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Prosthetically Driven Implant Planning: What You See Is What You Get
From the first time he heard of it, oral surgeon, Jay B. Reznick, DMD, MD, was taken with the concept of 3D-guided implant surgery, so it should come as no surprise that he became the first non-institutional owner of Sirona’s GALILEOS 3D imaging unit in the Western half of the United States when he purchased it in 2007 for his Tarzana, CA, practice. He was also the surgeon who first performed the technique live on stage at Sirona’s first 3D summit. “It was the very first time the technique for guided implant surgery with GALILEOS had ever been used clinically and I was doing it live on stage,” he began.
Reznick now does all implants using 3D-guided surgery because it gives him absolute precision and confidence.
Reznick describes how the process of implant placement using 3D-guided surgery differs from the traditional freehand approach based on a 2D radiograph. “Instead of starting at the beginning—ie, flapping open the site and placing the implant where the bone is best, then turning it over to the restorative dentist to restore—we start at the end.” This, he explains, means starting with the ideal final restoration and then working backwards, using 3D information from the GALILEOS scan to determine where that implant needs to be placed to line up precisely for that final restoration. Most of all, he says, by having the ability to examine all the issues ahead of time, both patient and dentist know ahead of time what needs to be done.
“There are no surprises. What you see on the scan is what you will see clinically in the patient, so you can anticipate problems. You can tell immediately from 3D imaging and guided implant planning if there is enough bone to stabilize the implant if you were to take out that tooth and place an implant at the same time,” he explains.
Reznick describes a typical scenario, one in which a patient presents for an extraction and immediate implant placement. “We first take the GALILEOS scan to determine and verify that the tooth definitely needs to be taken out and also evaluate the bone anatomy of the planned implant site using the GALILEOS implant software.
“This allows us to virtually place the implants on a 3D representation of the patient, placing that implant ideally where it needs to be for the final restoration, and to examine the bone to determine that there is sufficient bone volume and density at that site to place the ideal diameter of implant and possible provisional prosthesis,” Reznick says.
At the consultation appointment, doctor and patient sit down together to discuss the treatment plan. This may involve getting the go-ahead to proceed with a straightforward procedure, or it may involve discussing issues and options—eg, bone regeneration and delayed implantation, bone grafting and tissue regeneration in conjunction with implant surgery.
Once the treatment plan is approved, the digital information is uploaded to SICAT, which is owned by Sirona. SICAT then generates and sends the doctor versus the surgeon a surgical guide specific to the patient, which is placed in the patient’s mouth at the time of surgery. The guide includes a milled sleeve, which controls the position, depth, and angle of drilling and implant placement.
Reznick calls the surgical guide “a tool that allows general dentists to place their implants with precision and accuracy”; its margin of error, he adds, is said to be less than .5%, compared to 10%-15% in implants placed freehand. Summing up the advantages of 3D-guided implant planning and placement, Reznick says, “Not only does it allow you to place the implants much more accurately, but it also cuts your surgical time in half, which in effect reduces the trauma to the patient, and because the positioning is much better, the implants have a higher success rate.”
Sirona Dental Systems, Inc.
4835 Sirona Dr, Suite 100
Charlotte, NC 28273