Radiographic and surgical guides Flashcards
placement need to be planned in all dimensions
-apico-coronal
-mesio-distal
-bucco-lingual
implant:implant distance
3mm
tooth:implant distance
1.5mm
avoid _______ damage to adjacent critical structures
iatrogenic
preserves _____ bone and inter proximal _______ height
crestal, papillary
- any device used as a guide for surgically shaping the alveolar process or positioning of gingival tissue
- guide used to assist in proper surgical placement and angulation of dental implants
- guide used to assist in establishing the desired occlusion during orthognathic or grafting surgery
surgical guide
synonym surgical guide
surgical template
a surgical procedure that uses a device (surgical guide) that was printed from a digital file of the cone beam computed tomography
computer tomography guided surgery
synonym computer tomography guided surgery
stereotactic surgery
objectives of surgical templates
direct implant drilling system
provide an accurate placement of the implant according to the surgical treatment plan
what is implant placement guided by
-bone quality
-bone quantity
-position of surrounding teeth
-proposed final restoration (esthetics, phonetics)
Surgical guide fabrication depends on the restorative plan - things needed
-diagnostic wax up
-correct tooth arrangement
-duplication of existing dentition/restoration as long as occlusion is correct
two components to surgical guide
guiding cylinders
contact surface
guiding cylinders
transfers the plan by guiding the drill in the exact location and orientation
contact surface
verifies the guide is fully seated
three types of contact surface
bone supported
mucosa supported
tooth supported
3 different types of guides
non restricted
partially restricted
completely restricted
non-restricted
-only provides an indication to the surgeon of the proposal implant site
-may result in unacceptable implant placement (angulation and positioning)
partially restricted
-first drill used for the osteotomy
-remained of the osteotomy and implant placement is then freehanded by the surgeon
completely restricted
-restricts all of the instruments used for the osteotomy in a buccolingual and mesiodistal plane
-drill stops limit the depth of implant placement
- most accurate
surgical guide fabrication
-steriolithography (3D printing using planning software) -singe tooth
-vacuumform/pressure - single tooth
-acrylic resin - duplicate the denture for over denture
radiographic template (based on diagnostic wax up)
-CBCT with radiopaque markers - fiducial markers , 3 minimum, allows you to overlay. - radiopaque substance
-indicates position of teeth and zenith
CBCT scan
-with bite index - ensures correct positioning of the guide in the patients mouth
-easier to separate arches in planning software.
-double scan technique (pt w template in, just template)
3D computer stimulation
planning implant position
fabrication of templates
3D printing
Where is the access hole for posterior teeth vs anterior teeth?
Posterior teeth - center of ridge
Anterior teeth- out of the cingulum
Crown/FDP Restorative Space
5 mm (screw retained)
7 mm (cement retained)
Crown/FDP Buccal/Lingual
2 mm- buccal bone
1mm- lingual bone
Crown/FDP Mesial- Distal
3 mm implant
1.5-2mm tooth
Locator restorative space
8-10 mm
Locator buccal/lingual
2 mm buccal
1 mm lingual
Locator mesial-distal
9 mm
Ball restorative space
10-12 mm
Ball buccal/lingual
2 mm buccal
1 mm lingual
Ball mesial-distal
9 mm
Bar/clip restorative space
13-15 mm
Bar/clip buccal/liingual
2 mm buccal
1 mm lingual
Bar/clip mesial/distal
13 mm interfixture for clip
Bar/locator restorative space
15 mm
Bar/locator buccal/lingual
2mm buccal
1 mm lingual
Bar/locator Mesial-distal
3 mm between implant
fixed complete restorative space
8-15 mm
fixed complete buccal/linguial
2 mm buccal
fixed complete mesial-distal
3 mm between implant
Fabrication of templates
3D printing
Surgical guide: stereo lithographic templates order
- Radiographic template
- CBCT scan
- 3D computer stimulation
- Fabrication of templates
-2 mm sleeve guide initial osteotomy
-no other kit needed
-directly guides 2 mm straight drill
-smaller holes, round burr
-1st sequence, idea where placing implant
Pilot guide
-rests over dentition
-single tooth, multi-unit bridge, partially edentulous cases
-minimally invasive
-block out undercuts
Tooth supported
-rests on patients soft tissue
-fully edentulous cases
-minimally invasive
-not most stable, can rock
Mucosa supported
-rests on bone surface after flap
-fully edentulous mandibular cases only
-another pin fixation
Bone supported
