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Selecting The Precise Implant Site
CLINICAL PRACTICE
S E L E C T IN G T H E P R E C IS E
R IC H A R D A. K R A U T , D .D .S.
A three-dimensional study determined when bone volume was adequate for placing implants in a 63-year-old patient. The author has performed 224 successful implants using this technique. : hen planning the precise site for an endosteal implant, the dentist ! needs the most current tools for the best treatment plan.15Conventional I methods of assessing implant sites include: clinical examination, : mounted diagnostic casts and periapical, panoramic, tomographic or : cephalometric radiographs.6 The recent availability of three-dimensional imaging allows the : surgeon and restorative dentist to visualize the implant receptor site : accurately in three dimensions relative to the adjacent vital structures.711 In three-dimensional imaging, a computerized tomography scanner j scans the edentulous and partially edentulous arches. Additional : processing by software (3D/Dental, Columbia Scientific, Inc.) helps : determine the availability of suitable implant receptor sites. The threei dimensional scanner processes the CT scans and prints the image life-size : (one to one). The diagnostic information is transferred precisely from the i transaxial CT scans to the diagnostic cast and then to the patient. With a “China marker” pencil, the length and width are drawn directly : on the three-dimensional scan. The length is measured with a standard : millimeter ruler and marked directly on the study scan for reference : during the implant insertion. We have performed 224 implants using this technique; currently, all I implant sites determined in this way have been successful. When panoramic and cephalometric radiographs leave doubt about I the availability of bone volume for implant placement in the anterior ! mandible, the three-dimensional processing can determine if an : endosteal or subperiosteal implant procedure is indicated. When there is enough bone volume in the mandibular symphysis for an : endosteal implant, the detailed image of the buccal and lingual contour of : the symphysis provided by the scan guides the placement of the implants : so that they are contained within the cortices of the mandible. JADA, Vol. 122, May 1991
59
alternate sites if there is a problem with the planned primary site. The three: Dr. Kraut is director, dimensional and study confirmed : Oral Maxillofacial Surgery the adequacy of • Service Residency : P ro g ra m , Montefiore bone volume. : Medical Center, 111 The surgical East 210th St., j Bronx, N.Y. 10467. guide ensured : Address requests for transference of : reprints to Dr. Kraut. information from the diagnostic casts to the patient to properly place the endosteal implants. C O N C L U S IO N
The amount of available bone volume is critical to the success of implants; in instances in which the dentist must decide between endosteal or subperiosteal implants, three-dimensional imaging can determine the type of implant and aid its successful placement. ■
Cross-sectional images nos. 4 and 10 show adequate bone volume for 8-mm implants. R E P O R T OF CASE
A 63-year-old man needed implants in all four quadrants of his mouth. The maxillary threedimensional study scan showed adequate bone volume for placement of a 15-mm and a 13-mm implant in the maxillary right edentulous area. The study also indicated a decreased bone volume on the left side; therefore, two 8-mm implants 60
JADA, Vol. 122, March 1991
were placed in that area. The final contours of the fixed restorations to be placed were determined. A rigid surgical guide was fabricated of .080 clear surgical tray material (Dentiform, Dentiform, Inc.). The central fossae of the teeth to be replaced were connected, providing a trough indicating acceptable receptor sites. Use of the trough facilitates selection of
