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Fabrication of an implant surgical stent for the edentulous mandible
SECTIONEDITORS
of an implant Jeffrey
L. Tarlow,
surgical
sten
for the e
DDSa
VeteransAdministrationMedical Center,NewYork, N.Y. A successful implant restoration is dependent on proper implant position. Correct implant placement is more predictable when a surgical stent is used. This article describes the fabrication of a surgical stent for the edentulous mandibule using a denture with acceptable adaptation and tooth arrangement as a given. (J PROSTHET DENT 1992;67:217-8.)
roper implant location and angulation are essential for the desired restorative outcome in implant prosthodontics. The use of a surgical dent to aid in implant placement has been described by numerous authorsl-lo This article describesa technique for making a surgical %taff Prostbodontist. 1W1125666
stent for implant placement in the anterior edentulous mandible.
TECHNIQUE If an existing mandibular denture has good adaptation and an acceptabletooth position, duplicate it in clear acrylic resin with a denture duplicator (Lang Dental Mfg., Chicago, Ill.) (Figs. 1 and 2). Pour a stone cast into the duplicate denture (Fig. 3). Make a clear stent on the duplicate denture by using 0.02 inch polypropylene plastic in a vacuum-forming machine (Fig. 4).
1. Irreversible hydrocolloid impression of existing denture.
Fig.
Fig.
3. Stone cast poured into duplicate denture.
4. Vacuum-formed stem is made over duplicate denture. Fig.
Fig. 2. Clear acrylic resin duplicate denture. THE
JOURNAL
OF PROSTHETIC
DENTISTRY
217
TARLOW
Fig.
5. Anterior
lingual
portion
of stent is cut away. Fig.
7. Plastic stent placed over duphcate
denture.
can be removed and replaced easily during surgery, leaving the duplicate denture in place. The desired fixture location is thereby obtained with minimal interference to surgical access. REFERENCES
ig. 6. Anterior moved.
labial portion
of duplicate
denture
is re-
1. Blustein R, Jackson R, Rotskoff K, et al. Use of splint material in the placement of implants. Int 3 Oral Maxillofac Implants 1986$47-g. 2. Balshi TJ, Garver DG. Surgical guide stents for placement of implants. J Oral Maxillofac Surg 1987;45:463-5. 3. Edge MJ. Surgical placement guide for use with osseointegrated implants. J PROSTHET DENT 1987;57:719-22. 4. Murrell GA, Davis WH. Presurgical prosthodontics. J PROSTHET DENT 198&59:447-5X
4. Cut away the anterior lingual portion of the plastic stem, leaving the labial surfaces and incisal edges of the anterior teeth (Fig. 5). 5. Remove the anterior labial portion of the duplicate denture, exposing the entire surgical region (Fig. 6). The plastic stent fits securely over the duplicate denture, indicating the precise location and angulation of the labial surfaces of the anterior teeth (Fig. 7). For a fixed prosthesis, the screw access holes should be approximately 5 mm lingual to the anterior labial surfaces. A periodontal probe fitted with a rubber endodontic stop can be inserted through small holes made in the labial surface of the plastic stent to locate the labiolingual position of the fixture. The angulation of the fixture is determined by using the labial surface of the stent as a guide. The stent
218
5. Engelman MJ, Sorensen JA; Moy P. Optimum placement of osseointegrated implants. J PROSTHET DENT 1988;59:467-73. 6. Johnson CM, Lewandowski JA, McKinney JF. A surgical template for aligned placement of the osseointegrated implant. J PROSTHET DENT 1988;59:684-8.
7. Burns DR, Crabtree DG, Bell DH. Template for positioning and angulation of intraosseous implants. J PROSTHET DENT 1988;60:479-83. 8. Brose MO, Michney R, Rieger MR. A precision alignment frame for endosseous post dental implants. J PROSTHET DENT 1988;60:591-4. 9. Zinner ID, Small SA, Panno FV. Presurgical prosthetics and surgical templates. Dent Clin North Am 1989;33:619-33. 10. Cowan PW. Surgical templates for the placement of ossenintegrated implants. Quint Int 1990;21:391-6. Reprint requests to: DR. JEFFREY L. TARLOW DENTAL SERVICE (160) VA MEDICAL CENTER 423 EAST 23~~ STREET NEW YORK: NY 10010
FERRUARY
1992
VOLUME
67
NUMBER
2
of an implant Jeffrey
L. Tarlow,
surgical
sten
for the e
DDSa
VeteransAdministrationMedical Center,NewYork, N.Y. A successful implant restoration is dependent on proper implant position. Correct implant placement is more predictable when a surgical stent is used. This article describes the fabrication of a surgical stent for the edentulous mandibule using a denture with acceptable adaptation and tooth arrangement as a given. (J PROSTHET DENT 1992;67:217-8.)
