandible for endosseous implant surgery. Int J Oral Maxillofac Implants 1987;2:137-41.  Back to cited text no. 30
    
31.
Frederiksen NL. Diagnostic imaging in dental implantology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:540-54.  Back to cited text no. 31
    
32.
Abrahams JJ. The role of diagnostic imaging in dental implantology. Radiol Clin North Am 1993;31:163-80.  Back to cited text no. 32
    
33.
Sicilia A, Noguerol B, Cobo J, Zabalegui I. Profile surgical template: A systematic approach to precise implant placement. A technical note. Int J Oral Maxillofac Implants 1998;13:109-14.  Back to cited text no. 33
    
34.
Park C, Raigrodski AJ, Rosen J, Spiekerman C, London RM. Accuracy of implant placement using precision surgical guides with varying occlusogingival heights: An in vitro study. J Prosthet Dent 2009;101:372-81.  Back to cited text no. 34
    
35.
Petersson A, Lindh C, Carlsson LE. Estimation of the possibility to treat the edentulous maxilla with osseointegrated implants. Swed Dent J 1992;16:1-6.  Back to cited text no. 35
    
36.
Weinberg LA. CT scan as a radiologic data base for optimum implant orientation. J Prosthet Dent 1993;69:381-5.  Back to cited text no. 36
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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