JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2010  |  Volume : 2  |  Issue : 1  |  Page : 30-34

Guided implant placement in the edentulous mandible: A novel approach


1 Department of Prosthodontics, Crown and Bridge and Implantology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune - 18, India
2 Department of Periodontics and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune - 18, India

Date of Web Publication18-Nov-2011

Correspondence Address:
Swati S Bhosale
House No 2- 41, Opposite Corporation Building, Jagat Main Road, Gulbarga, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.89994

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   Abstract 

One of the most important and challenging aspects of implant dentistry is the correct planning and placement of the dental implant so as to achieve a prosthetically, aesthetically, and biologically stable outcome. It is also important to prevent encroachment on vital structures. To aid in the correct placement of dental implants, a variety of surgical guides have been proposed. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes an acrylic resin implant placement guide, which is based on bone mapping of the edentulous ridge at the implant site.

Keywords: Bone mapping, Acrylic resin stent, Implant placement


How to cite this article:
Bhosale SS, Raman P B, Mall J. Guided implant placement in the edentulous mandible: A novel approach. J Int Clin Dent Res Organ 2010;2:30-4

How to cite this URL:
Bhosale SS, Raman P B, Mall J. Guided implant placement in the edentulous mandible: A novel approach. J Int Clin Dent Res Organ [serial online] 2010 [cited 2020 Oct 21];2:30-4. Available from: https://www.jicdro.org/text.asp?2010/2/1/30/89994


   Introduction Top


One of the challenges of implant placement is the correct positioning of the implant in the bone. [1] Many designs exist as dental implant placement guides. Some are simple such as the clear vacuum form matrix, with a hole drilled through it in the desired position of the implant. These are quick and simple to fabricate, but may allow too much flexibility in the final positioning of the implant. Other designs have been described involving guide wires, guide tubes, [2] laser welding, [3] and computer tomography. [4] These implant placement guides are more accurate and provide an improved three-dimensional representation of the surgical area. A stable and accurate surgical guide provides the precise reference for implant placement. [5]


   Technique Top


The denture was fabricated using the conventional technique for the patient. For the fabrication of the surgical stent, an irreversible hydrocolloid impression was made. The impression was poured in the dental stone.

Before fabricating the base, a die pin was inserted in the center of the anterior mandibular region and then the base was fabricated. The die pin was inserted to separate the anterior section of the cast from the base. The canine region was marked on the cast according to the denture [Figure 1].
Figure 1: Mandibular cast with marking

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A self-curing clear acrylic resin stent was prepared for the bone mapping, and seven holes were prepared in the marked canine region, 2 mm apart from each other. Three holes were prepared on the buccal slope of the ridge, three holes were prepared on the lingual slope of the ridge, and one on the crest of the ridge [Figure 2]. The cast was sectioned in the canine region using a saw before bone mapping [Figure 3].
Figure 2: Self cure clear acrylic resin stent

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Figure 3: Sectioned mandibular cast

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The fit of the clear acrylic resin stent was checked in the patient's mouth [Figure 4]. The stent was checked for stability.
Figure 4: Stent in oral cavity

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Before starting the bone mapping procedure, buccal and lingual local anesthetic infiltration was given to the patient. Bone mapping was done according to the holes prepared on the stent using the No. 20, sterile, endodontic file. The endodontic file was introduced perpendicular to the soft tissue until it was stopped by the resistance of the underlying bone. The rubber stop was placed near the external surface of the stent [Figure 5].
Figure 5: Bone mapping

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The reading were calculated on a scale and transferred on to the sectioned part of the cast using the resin stent and the same endodontic file [Figure 6]. The markings on the cast were connected to get the morphology of the bone [Figure 7]. According to the bone morphology, the implant diameter was decided and osteotomy of the cast was done at the implant site [Figure 8].
Figure 6: Marking on sectioned cast

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Figure 7: Bone morphology on the cast

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Figure 8: Guiding rod placement