roper implant location and angulation are essential for the desired restorative outcome in implant prosthodontics. The use of a surgical dent to aid in implant placement has been described by numerous authorsl-lo This article describesa technique for making a surgical %taff Prostbodontist. 1W1125666
stent for implant placement in the anterior edentulous mandible.
TECHNIQUE If an existing mandibular denture has good adaptation and an acceptabletooth position, duplicate it in clear acrylic resin with a denture duplicator (Lang Dental Mfg., Chicago, Ill.) (Figs. 1 and 2). Pour a stone cast into the duplicate denture (Fig. 3). Make a clear stent on the duplicate denture by using 0.02 inch polypropylene plastic in a vacuum-forming machine (Fig. 4).
1. Irreversible hydrocolloid impression of existing denture.
Fig.
Fig.
3. Stone cast poured into duplicate denture.
4. Vacuum-formed stem is made over duplicate denture. Fig.
Fig. 2. Clear acrylic resin duplicate denture. THE
JOURNAL
OF PROSTHETIC
DENTISTRY
217
TARLOW
Fig.
5. Anterior
lingual
portion
of stent is cut away. Fig.
7. Plastic stent placed over duphcate
denture.
can be removed and replaced easily during surgery, leaving the duplicate denture in place. The desired fixture location is thereby obtained with minimal interference to surgical access. REFERENCES
ig. 6. Anterior moved.
labial portion
of duplicate
denture
is re-
1. Blustein R, Jackson R, Rotskoff K, et al. Use of splint material in the placement of implants. Int 3 Oral Maxillofac Implants 1986$47-g. 2. Balshi TJ, Garver DG. Surgical guide stents for placement of implants. J Oral Maxillofac Surg 1987;45:463-5. 3. Edge MJ. Surgical placement guide for use with osseointegrated implants. J PROSTHET DENT 1987;57:719-22. 4. Murrell GA, Davis WH. Presurgical prosthodontics. J PROSTHET DENT 198&59:447-5X
4. Cut away the anterior lingual portion of the plastic stem, leaving the labial surfaces and incisal edges of the anterior teeth (Fig. 5). 5. Remove the anterior labial portion of the duplicate denture, exposing the entire surgical region (Fig. 6). The plastic stent fits securely over the duplicate denture, indicating the precise location and angulation of the labial surfaces of the anterior teeth (Fig. 7). For a fixed prosthesis, the screw access holes should be approximately 5 mm lingual to the anterior labial surfaces. A periodontal probe fitted with a rubber endodontic stop can be inserted through small holes made in the labial surface of the plastic stent to locate the labiolingual position of the fixture. The angulation of the fixture is determined by using the labial surface of the stent as a guide. The stent
218
5. Engelman MJ, Sorensen JA; Moy P. Optimum placement of osseointegrated implants. J PROSTHET DENT 1988;59:467-73. 6. Johnson CM, Lewandowski JA, McKinney JF. A surgical template for aligned placement of the osseointegrated implant. J PROSTHET DENT 1988;59:684-8.
7. Burns DR, Crabtree DG, Bell DH. Template for positioning and angulation of intraosseous implants. J PROSTHET DENT 1988;60:479-83. 8. Brose MO, Michney R, Rieger MR. A precision alignment frame for endosseous post dental implants. J PROSTHET DENT 1988;60:591-4. 9. Zinner ID, Small SA, Panno FV. Presurgical prosthetics and surgical templates. Dent Clin North Am 1989;33:619-33. 10. Cowan PW. Surgical templates for the placement of ossenintegrated implants. Quint Int 1990;21:391-6. Reprint requests to: DR. JEFFREY L. TARLOW DENTAL SERVICE (160) VA MEDICAL CENTER 423 EAST 23~~ STREET NEW YORK: NY 10010
FERRUARY
1992
VOLUME
67
NUMBER
2