This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.

1. Dental Implants
Computer guided treatment planning and
implant placement
John Beumer III DDS, MS
Allesandro Pozzi DDS
Robert Faulkner DDS
Division of Advanced Prosthodontics, UCLA
This
program
of
instruc1on
is
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by
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©.
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of
this
program
of
instruc1on
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permission.

2. Computer guided treatment
planning and surgery

3. Computer
guided
planning
and
surgery
• Computer
guided
treatment
planning
will
be
the
standard
of
care
within
the
next
few
years

4. Computer
guided
planning
and
surgery
Defini1on
–
selec1on
of
implant
sites
and
placement
of
dental
implants
employing
surgical
templates
developed
with
CBCT
scans
and
soCware
programs.

5. Free
hand
drilling
Previous
method
• Free
hand
drilling
uses
the
template
to
iden1fy
the
posi1on
of
the
implants.
• The
clinician
decides
the
angula1on
and
depth
of
the
osteotomy
prepara1on.

6. Disadvantages
of
free
hand
implant
placement
Catastrophic
mistakes
made
in
posi1on
and
angula1on
Labially
inclined
implants
Buccally
inclined
implants
Implants
posi1oned
interproximally
Misaligned
implants

7. Advantages
of
computer
guided
treatment
planning
and
surgery
• Visualize
poten1al
implant
sites
in
3D
in
rela1on
to
the
proposed
prosthesis
• Precise
implant
placement
• Less
risk
of
compromising
adjacent
vital
structures
• Prefabrica1on
of
the
prosthesis,
abutments
and
immediate
loading
• Enables
flapless
surgery

8. Advantages
Visualize
poten1al
implant
sites
in
3D
in
rela1on
to
the
proposed
prosthesis

9. Advantages
Enables
flapless
surgery
– Less
postsurgical
morbidity
(pain,
swelling
etc.)

10. Advantages
• BeSer
implant
distribu1on
paSern
for
more
favorable
biomechanics

11. Advantages
– Select
an
implant
of
proper
Length
and
diameter

12. Advantages
Precise
implant
placement
Implants
can
be
precisely
placed
in
tooth
posi1ons
as
opposed
to
interproximal
posi1ons

13. Advantages
Less
risk
of
compromising
adjacent
vital
structures
– Inferior
alveolar
nerve
– Branches
of
the
lingual
artery
Courtesy
Dr.
N.
Barakat

14. Advantages
Less
risk
of
compromising
adjacent
vital
structures
– Maxillary
sinus
– Anterior
pala1ne
foramen

15. Advantages
Prefabrica1on
of
the
abutments,
prostheses

16. Two
types
– Fully
guided
surgery
-­‐
implies
that
the
surgical
templates
with
their
drill
sleeves
(bushings)
control
the
posi1on,
angula1on,
diameter
as
well
as
the
depth
of
the
implant
osteotomy
sites
Computer
guided
implant
placement

17. Indica1ons
–
Fully
guided
approach
• Edentulous
pa1ents
Computer
guided
planning
and
surgery

18. Fully
guided
implant
placement
Provides
more
flexibility
during
placement
of
the
implants-­‐soC
1ssue
manipula1ons,
bone
graCing
etc.
2
Piece
surgical
template

19. 2
Piece
surgical
template
Fully
guided
implant
placement
Used
to
Ensure
the
implants
are
perfectly
parallel
to
one
another
Perform
the
desired
alveoloplasty
prior
to
implant
placement

20. Fully
guided
approach
• Used
less
frequently
in
par1ally
edentulous
pa1ents
– Lack
of
mesial
distal
space
– Lack
of
interocclusal
space
Computer
guided
planning
and
surgery

21. Fully
guided
approach
• Used
less
frequently
in
par1ally
edentulous
pa1ents
– Lack
of
mesial
distal
space
– Lack
of
interocclusal
space
– Disadvantageous
when
bone
or
soC
1ssue
graCing
is
necessary
– Verifica1on
and
altera1on
of
apical
coronal
posi1on
is
difficult
Computer
guided
planning
and
surgery

22. Disadvantages
• Lack
of
flexibility
during
surgery
– SoC
1ssue
and
bone
graCing
is
more
difficult
– Coronal
-­‐
apical
posi1on
is
difficult
to
visualize
and
control

23. Two
types
Semi-­‐guided
surgery
-­‐
employs
the
same
treatment
planning
soCware
programs
as
fully
guided
surgery,
but
the
drill
sleeves
(bushings)
incorporated
within
the
surgical
templates
are
designed
to
accommodate
the
2-­‐3
mm
twist
drills
and
as
a
result,
control
only
the
posi.on,
and
angula.on
of
the
ini)al
osteotomy.
Computer
guided
implant
placement

24. Indica1ons
-­‐
Semi-­‐guided
approach
• Par1ally
edentulous
pa1ents
– Posterior
quadrants
with
limited
interocclusal
space
• The
esthe1c
zone
• Apical
-­‐
coronal
posi1oning
and
angula1on
is
cri1cal
• Permits
bone
and
soC
1ssue
graCing
Computer
guided
planning
and
surgery

25. Semi-­‐guided
implant
placement
When
soC
1ssue
procedures
or
bone
graCing
are
an1cipated
during
surgery
– Pa1ents
with
thin
periodontal
biotype
frequently
require
soC
1ssue
supplementa1on
and
bone
graCing

26. • When
flexibility
is
required
during
surgery
– The
esthe1c
zone
• Apical
–
coronal
posi1oning
• GraCing
Semi-­‐guided
implant
placement

27. Combined
fully
guided
and
semi-­‐
guided
implant
placement

28. Combined
fully
guided
and
semi-­‐
guided
implant
placement
• Posterior
implants
placed
with
fully
guided
approach
• Anterior
implants
placed
with
a
semi-­‐guided
approach

29. Combined
fully
guided
and
semi-­‐
guided
implant
placement
• The
1lted
implants
were
placed
using
fully
guided
technique
• The
anterior
implants
were
placed
with
a
semi-­‐guided
technique

30. Fully
guided
or
semi-­‐
guided
approach?
• Interocclusal
space
• Mesial
distal
space
• The
need
for
bone
or
soC
1ssue
graCing

31. Issues
to
consider
Interocclusal
space
Limited
mesial
distal
space
Requires
a
minimum
of
40
mm
in
the
anterior
region

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