Implant planning has moved in recent years to virtual planning with a CBCT scan and fabrication of a surgical guide based on that virtual planning. Unfortunately, positioning based on prosthetics is ...typically missing from the CBCT scan. Use of a diagnostic guide fabricated in office permits information from ideal prosthetic positioning to improve virtual planning and subsequent fabricated of a corrected surgical guide. This becomes more important when insufficiencies in the ridges horizontal aspects (width) will require ridge augmentation to allow later implant placement. This article discusses a case with insufficient ridge width and determination of where augmentation is required to house implants in ideal prosthetic positions, the subsequent grafting, implant placement and restoration.
Implant surgical guides are often fabricated using CBCT technology. In this study, an alternative technique is proposed. The aim of this in vitro study was to compare the accuracy of the guide sleeve ...corrections of a geometric approach to guided surgery to the accuracy of in vitro studies of stereolithographic guides.
Four arch forms were milled from acrylic blocks each with 12 root form sites. Root form inserts were made. Holes were milled in the inserts at arbitrary angles. Guide posts were placed in these sites. Guide sleeves were placed on the posts and connected with light-cured resin to form verification jigs. The goal was to correct the angles of the guide sleeves to a vertical position 90 degrees from the base of the arch forms. The initial angles from the vertical and horizontal positions of the center of each guide sleeve were determined radiographically and geometrically. Horizontal and angle corrections were made using two-piece guide posts. Guide sleeves placed over the corrected guide posts were connected with light-cured resin, forming new verification jigs. The accuracy of the angle correction and the coronal horizontal and apical horizontal deviations of the 3-mm guide sleeves were determined. The experimental sites were divided into two groups to determine if the size of the initial angles of the guide sleeves had any effect on the accuracy of the corrections.
The initial angles of the guide sleeves before corrections revealed the mean difference between the two methods of measurements in groups 1 and 2 as 0.36 degrees (P = .14) and 0.69 degrees (P = .07), respectively. A comparison of the angle error measurements from 90 degrees after corrections between the two groups in the mesiodistal and buccolingual planes was not significant. The coronal and apical horizontal deviations after corrections revealed a significant difference between the two groups at the coronal level (P = .005) but not at the apical level (P = .14). In comparison of the methods of the two measurements of the angle error from vertical after corrections, the mean difference was 1.23 degrees (P = .01) and 0.69 degrees (P = .02).
The in vitro accuracy of the guide sleeve corrections made with the geometric approach for implant guidance was compared to the results of the meta-analyses of in vitro studies of implant placement with stereolithographic guides. The mean errors were smaller and within the recommendations of the EAO Consensus Conference of 2012.
An alternative approach was used to increase the buccal vestibular depth of two edentulous patients, using free epithelialized palatal grafts. Two edentulous patients presented with shallow ...vestibules and inadequate keratinized tissue width in the mandibular anterior region. These sites were treated with vestibuloplasty followed by placement of an epithelialized palatal graft. In order to minimize graft movement and possible mechanical trauma to the area, the graft was covered with the buccal flap during the initial stages of healing. The patients maintained an increase in the vestibular depth as well as the keratinized tissue width at 14 months and 5 years postoperatively. Successful outcomes in terms of increase in vestibular depth can be achieved with the use of epithelialized palatal graft that is covered during the initial stage of healing. The dental practitioner fabricating the complete denture should be aware of the advantages offered by this alternative surgical technique.
Implant failures due to apical pathology are conditions that have not been extensively studied nor reported in the literature. The implant periapical lesion (IPAL) has different symptoms, and several ...etiologies have been proposed in the literature. This article reviews cases of IPAL reported in peer-reviewed journals and presents possible treatment options. Analysis of the data collected was performed based on diagnosis, cause of extraction of the natural tooth, location, period of implant placement, implant surface, and treatment approach. Even the data presented in this review are based on few reported cases the etiology of these lesions seems to be multifactorial or with an unknown origin. Contamination of the implant surface, bone overheating during surgery, excessive torquing of the implant, poor bone quality, perforation or thinning of the cortical bone, premature or excessive load over the fixture, fracture of the bone inside the hollow portion of the hollow implant, and an implant placement in an infected maxillary sinus have been discussed. In general, areas around endodontically compromised teeth should be carefully analyzed prior to implant placement to prevent implant failures.