1. B lustein R, Jackson R, Rotskoff K, Coy R, Godar D. Use o f sp lin t m aterial in th e placem en t of im plants. In t J Oral Maxillofac Im plants, 1986;1:47-9 2. Edge M. Surgical placem en t guide for use with osseointegrated im plants. J P ro sth e tD e n t 1987;57:719-22. 3. Engelm an MJ, So ren sen JA, Moy P. Optim um placem en t of osseointegrated im plants. J P ro sth et D ent 1988:59; 467-73. 4. Chiche GJ, Block MS, P in a u lt A. Im plant surgical tem plate fo r p artially ed en tu lo u s patients. In t J Oral Maxillofac Im plants 1989;4:289-92. 5. Zinner ID, Small SA, P an n o FV. Presurgical prosthetics a n d surgical tem plates. D ent Clin N orth Am 1989;33:619-33. 6. Buser D, W eber HP, Bragger U. The tre a tm e n t of p artially en d e n tu lo u s p a tie n ts w ith ITI hollow-screw im plants: P resurgical evalu atio n and surgical procedures. In t J Oral Maxillofac Im p lan ts 1990;5:165-74. 7. M cGivney GP, H aughton V, S tra n d t JA, Eichholz JE, Lubar DM. A com parison o f com puter-assisted tom ography a n d d ata-gathering m odalities in prosthodontics. In t J O ral Maxillofac Im plants 1986;1:55-
68. 8. Klinge B, Petersson A, Maly P. Location o f the m an d ib u lar canal: C om parison of m acroscopic findings, conventional radiography, and co m p u ter tom ography. Int J Oral Maxillofac Im plants 1989;4:327-32. 9. Stella JP , T h aran o n W. A precise radiographic m ethod to d eterm in e th e location of the inferior alveolar canal in th e p o sterio r ed en tu lo u s m andible: Im plications for d en tal im plants-Part 1: T echnique. In t J Oral Maxillofac Im plants 1990;5:15-22. 10. Stella JP, T h aran o n W. A precise radiographic m ethod to d eterm in e th e location of the inferior alveolar canal in th e p o sterio r ed en tu lo u s m andible: Im plications for den tal im plants-P art 2: Clinical application. Int J Oral Maxillofac Im plants 1990;5:23-9. 11. S h im u ra M, Babbush CA, Majima H, Yanagisawa S, Sairenji E. Presurgical evalu atio n for d en tal im plants using a refo rm attin g program of com puted tom ography: M axilla/m andible sh a p e p attern analysis (MSPA). In t J Oral Maxillofac Im p lan ts 1990;5:175-81.
S E L E C T IN G T H E P R E C IS E
R IC H A R D A. K R A U T , D .D .S.
A three-dimensional study determined when bone volume was adequate for placing implants in a 63-year-old patient. The author has performed 224 successful implants using this technique. : hen planning the precise site for an endosteal implant, the dentist ! needs the most current tools for the best treatment plan.15Conventional I methods of assessing implant sites include: clinical examination, : mounted diagnostic casts and periapical, panoramic, tomographic or : cephalometric radiographs.6 The recent availability of three-dimensional imaging allows the : surgeon and restorative dentist to visualize the implant receptor site : accurately in three dimensions relative to the adjacent vital structures.711 In three-dimensional imaging, a computerized tomography scanner j scans the edentulous and partially edentulous arches. Additional : processing by software (3D/Dental, Columbia Scientific, Inc.) helps : determine the availability of suitable implant receptor sites. The threei dimensional scanner processes the CT scans and prints the image life-size : (one to one). The diagnostic information is transferred precisely from the i transaxial CT scans to the diagnostic cast and then to the patient. With a “China marker” pencil, the length and width are drawn directly : on the three-dimensional scan. The length is measured with a standard : millimeter ruler and marked directly on the study scan for reference : during the implant insertion. We have performed 224 implants using this technique; currently, all I implant sites determined in this way have been successful. When panoramic and cephalometric radiographs leave doubt about I the availability of bone volume for implant placement in the anterior ! mandible, the three-dimensional processing can determine if an : endosteal or subperiosteal implant procedure is indicated. When there is enough bone volume in the mandibular symphysis for an : endosteal implant, the detailed image of the buccal and lingual contour of : the symphysis provided by the scan guides the placement of the implants : so that they are contained within the cortices of the mandible. JADA, Vol. 122, May 1991
