Introduction To Guided Implant Surgery [PDF]

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Introduction to Guided Implant Surgery

Table of Contents 1 What is Guided Implant Surgery? 2 The Pros and Cons of Guided Implant Surgery 3 Cone-beam CT 4 Implant planning software 5 Surgical Template 6 Guided Implant Surgery kit 7 Surgery 8 How Surgical Templates Work

Introduction to Guided Implant Surgery

In2Guide™

1 What is Guided Implant Surgery? Guided implant surgery is the process of planning the implant surgery on a computer using the patient’s CT image. The conventional method of using the patient’s panoramic x-ray to plan implant surgery cannot transfer the planning exactly as planned, however, guided implant surgery can transfer the plan as exactly as the doctor plans on the computer. To carry out the surgery exactly as the surgery plan, a custom surgical template and guided implant surgery kit are needed.

The followings are needed for guided implant surgery. Medical or Cone-beam CT Implant planning software Guided implant surgery drill kit Custom surgical template

The general workflow for guided implant surgery is as shown below.

CT scan

Treatment planning

>> Figure 1.

Order surgical template

Surgery

Workflow of guided implant surgery

2 The Pros and Cons of Guided Implant Surgery Guided implant surgery uses the patient’s CT data to diagnose the patient beforehand, can mimic the surgery according to the surgery plan, and has the following advantages: Surgery can be precise, safe, and predictable. Surgery time is shorter. Generally carried out as a flapless surgery and shorter recovery time for the patient. Less invasion, blood, and pain for the patient. Immediate loading is possible. Bone grafts can be minimized.

The disadvantages of guided implant surgery are as follows: Expensive CT machine is necessary. When doing a flapless surgery, the patient’s bone situation cannot be assessed. The surgery planning time takes longer. The user must learn the planning software. Any unexpected situations during surgery are hard to be dealt with. Surgical kits and surgical templates must be purchased.

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

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Introduction to Guided Implant Surgery

In2Guide™

3 Cone-beam CT A Cone-beam CT is an x-ray machine capable of taking 3D images of the patient. Using a cone-beam CT and software allows for accurate patient diagnosis, and more realistic visualization. >> Figure 2. Cone-beam CTs from various manufacturers

4 Implant planning software Cone-beam CTs generate data in a special format, called a DICOM. Implant planning software uses DICOM data and renders the data in 2D and 3D. Implant planning software provides various tools for implant surgery planning, allowing the user to view important anatomical structures and plan implant surgeries safely. >> Figure 3. Implant planning software screen

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

5 Surgical Template A surgical template holds the surgical planning information made with implant planning software. Generally, surgical templates are shaped like orthodontic splints and are designed to fit into the patient’s oral cavity during surgery. Surgical templates have small metal objects called sleeves inserted in place to guide the drilling and implant direction. Surgical templates must be fabricated to snugly fit the oral cavity according to the surgical plan, and many companies offer surgical template manufacturing services. Surgical template manufacture companies usually provide implant planning software along with the surgical templates, fabricate and send out the surgical template when the user sends in the planning data using the software.

>> Figure 4. How a surgical template generally looks like. There are 6 sleeves for guiding the implant drilling and 2 sleeves to place the anchor pins in place. An anchor pin allows the surgical template to be fixed tightly in the patient’s oral cavity.

>> Figure 5. Image of surgical template fitted inside patient’s oral cavity

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

6 Guided Implant Surgery kit To use a surgical template for implant surgery, a special drill kit designed to be used with the surgical templates must be used. The shape of a surgical template and implant specifications vary by manufacturer, resulting in differences in guided surgery kits. Therefore, it is essential to know which surgery kit is used for the different surgical templates.

Table 1. Surgical Kit manufacturers of Guided Implant Surgery

Guided surgery kit

Planning software

Surgical template

Manufacturer

Product

Cybermed

In2Guide

Nobel Biocare

NobelGuide

Biomet 3i

Navigator

Straumann

Guided Surgery

Astra

Facilitate

Densplay

ExpertEase

Materialise

SAFE SurgiGuide Kit

Cybermed

In2Guide

Nobel Biocare

Procera

Materialise

Simplant

Cybermed

In2Guide

Nobel Biocare

NobelGuide

Materialise

SurgiGuide

TM

TM

TM

TM

TM

TM

TM

TM

Surgery kits are usually comprised of the following components.

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

Table 1. Component manufacturers of Guided Implant Surgery Component

Anchor pin Anchor drill

Description Used to affix the surgical template inside the patient’s oral cavity during surgery. The anchor pin is placed to fix the surgical template in place after drilling a hole with the anchor drill. Used to remove the tissue for flapless implant surgery.

Tissue punch

Drill guide

Drill

Guides the drill direction along with the Sleeve. There are various drill guides that match the diameter of the drills used for surgery.

The direction is guided by the drill guide, and placed with a self-stopper so that the drilling only goes in as planned.

The anchor pin is placed to secure the surgical template into the patient’s oral cavity so that the template does not get detached during surgery.

>> Figure 6. The surgical template secured into place with the anchor pin

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

Table 3. Surgical procedure of guided implant surgery Prepare the surgical template · Remove any unnecessary ridges using a bur. · Disinfect the surgical template.

Secure the surgical template in place · Secure the surgical template into place using the bite index. · Drill with the anchor drill. · Insert the anchor pin in place.

Remove the soft tissue · Use the tissue punch to punch out the soft tissue. · Remove the anchor pin and surgical template from the patient’s oral cavity. · Remove the soft tissue from the patient’s oral cavity. · Place the surgical template and anchor pin back into the patient’s oral cavity.

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

Table 3. Surgical procedure of guided implant surgery Drilling · Begin drilling with the 2.0mm drill and 2.0mm drill guide placed into the sleeve. · Switch to the 3.0mm drill guide and 3.0mm drill and continue drilling.

Implant Fixture Installation · Place the implant fixture onto a guided surgery mount. · Place the implant into the patient’s oral cavity. · Remove the anchor pin and surgical template after all the implant fixtures are installed.

Placing provisional restoration · Place the provisional restoration that has been prepared beforehand into the patient’s oral cavity.

· This process can be skipped if the procedure does not include immediate loading.

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.

Introduction to Guided Implant Surgery

In2Guide™

8 How Surgical Templates Work It was explained above that if implant planning software is used to plan the placement of an implant fixture, a surgical template must be fabricated. Here it is explained how the drilling angle and depth is reflected on the surgical template. >> Figure 7. The location of the sleeve is determined by the implant and drill used. Here the sleeve is placed in accordance with a 0.5mm implant and 21mm drill.

The left image in Figure 7 shows an image of an 11.5mm implant fixture placed on tooth #36 by using implant planning software. If the user uses a 21mm drill, the sleeve is placed 8.5mm above the bone level of the implant planned. The remaining 1mm is the thickness of the drill guide, resulting in an accurate depth drilling of the implant length.

OnDemand3D Technology Inc.

For more information visit www.ondemand3d.com or contact Customer Care at 949-341-0623

310 Goddard Way, Suite 250 Irvine, CA 92618 Tel : 949-341-0623 Fax : 949-334-1317

Please recycle. Printed in USA. ©Cybermed Inc 2013. All rights reserved.

OnDemand3DTM is a trademark of Cybermed Inc. Used under license in USA.