Managing crown lengthening in cases of attrition (wear or loss of tooth substance) and achieving desired esthetic outcomes, especially in the esthetic zone, is challenging. This case report presents ...an interdisciplinary approach to case management. Concomitant use of digital imaging, along with model wax-ups and surgical guide, were used to enhance patient acceptance during treatment planning and to facilitate communication and treatment implementation among dental professionals and laboratory technicians. Resulting surgical template was used for crown lengthening to apically position the gingival zenith (margin) to a predetermined level, crown preps and final restorations, respectively, ultimately improving esthetics and patient satisfaction. Supplementing esthetic treatment planning with digital imaging, model wax-ups and a surgical template allows a dentist to carry information into the mouth and incorporate it into the surgical procedure, crown preps, temps and, ultimately, the final restoration.
Use of imaging guides in preimplant tomography Almog, Dov M.; Torrado, Eduardo; Moss, Mark E. ...
Oral surgery, oral medicine, oral pathology, oral radiology and endodontics,
04/2002, Volume:
93, Issue:
4
Journal Article
Peer reviewed
Objectives. The objective of this study was to quantify the variation in use and type of imaging guides used by community-based specialists and general practitioners during dental implant treatment ...planning phases. The specific aim of this study was to test the hypothesis that specialists are more likely to use some form of cross-sectional imaging in conjunction with imaging guides during the preoperative assessment of dental implant procedures. Study Design. Records from 630 patients with implants (1640 implants) referred for cross-sectional tomography were reviewed. Imaging guide type and implant sites were noted. Results. The distribution of referring dentists by specialty was as follows: general practitioners (42.2%), periodontists (35.1%), oral and maxillofacial surgeons (13.3%), and prosthodontists (7%). Of patients referred for tomograms, 52% were referred without a surgical guide. Conclusion. Specialists ordered tomograms in conjunction with imaging guides more often than did general practitioners. Prosthodontists and periodontists preferred to use more restrictive guides than did general practitioners or oral and maxillofacial surgeons. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:483-7)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Research and experience have suggested that the success of dental implants depends on a well-developed and careful treatment plan approach. Historically, implant size and angulation were determined ...with the use of panoramic radiographs and clinical judgment during surgery. This occasionally resulted in mechanical and esthetic compromise. This article describes the step-by-step fabrication process for 4 different imaging and surgical guides. Set-up disks, which enhance the design and fabrication of guides, also are introduced. These guides are used in conjunction with cross-sectional tomography during the preimplant assessment of surgical sites. (J Prosthet Dent 2001;85:504-8.)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
When repetitive mechanical injury was produced in combination with marginal periodontitis a significant loss of connective tissue attachment did not occur as compared with specimens in which ...periodontitis alone was produced. It seems unlikely, therefore, that there is a "co-destructive" factor effect on the loss of connective tissue attachment. The amount of alveolar bone lost as a result of marginal periodontitis was increased by the addition of repeated mesiodistal jiggling of the teeth. This could represent an irreversible "co-destructive" effect or could merely be a functional adaptation of the periodontium.
Identification of inflamed gingival surfaces Meitner, Sean W.; Zander, Helmut A.; Iker, Howard P. ...
Journal of clinical periodontology,
April 1979, Volume:
6, Issue:
2
Journal Article
Peer reviewed
. The present study was undertaken to clarify whether visual inflammation or gingival bleeding on probing is the earlier indicator of gingivitis. A dental prophylaxis was given to 90 male students ...and 1 month later the gingiva adjacent to the mesio‐buccal, mid‐buccal and mid‐lingual surfaces of all teeth was evaluated. Two subsequent examinations were done at 1‐month intervals. Each gingival margin was examined visually and classified as either non‐inflamed or inflamed and these same surfaces were then probed for bleeding. The number of gingival surfaces at each examination was 6990 and, at the first examination, 16798 of these combined absence of visual inflammation and bleeding (healthy). One month later only 766 of these surfaces were still healthy. Inspection of the data from the surfaces which had changed since the first examination showed that there were a significantly greater number of surfaces which bled after probing compared to either a color change only or combined both a color change plus bleeding. The same trend was seen between the second and third examinations. It was concluded that substantial changes in healthy gingival surfaces occur in as brief a period as 1 month. When healthy gingival surfaces (no visual inflammation and no bleeding) developed clinically detectable signs under investigation, a significantly greater number manifested bleeding alone compared to either visual inflammation alone or a combination of visual inflammation plus bleeding. These findings support an emphasis on gingival bleeding indices for detection of early deviations from health.
