Software screen shot showing implant and prosthetic planning (NobelBiocare).
Click here to enlarge imageUnfortunately, many implants have been placed in sinuses, lingual fossae, mandibular canals, and other incorrect areas. At the very least, this has resulted in failed cases and unhappy patients.
By using new software that is coordinated with CBCT scans, not only can implant placement become more predictable, but in many cases it can be done without reflecting a flap. This is due to computer-created "surgical guides."
In a partial dentition, the appliance looks similar to a nightguard, with a few holes and sleeves placed over the edentulous areas that will ultimately house the implant(s). Since the sleeve has been aligned to the precise angle and the program has instructed the dentist what the depth of the hole should be, the operator merely puts the depth stop on the drill and drops it through the hole.
The implant is then placed through the guide into the osteotomy and is ready for the cover, healing abutment, or even a provisional or final abutment if immediate loading is indicated.
In an edentulous mouth, the guide is slightly more elaborate. Since there is soft tissue and a chance for movement, it is actually fixed in place with horizontal anchor pins. If you observe these cases, it almost looks too simple. It is reminiscent of the old color-by-numbers method of creating art masterpieces, as long as you could stay inside the lines.
These guides are not a substitute for training and expertise, but they take the guesswork out of the process. This reminds me of Dr. Paul Vinton, the head of the prosthetics department of my dental school, the University of Medicine and Dentistry of New Jersey.
He would say that these are a "guide for the intelligent and a refuge for the stupid." The most visible systems are Nobel Biocare (NobelGuide) and Simplant. These two were released early, and had the marketing clout to become well known.
Now there are many. An incomplete list includes iDent, Biomedical Modeling, 3D Diagnostix, Implant Logic, CadImplant, DENX, Medical Modeling, Anatomage, Dolphin, 3dMD, and Medicim. In the future, I will offer a more comprehensive discussion of these products.
Nobel has coined the term "Teeth-in-an-Hour." This procedure not only uses a surgical guide to place the implants, but is coordinated with Nobel’s Procera system to allow prosthetics to be predesigned and fabricated prior to the surgery.
The system is so sure of the CBCT scans and software that titanium or zirconia frameworks can be fabricated and the provisional or final prosthesis delivered at the time of surgery.