Prosthetically driven implant planning

Abstract

Introduction. Ideal implant treatment planning requires close collaboration between the prosthodontist and the surgeon to determine the optimal placement of the implant in relation to the available bone and the prosthetic requirements. The ideal placement of dental implants should be determined by prosthetic parameters which depend on the position of a tooth in the arch and occlusion. The exact position of the implant in the bone with respect to location and angulation is often difficult to accurately achieve. Aim of the study. Evaluation of the most commonly used surgical guides for backward planning. Materials and methods.. Five patients, 3 men and 2 women (aged between 30 and 50 years old), have been included in the research. Two cases out of 5 were with frontal single tooth edentation, 1 patient had Kennedy Class II partial edentation, 1 patient with Kennedy Class I edentation and 1 patient with complete edentulism. Ten implants of 2 stages were inserted with partially guided surgery (static guided surgery). One-demand software was used for CBCT analysis and for planning. The Blue Sky Plan and 3Shape softwares were used for surgical guide fabrication. As for the initial planning in 4 cases wax up had been made and scanned, in 1 case for CBCT patient’s old prosthesis had been contrasted. Different surgical guides have been used: 3 of them were tooth-supported, 1 was tooth and tissue supported and 1 was solely tissue supported without the usage of support pins. The deviation degree was analyzed after the implantation by merging the CBCT with the initial planning. Results. In this study, 1 surgical guide was fractured, another surgical had positioning difficulties wich required adjustment. Other guides fitted with no adjustments. After the radiological evaluation it was found a favorable/good angulation and position wich was almost alike with the one planned initilally. Conclusions. It can be concluded that the surgical guides will continue to be a valuable adjunct to achieve precision in today’s prosthetic driven implantology. Backward planning allows for a precise and predictable implant placement that improves the communication between prosthodontist and surgeon with the acheivement of a better result of the treatment.