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Case Reports
. 2016 Nov 13;9(1):33-48.
doi: 10.11138/orl/2016.9.1.033. eCollection 2016 Jan-Mar.

A novel workflow for computer guided implant surgery matching digital dental casts and CBCT scan

G DE Vico  1 , F Ferraris  2 , L Arcuri  3 , F Guzzo  3 , D Spinelli  1
Affiliations
Case Reports

A novel workflow for computer guided implant surgery matching digital dental casts and CBCT scan

G DE Vico et al. Oral Implantol (Rome). .

Abstract

Nowadays computer-guided "flap-less" surgery for implant placement using stereolithographic tem-plates is gaining popularity among clinicians and patients. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, less post-surgical discomfort and reduced time required for definitive rehabilitation. Aim of this work is to describe a new protocol (Smart Fusion by Nobel Biocare), thanks to which is now possible to do a mini-invasive static guided implant surgery, in partially edentulous patients with at least 6 remaining teeth, without the use of a radiographic guide. This is possible thanks to a procedure named surface mapping based on the matching between numerous points on the surface of patient's dental casts and the corresponding anatomical surface points in the CBCT data. The full protocol is examined focusing the attention on the clinical and laboratory procedures.

Conclusions: Also with some critical points and needing an adequate learning curve, this protocol allows to select the ideal implant position in depth, inclination and mesio-distal distance between natural teeth and or other implants enabling a very safe and predictable rehabilitation compared with conventional surgery. It represents a good tool for the best compromise between anatomy, function and aesthetic, able to guarantee better results in all clinical situations.

Keywords: CBCT; dental implants; digital dental casts; guided implant surgery; smart fusion; surface mapping.

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Figures

Figure 1
Figure 1
Procera software planning program allows for prosthetic guided implant positioning.
Figure 2
Figure 2
CAD/CAM manufactured surgical template.
Figure 3
Figure 3
Pre and postoperative radiographs of a periodontal compromised extraction case.
Figure 4
Figure 4
Radiographic guide stabilized with a rigid silicon index.
Figure 5
Figure 5
Radiographic guide with radiopaque gutta-percha markers.
Figure 6
Figure 6
In spite of the absence of prosthetic information, before surgery, also these “free hand” cases were studied using a software for computer guided implant planning.
Figure 7
Figure 7
Well-extended impressions of the arches of the patient are mounted on an articulator.
Figure 8
Figure 8
On the master cast the dental technician will prepare a removable wax-up of the teeth in the desired and corrected final position.
Figure 9
Figure 9
The dental technician will scan the models with and without wax-up charging the two relative files STL on Nobel Connect.
Figure 10
Figure 10
Fusion between digital dental casts and cone beam computed tomography.
Figure 11
Figure 11
Check alignment: this is a fundamental step in order to verify the correct superimposition between the two different files (STL and DICOM).
Figure 12
Figure 12
The operator, thanks to different and predefined colors for the patient’s anatomical model and the prosthetic model, will be able to verify the correct matching point by point.
Figure 13
Figure 13
Procera Software Planning Program allows for prosthetic guided implant positioning.
Figure 14
Figure 14
An ideal implant positioning can be achieved thanks to the 3D software.
Figure 15
Figure 15
First of all the dental technician will verify the correct adaptation of the surgical template on the master model discarding some points of precontacts or friction.
Figure 16
Figure 16
After the adjustment the surgical template seat well on the master cast.
Figure 17
Figure 17
In many cases the Authors reinforce the surgical guide with acrylic resin.
Figure 18
Figure 18
The day of the surgery the template will be checked in patient’s mouth, discarding some friction points.
Figure 19
Figure 19
Surgical guide before and after relayning.
Figure 20
Figure 20
Provisional and final restorations with the OPG and peri-apical control X-rays.
Figure 21
Figure 21
Smart fusion protocol in post-extraction cases: initial situation and wax-up after removing teeth from master cast.
Figure 22
Figure 22
Computer guided implant planning after the fusion between CBCT and the dental cast digitalized.
Figure 23
Figure 23
Surgical procedure with stereolithographic template after removing the compromised teeth (mobility 3rd grade) and post-surgery Rx control.
Figure 24
Figure 24
Final clinical situation with Rx-control.
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References

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