59
alternate sites if there is a problem with the planned primary site. The three: Dr. Kraut is director, dimensional and study confirmed : Oral Maxillofacial Surgery the adequacy of • Service Residency : P ro g ra m , Montefiore bone volume. : Medical Center, 111 The surgical East 210th St., j Bronx, N.Y. 10467. guide ensured : Address requests for transference of : reprints to Dr. Kraut. information from the diagnostic casts to the patient to properly place the endosteal implants. C O N C L U S IO N
The amount of available bone volume is critical to the success of implants; in instances in which the dentist must decide between endosteal or subperiosteal implants, three-dimensional imaging can determine the type of implant and aid its successful placement. ■
Cross-sectional images nos. 4 and 10 show adequate bone volume for 8-mm implants. R E P O R T OF CASE
A 63-year-old man needed implants in all four quadrants of his mouth. The maxillary threedimensional study scan showed adequate bone volume for placement of a 15-mm and a 13-mm implant in the maxillary right edentulous area. The study also indicated a decreased bone volume on the left side; therefore, two 8-mm implants 60
JADA, Vol. 122, March 1991
were placed in that area. The final contours of the fixed restorations to be placed were determined. A rigid surgical guide was fabricated of .080 clear surgical tray material (Dentiform, Dentiform, Inc.). The central fossae of the teeth to be replaced were connected, providing a trough indicating acceptable receptor sites. Use of the trough facilitates selection of
1. B lustein R, Jackson R, Rotskoff K, Coy R, Godar D. Use o f sp lin t m aterial in th e placem en t of im plants. In t J Oral Maxillofac Im plants, 1986;1:47-9 2. Edge M. Surgical placem en t guide for use with osseointegrated im plants. J P ro sth e tD e n t 1987;57:719-22. 3. Engelm an MJ, So ren sen JA, Moy P. Optim um placem en t of osseointegrated im plants. J P ro sth et D ent 1988:59; 467-73. 4. Chiche GJ, Block MS, P in a u lt A. Im plant surgical tem plate fo r p artially ed en tu lo u s patients. In t J Oral Maxillofac Im plants 1989;4:289-92. 5. Zinner ID, Small SA, P an n o FV. Presurgical prosthetics a n d surgical tem plates. D ent Clin N orth Am 1989;33:619-33. 6. Buser D, W eber HP, Bragger U. The tre a tm e n t of p artially en d e n tu lo u s p a tie n ts w ith ITI hollow-screw im plants: P resurgical evalu atio n and surgical procedures. In t J Oral Maxillofac Im p lan ts 1990;5:165-74. 7. M cGivney GP, H aughton V, S tra n d t JA, Eichholz JE, Lubar DM. A com parison o f com puter-assisted tom ography a n d d ata-gathering m odalities in prosthodontics. In t J O ral Maxillofac Im plants 1986;1:55-
68. 8. Klinge B, Petersson A, Maly P. Location o f the m an d ib u lar canal: C om parison of m acroscopic findings, conventional radiography, and co m p u ter tom ography. Int J Oral Maxillofac Im plants 1989;4:327-32. 9. Stella JP , T h aran o n W. A precise radiographic m ethod to d eterm in e th e location of the inferior alveolar canal in th e p o sterio r ed en tu lo u s m andible: Im plications for d en tal im plants-Part 1: T echnique. In t J Oral Maxillofac Im plants 1990;5:15-22. 10. Stella JP, T h aran o n W. A precise radiographic m ethod to d eterm in e th e location of the inferior alveolar canal in th e p o sterio r ed en tu lo u s m andible: Im plications for den tal im plants-P art 2: Clinical application. Int J Oral Maxillofac Im plants 1990;5:23-9. 11. S h im u ra M, Babbush CA, Majima H, Yanagisawa S, Sairenji E. Presurgical evalu atio n for d en tal im plants using a refo rm attin g program of com puted tom ography: M axilla/m andible sh a p e p attern analysis (MSPA). In t J Oral Maxillofac Im p lan ts 1990;5:175-81.