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Guiding rods were placed in the osteotomy site and the parallelism of the rods was checked [Figure 9]. Metal sleeves of 2 mm diameter were inserted in the resin stent at the osteotomy site [Figure 10].
Figure 9: Parallel guiding rods

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Figure 10: Guiding rods from occlusal view

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The osteotomy sites must correlate with the stent when the patient has his mouth wide open during the surgical procedure. It is important to stabilize the stent during maximum mouth opening. The maxillary, self-cure, clear, acrylic record base was fabricated. The maxillary record base and the lower surgical guide stent were stabilized with acrylic stops in the maximum mouth-opening position [Figure 11].
Figure 11: Stent with metal sleeves in oral cavity

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According to the bone mapping, a 2 mm crestotomy was required to get the adequate bone width in the canine region. At the surgical appointment, the patient was prepared for surgery and local anesthesia was given at the implant site. The flap was raised from the right premolar to the left premolar area and crestotomy was done at the implant site. Then the pilot drill was inserted through the metal sleeve and the osteotomy site was prepared to the required length [Figure 12].
Figure 12: Osteotomy site preparation

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Osteotomy sites were prepared with the sequence of the drill and then checked for parallelism using paralleling rods in the osteotomy sites. [Figure 13].
Figure 13: Osteotomy site with parelling rods

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Implants (3.8 mm diameter and10 mm length) were placed at the osteotomy site and the flap was closed [Figure 14].
Figure 14: Implant in place

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Antibiotics and anti-inflammatory agents were given to the patient and patient was called next day for a check up.

After a week, nylon caps were placed on the implants and were picked up from the lower dentures using an autopolymerizing resin [Figure 15]. The implant-retained mandibular complete denture was inserted [Figure 16].
Figure 15: O-Rings in position

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Figure 16: Post-operative

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   Summary Top


This article describes how to construct and use a simple implant placement guide, to ensure proper positioning of the implants during surgical placement. It is a time-efficient procedure and can be fabricated from materials readily available in most dental offices and laboratories. The surgical implant placement appointment is different compared to that in conventional surgery. All decisions regarding implant positioning have to be previously made. It is a matter of executing the plan according to the restrictive surgical guide; this is in contrast to conventional surgery with less restrictive guides, where decision-making and execution occur simultaneously.

Bone sounding has been used in clinical dentistry to acquire an understanding of the thickness of the soft tissue overlying the bone. [6],[7] By subtracting the thickness of the soft tissues from the total width of the alveolar ridge, an estimation of the bone volume can be made at the measured sites.

Clinically, this provides the clinician reliable information, with a small margin of safety. By subtracting the measured tissue thickness of the corresponding sites on a dental cast, a three-dimensional representation of the bone volume will be created within this volume of bone, and thus, the correct position of the dental implant can be established.

 
   References Top

1.Labert JS. Cast based guided implant placement. J Prosthet Dent 2008;100:61-96.  Back to cited text no. 1
    
2.Becker CM, Kaiser DA. Surgical guide for dental implant placement. J Prosthet Dent 2000;83:248-51.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Koyanagi K. Development and clinical application of a surgical guide for optimum implant pacement. J Prosthet Dent 2002;88:548-52.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Cehreli MC, Calis AC, Sahin S. A dual-purpose guide for optimum placement of dental implants. J Prosthet Dent 2002;88:640-3.  Back to cited text no. 4
    
5.Chiche GJ, Block MS, Pinault A. Implant surgical template for partially edentulous patients. Int J oral Maxillofac Implants 1989;4:289-92.  Back to cited text no. 5
[PUBMED]    
6.Traxler M, Ulm C, Solar P, Lill W. Sonographic measurement versus mapping for determination of residual ridge width. J Prosthet Dent 1992;67:358-61.  Back to cited text no. 6
[PUBMED]    
7.Flanagan D. A nonradiologic method for estimating bone volume for dental implant placement in the completely edentulous arch. J Oral Implantol 2001;27:115-7.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16]


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