Efficient dental implants: Incorporating 3-D printing into digital implant planning
Prosthetic-driven dental implant planning and placement form the foundation for success in implant dentistry. Dr. Murtaza Paghdiwala presents a case study that describes how a surgical guide can be planned and fabricated using CBCT technology combined with powerful planning software, and then printed from a mid-level 3-D printer in-house.
Prosthetic-driven dental implant planning and placement form the foundation for success in implant dentistry. CBCT technology combined with powerful planning software has simplified the achievement of ideal implant positioning. Incorporation of 3-D printing is the final step in taking the digital implant workflow to the mouth.
Having the proper diagnostic information can facilitate success even in less than ideal clinical presentations. CBCT scans are becoming the accepted standard of care in dental implant placement. (1) A fully limiting surgical guide based on a CBCT scan has been shown to be the superior surgical guide design. (2) Previously, the high costs associated with lab planning and lab fabrication of surgical guides forced practitioners to limit the use of guided surgery to large cases or to use inferior model-based guides. By planning and fabricating the surgical guide in-house, every implant can be placed with increased efficiency and precision.
CBCT scans are ideal for analysis of the bony architecture, but additional information is needed to accurately fabricate a 3-D printed tooth-supported guide. Scatter radiation and low resolution associated with cone beam technology create a poor image of the dentition. (3) An optical scan of the patient’s teeth, stone model, or simply a CBCT scan of a PVS impression can be used to create a digital study model. The digital model can be aligned with the CBCT scan, resulting in incredible accuracy of the bone and the dentition. The implant is placed digitally into the ideal position and a fully limiting tooth-supported guide is designed in the software and exported as a 3-D file. The guide can be printed in-house from a mid-level 3-D printer, or printed economically at a 3-D print lab.
The preoperative planning combined with a 3-D printed guide allows for easier surgery for both the patient and clinician. The guide controls drill positioning in all dimensions, including depth. This eliminates the need for sequential drilling. One implant drill can be used to create the osteotomy to the final width and depth. Research has shown no decrease in implant survivability (4) and no increase in the heat that’s generated with this method, compared to sequential drilling. (5) Surgical time decreases and patient comfort increases. A 3-D printed fully limiting surgical guide makes implant placement more efficient and more predictable.
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