Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 59

If the implant insertion is planned simultaneously with the grafting procedure and with the software utilizing a reference plate, it is recommended to convert the prosthetic setup into a radiologic template. To obtain information about the planned crown position, it is necessary to implement radiopaque structures in the template. This can be done by gutta-percha pins, which represent the ideal axes of the implant abutments. With this approach, no specific software is necessary for the implant planning. After the analysis of the position and the axis of the future implant, the dental technician will replace the corrected position of the guttapercha pin through a hole for the pilot bur.

More orientation is given if the crowns are converted into barium sulfate resin. For the best possible information, the crowns should rest on the soft tissue with the natural anatomical profile. This allows the determination of the thickness of the soft tissue during the scan. For the exact determination of the position, it is important that the crowns are separated at the mucosal level and partly reduced to the diameter of the putative root (Fig 2-21). If a mucosa-supported surgical guide has to be used, a different doping with barium sulphate is recommended for the template base and the setup teeth in order to visualize the soft tissue, so that the soft tissue contours and the prosthetic orientation are reproduced in the image. Depending on the software, a double scan of the patient with the prosthetic setup and the setup alone is sometimes recommended.²⁷ Both scans are matched to give the best visualization of the prosthetic setup for the orientation of the implants and the amount of grafting.

Fig 2-20a Significant atrophy of the anterior maxilla after several infections.

Fig 2-20b Importing the digital wax-up into the implant planning software (Sicat Implant 2.0; Sicat, Bonn, Germany).

Fig 2-20c Selection of marker point on residual teeth of the digital model and corresponding structure within the CBCT to match the data sets.

Fig 2-20d Control of the contours of the optical model over the crowns of the corresponding teeth in the matched data set.

Fig 2-20e Selection of implant size, abutments, and sleeves for the detailed plan for simultaneous implant placement and lateral grafting.

Fig 2-20f Digital planning with volumetric samples of implant bodies and drill sleeves in the position of the planned implants in the anterior maxilla.

Fig 2-20g Guided pilot drilling with the 3D surgical guide (Optiguide; Sicat).

Fig 2-20h Implant insertion (XiVE; Dentsply Sirona) with simultaneous lateral block grafting.

Fig 2-20i Use of a surgical guide at second stage surgery to determine the positions of the implants.

Fig 2-20j Control of implant positions using the surgical guide after insertion of the healing abutment at second stage surgery.

Fig 2-20k Definitive restoration with stable and healthy soft tissue 2 years postoperatively.

Fig 2-20l Radiographic control of the implants in the right maxilla.

Fig 2-20m Radiographic control of the implants in the left maxilla.

Fig 2-21 Tooth-shaped radiologic template for the edentulous maxilla in transparent resin for the base. The clearly separated crowns rest on the base so that the soft tissue configuration can be determined indirectly.