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Inside Dentistry
May 2016
Volume 12, Issue 5

Placement Technique

After routine preparation, premedication was delivered and surgery was performed under local anesthesia (3% mepivacaine plain bilaterally, 2 carpules and 3% Marcaine with 100,000 epinephrine infiltration for mental foramen area bilaterally, 1 carpule). An aseptic technique was followed, and the surgical guide was verified in the mouth for perfect seating (Figure 11). Implant placement (MIS SEVEN implants, MIS Implants Technologies Inc) was performed using a flapless method with tissue punch by a precision tissue-incising drill in the posterior region. Posterior implants Nos. 19 and 30 were sequentially placed with support from the existing anterior and premolar teeth.

After placement of the posterior implants, the anterior teeth Nos. 22 through 27 were extracted, and implants were placed in the region of No. 22, Nos. 26 through 28. Final extraction of the premolars (Nos. 20 and 21) was performed, and the final implant was placed in the region of Nos. 20 and 21.

Primary stability was achieved in all implants with a torque value greater than 55 Ncm, except for the area of Nos. 22 through 27, which was 35 Ncm. Mineralized allograft cortical-cancellous bone grafts (Rocky Mountain Tissue Bank, www.rmtb.org) were used to graft the extraction and implant site areas, and final multi-unit abutments were placed. Temporary cylinders were used to immediately load the implants (Figure 12), and the screw-retained temporary hybrid denture was delivered (Figure 13). Proper implant placement was verified radiographically.

The patient required 4 months to heal, during which time the single zirconia fixed hybrid denture (Prettau® Zirconia, Zirkonzahn USA Inc, www.zirkonzahn.com) was fabricated in the laboratory. After 16 weeks, the final prosthesis was delivered, and postoperative panoramic radiographs and photographs were taken and the bite was adjusted (Figure 14 and Figure 15).

Conclusion

Using CBCT technology allows for accurate diagnosis of a patient’s preoperative condition, including bone height, width, and density. Unlike conventional radiographs, CBCT scans provide a 3D image of the anatomy, offering essential diagnostic and planning information when implants and restorations must be immediately placed. With CBCT scans and computer-generated surgical guides, clinicians can place implants more efficiently with high predictability, accuracy, and stability.

Disclosure

Datta Malyavantham, BDS, DDS, FICOI, has no relevant financial relationships to disclose.

References

1. Harris D, Buser D, Dula K, et al. E.A.O. guidelines for the use of diagnostic imaging in implant dentistry. A consensus workshop organized by the European Association for Osseointegration in Trinity College Dublin. Clin Oral Implants Res. 2002;13(5):566-570.

2. Garg AK, Vicari A. Radiographic modalities for diagnosis and treatment planning in implant dentistry. Implant Soc. 1995;5(5):7-11.

3. Batenburg RH, Stellingsma K, Raghoebar GM, Vissink A. Bone height measurements on panoramic radiographs: the effect of shape and position of edentulous mandibles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(4):430-435.

4. Choi YG, Kim YK, Eckert SE, Shim CH. Cross-sectional study of the factors that influence radiographic magnification of implant diameter and length. Int J Oral Maxillofac Implants. 2004;19(4):594-596.

5. Zhang W, Skrypczak A, Weltman R. Anterior maxilla alveolar ridge dimension and morphology measurement by cone beam computerized tomography (CBCT) for immediate implant treatment planning. BMC Oral Health. 2015;15:65.

6. Tardieu PB, Vrielinck L, Escolano E, et al. Computer-assisted implant placement: scan template, simplant, surgiguide, and SAFE system. Int J Periodontics Restorative Dent. 2007;27(2):141-149.

7. Shotwell JL, Billy EJ, Wang HL, Oh TJ. Implant surgical guide fabrication for partially edentulous patients. J Prosthet Dent. 2005;93(3):294-297.

8. Mello LA, Garcia RR, Leles JL, et al. Impact of cone-beam computed tomography on implant planning and on prediction of implant size. Braz Oral Res. 2014;28(1):46-53.

9. Wöhrle PS. Predictably replacing maxillary incisors with implants using 3-D planning and guided implant surgery. Compend Contin Educ Dent. 2014;35(10):758-762, 764-766, 768.

10. De Oliveira RC, Leles CR, Normanha LM, et al. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(2):231-238.

11. Eufinger H, König S, Eufinger A, et al. Significance of height and width of the alveolar ridge in implantology in the edentulous maxilla. Analysis of 95 cadaver jaws and 24 consecutive patients. [In German] Mund Kiefer Gesichtschir. 1999;3 Suppl 1:S14-S18.

12. Roźe J, Babu S, Saffarzadeh A, et al. Correlating implant stability to bone structure. Clin Oral Implants Res. 2009;20(10):1140-1145.

13. Lin MH, Mau LP, Cochran DL, et al. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: a virtual implant placement study. J Dent. 2014;42 (3):263-270.

14. Salimov F, Tatli U, Kürkçü M, et al. Evaluation of relationship between preoperative bone density values derived from cone beam computed tomography and implant stability parameters: a clinical study. Clin Oral Implants Res. 2014;25(9):1016-1021.

15. Greenberg AM. Digital technologies for dental implant treatment planning and guided surgery. Oral Maxillofac Surg Clin North Am. 2015;27(2):319-340.

16. Klein M, Abrams M. Computer-guided surgery utilizing a computer-milled surgical template. Pract Proced Aesthet Dent. 2001;13(2):165-169; quiz 170.

17. Klein M, Cranin AN, Sirakian A. A computerized tomography (CT) scan appliance for optimal presurgical and preprosthetic planning of the implant patient. Pract Periodontics Aesthet Dent. 1993;5(6): 33-39; quiz 39.

About the Author

Datta Malyavantham, BDS, DDS, FICOI
Private Practice
Sterling, Virginia

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