Tardieu, Philippe B.

Die navigierte orale Implantation nimmt heute einen immer größeren Stellenwert in Zahnmedizin und Zahntechnik ein. Der Autor hat ein Protokoll zur Herstellung einer Scanschablone, den sogenannten "ScannoGuide", entwickelt, um den gesamten Planungsprozess der Behandlung zu erleichtern. Der Beitrag dokumentiert seine Vorgehensweise bei der Versorgung sowohl zahnloser wie auch teilbezahnter Patienten und diskutiert verschiedene Versorgungsmöglichkeiten anhand einer klinischen Situation. Neben relevanten Schritten zur Fertigung einer Scanschablone und der Prothesenbasis werden auch der "ScannoGuide" und das "Virtual Tooth"-Werkzeug genau erläutert. Schlagwörter: Implantatprothetik, navigierte orale Implantation, Planung, Scanschablone, ScannoGuide, virtuelle Zähne

Computer-driven implant dentistry uses the latest technology to coordinate every aspect of implant treatment. It provides a means with which to control the placement of implants with a high degree of accuracy. This is important, since accuracy has a direct bearing on the safety, esthetics, invasiveness, and cost of implant treatment. Computer-driven implant dentistry must be conceived as a chain in which every link is related to the others. Within this chain, there are elements that can be employed to maximize the benefits realized by computer-guided implant dentistry. A scan template is a radiologic template that permits visualization of the prosthetic plan prior to treatment and determines the course of implant treatment from the perspective of esthetics. The SimPlant software program (Materialise) allows implants to be planned in two and three dimensions using data received from a computerized tomographic scan. The resulting implant plan can be transferred to the mouth and implemented by means of a stereolithographic surgical guide (SurgiGuide, Materialise). Finally, the SAFE System (Materialise) is used for guided implant placement. It is associated with dedicated drilling devices and can be used in combination with SurgiGuides or with traditional acrylic resin guides manufactured by the dental lab on a synthetic plaster cast.

Previous publications have reviewed the concepts of implant diagnostics and computerized tomographic imaging used together to create an atmosphere of collaborative accountability. The use of SimPlant software in combination with stereolithographic medical modeling facilitates the fabrication of surgical drilling guides, which assist in precise placement of dental implants. In this article, the use of gradient density scanning appliances will be discussed. This type of scanning appliance allows tooth- or mucosa-supported surgical drilling guides to be fabricated and used for implant placement without bone exposure. The use of the SAFE System will be introduced, along with its application in simplifying the immediate-loading prosthesis concept, which can often bypass the need for traditional dental impressions.

The purpose of this paper is to expand on part 1 of this series (published in the previous issue) regarding the emerging future of computer-guided implant dentistry. This article will introduce the concept of rapid-prototype medical modeling as well as describe the utilization and fabrication of computer-generated surgical drilling guides used during implant surgery. The placement of dental implants has traditionally been an intuitive process, whereby the surgeon relies on mental navigation to achieve optimal implant positioning. Through rapid-prototype medical modeling and the ste-reolithographic process, surgical drilling guides (eg, SurgiGuide) can be created. These guides are generated from a surgical implant plan created with a computer software system that incorporates all relevant prosthetic information from which the surgical plan is developed. The utilization of computer-generated planning and stereolithographically generated surgical drilling guides embraces the concept of collaborative accountability and supersedes traditional mental navigation on all levels of implant therapy.

The need for an accurate diagnosis and treatment plan remains essential for predictable treatment outcomes with dental implants. Advances in computerized tomography (CT) technology now enable the execution of a surgical outcome based on presurgical planning. Precise implant placement no longer relies on socalled mental navigation but rather can be computer guided, based on a threedimensional, prosthetically directed plan. Current CT technology enables all implant team members to embrace the concept of collaborative accountability, which can ensure consistent outcomes. Clinicians can fabricate an implantsupported prosthesis presurgically using patients' CT scan data. The purpose of this paper is to discuss the use of scanning appliances to transfer clinically relevant prosthetic outcome information to a CT data set. With SimPlant software, this information can be used to provide a pretreatment outcome analysis, which can be used for fabrication of stereolithographic models and surgical drilling guides used during osteotomy preparation.

The authors present a case of immediate loading of mandibular implants using a 5-step procedure. The first step consists of building a scannographic template, the second step consists of taking a computerized tomographic (CT) scan, and the third step consists of implant planning using SurgiCase software. The final 2 steps consist of implant placement using a drill guide created by stereolithography and placement of the prosthesis. Using a CT scan-based planning system, the surgeon is able to select the optimal locations for implant placement. By incorporating the prosthetic planning using a scannographic template, the treatment is optimized from a prosthetic point of view. Furthermore, the use of a stereolithographic drill guide allows a physical transfer of the implant planning to the patient's mouth. The scannographic template is designed so that it can be transformed into a temporary fixed prosthesis for immediate loading, and the definitive restoration is placed 3 months later.