Implant Placement and Immediate Final Rehabilitation

EDI Case Studies 4 Extended backward planning (overview) 1. Evaluation and documentation of baseline situation (history and findings) This will give rise to a record showing the baseline condition of the oral system and its deficits. 2. Definition of potential rehabilitation Options of functional and aesthetic restoration are discussed and coordinated in a team-oriented approach. 3. Definition of fixation points for the stent for the CT scan, planning, implant placement and final restoration Any temporary implants that may be required are placed at this time. 4. Transfer of reference/fixation points to the master cast A planning template with radiopaque teeth is fabricated on the master cast. 5. CT scan with the diagnostic stent in place, followed by 3D implant planning Treatment options are discussed in a team-oriented approach, including the patient’s input. The patient is informed about any risks as well as about any functional or aesthetic limitations of therapy. Alternative options are discussed. 6. Definition of the treatment sequence Treatment steps are defined in terms of sequence and scope. The anticipated result is outlined. 7. Modification of the diagnostic stent to a surgical stent Based on the data supplied by the CT analysis software, drilling sleeves are polymerized into the planning stent. These sleeves are used to position implant analogs into the master cast. 8. Fabrication of the restoration As the implant position has been precisely defined on the master cast and this can be reproduced intraorally, the rehabili- tation can be fabricated prior to implant placement. 9. Implant insertion With the help of the surgical stent, the implants are precisely positioned in terms of location, depth and axial orientation. 10.Delivery of the rehabilitation Following abutment connection and wound closure, the previously completed rehabilitation is delivered. Tolerances cannot be completely avoided, but the passive-fit technique with appropriate abutments is able to compensate for these inaccuracies. The Camlog Guide system allows for template-guided preparation of implant sites and insertion of Camlog Screw Line implants. These can be immediately restored with a temporary or definitive rehabilitation. Alternatively, they can be restored following osseointegration. Currently implemented planning software includes implant3D (med3D) and coDiagnostix (IVS). Team approach to planning Patient, surgeon, prosthodontist, dental technician, chairside assistant Dental technician, surgeon, prosthodontist Backward planning “Ultimate” treatment goal until wax-up/set-up/mock-up. Transfer of clinical reference points (temporary implants or natural teeth) to the master cast for fabrication of the diagnostic stent with radiopaque teeth. Definition of clinical reference points for the diagnostic stent (temporary implants or natural teeth). Insertion of temporary implants if required. Radiologist, technician, surgeon, chairside assistant CT scan with the diagnostic stent in place. 3D planning of implant positions. Definition of treatment sequence. Dental technician Modification of the diagnostic stent to a surgical stent (incorporation of guide sleeves) for implant placement. Use of the surgical stent to incorporate implant analogs into the master cast. Pre-insertion fabrication of the planned restoration. Surgeon, prosthodontist Use of the surgical stent for guidance in preparing the implant beds and inserting the implants. Dentist, dental technician Delivery of the restoration (passive fit) and final verification. Dentist, dental technician Dental technician