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Lees Summit, MO 64064
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Lakewood OMFS introduces virtual dental implant treatment planning and placement utilizing cone beam CT guided surgery and the i-Tero digital scanner. “The combination of the cone beam CT (CBCT) scanner and the i-Tero digital scanner allows us to obtain more information than traditional 2D films, increases treatment predictability, enables restoration-driven implant treatment planning, allows for the fabrication of custom guides prior to implant placement and allows us to provide our referrals with an articulated model with the implant analog (s) in place” Christopher Haggerty DDS, MD, FACS.
Image 1. Implant treatment planning is performed virtually using restoration guided implant planning (crown-down approaches).
Image 2. A virtual crown is placed within the edentulous area and is modified to anatomically fit the embrasures/contacts, occlude ideally with the opposing dentition and to match adjacent and contralateral dentition.
Virtual Treatment Planning and Custom Guide Fabrication
- A CBCT and an i-Tero (with a bite registration) scan are taken and merged together using surface mapping technology.
- The patient’s bony anatomy (CBCT), soft tissue anatomy (i-Tero) and dentition (combined CBCT and i-Tero) are evaluated in a layered 3D environment.
- Anatomical structures are highlighted (sinuses, mandibular canal, mental foramen, incisive foramen, etc.) (Image 3).
- Implant treatment planning is performed virtually using restoration guided implant planning (crown-down approach) (Image 1).
- A virtual crown (Image 2) is placed within the edentulous area (s) and is modified to:
- Anatomically fit the embrasures/contacts
- Occlude ideally with the opposing dentition
- Match the adjacent and contralateral dentition
- Once the final crown is positioned, a virtual implant is placed within the edentulous site (s).
- Manipulation of the implant is performed under the virtual crown with the aid of axial, sagittal and coronal CBCT views.
- If multiple implants are to be placed, the implants are placed as parallel as possible and spacing is optimized (Images 4 through 7). The software systems used have specific implant paralleling software for above-mentioned cases.
- The final 3D treatment plan is approved and the surgical guide is fabricated.
- The implant placement surgical guide interdigitates with the occlusal third of the clinical crowns of adjacent teeth and is rigid to prevent rocking and torquing forces to minimize errors in implant placement (Image 8).
- With the use of the implant placement surgical guide, dental implants can be placed precisely and accurately, often without the need of incisions (Figure 9).
Image 3. Vital structures such as the inferior alveolar nerve are highlighted.
Image 4. Patient presents for implant work-up after traumatically avulsing teeth 7-10. Virtual crowns and implants are placed utilizing implant specific software.
Image 5. Implants are positioned palatal for the fabrication of individual screw-retained crowns.
Image 6. Implants are placed as parallel as possible using the crown-down approach.
Image 7. A custom guide is computer generated, virtual drill sleeves are placed and interference’s are removed.
Image 8. A custom guide is fabricated, which articulates with the occlusal third of the clinical crowns of adjacent teeth
Image 9. Final implant placement.
Fabrication of Articulated Models with Implant Analog(s)
After implant osseointegration, a new i-Tero digital scan is obtaining using a scan body (Image 10). The scan body allows the i-Tero to take a digital impression of the patient while recording the exact size and location of the dental implant (s), the adjacent/opposing dentition and a bilateral bite registration (Images 11 & 15).
The i-Tero digital scan is then used to:
- Fabricate an articulated model with the implant analog (s) in place (Images 12, 16 & 17). The restoring doctor then selects a shade for the final restoration and delivers this final model to the lab of their choice for fabrication of the final restoration.
- Provide open connectivity with the preferred dental laboratory. Open connectivity refers to the ability of data sharing of the scanned digital impression between the dental laboratory and the restoring doctor. Open connectivity allows the restoring laboratory’s technician to receive and review the i-Tero STL files and to make suggestions to the restoring doctor regarding the use of different restorative options such as stock vs. custom abutment, cement vs. screw-retained abutments, abutment materials and final restoration designs and dimensions. The restoring doctor then approves the laboratories abutment and crown work-up and selects the shade of the final restoration.
“At Lakewood OMFS, we strongly believe that better planning leads to more predictable treatment results. The combination of our cone beam CT scanner and i-Tero digital scanner allow us to provide our referring doctors with the tools that they need to ensure predictable and outstanding prosthetic outcomes” Christopher Haggerty DDS, MD, FACS.
Image 10. Scan bodies are placed in preparation for i-Tero.
Image 11. i-Tero digital scanning with scan bodies in place. The digital scan is used to create a digital impression of the patient while recording the exact size and location of the dental implants, the adjacent/opposing dentition and a bilateral bite registration.
Image 12. Final impression with implant analogs in place. The model is sent to the laboratory for the fabrication of custom abutments and individual screw-retained crowns.
Image 13. Final result using CBCT virtual treatment planning and i-Tero digital scanning.
Image 14. Implant #3 is placed using CBCT virtual treatment planning and i-Tero digital scanning. Implant is positioned using restoration guided implant planning (crown-down approach).
Image 15. I-Tero digital scan demonstrating the position of the scan body and adjacent teeth.
Image 16. Articulated model is delivered to the restoring doctor.
Image 17. Implant analog in place. The articulated model is sent to the restoring doctors preferred dental lab for the fabrication of the final crown. Due to ideal implant placement, a stock abutment will be utilized.