3D Digital Dentistry
The Use of Implant Simulation in Prosthetic Rehabilitation of a Class II Maxilla*
1. The temporary teeth set-up
The wax set-up in the articulator (Hanau) showed a large inter-maxillary gap in the distal region (fig. 1). Based on this and the
fact that the anatomy of the edentulous maxilla was flat with a shallow palate, they concluded that it was not possible to create
a fixed prosthesis in the distal area.
2. Medical Imaging
Although the clinical examination and the panoramic radiographs showed adequate bone volume, the CT scan revealed an atrophic maxilla (fig. 2). Horizontal and vertical bone resorption was evident in the anterior and the alveolar height in the posterior was also inadequate for implants (fig. 3). Dr. Claeys and Lth. Kint strive for a bilaterally balanced occlusal pattern in Class II maxilla-treatment plans. Group guidance should occur at both the active and passive sides without anterior interference. A barretained
overdenture is not indicated here.
3. Implant simulation
Since the final location and angulation of the implants determine the esthetical and functional results, it was decided that a
SurgiGuide drill guide would be required to achieve precise implant placement in a predictable fashion. Based on the temporary teeth set-up, a radiopaque CT scan appliance was made (fig.5). The patient was then scanned on a CT scanner with the appliance in place. Then the CT data was processed to produce a SimPlant study that included 2D and 3D images of the maxilla with the desired location of the teeth to be restored provided by the CT scan appliance. Dr. Claeys and Lth. Kint then used their SimPlant software to simulate possible treatment planning solutions, choosing the most ideal treatment plan for their patient (fig. 6). The SimPlant treatment plan was then used
to produce a SurgiGuide drill guide that would fit perfectly on the patient’s maxillary bone (fig. 7), with drill guides to accurately position each implant exactly as it had been simulated in the SimPlant treatment plan. The implants were quickly and easily placed using the SurgiGuide and the healing abutments were immediately positioned. After an integration period of six months, the implants were uncovered and the prosthesis was installed. Because of the accurate placement of the implant, the prosthesis could be created with the normal prosthetic lab techniques.
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Dr. Claeys and Lth. Kint use SurgiGuides when:
- Accurate and predictable location and
angulation of multiple implants are
- Adequate bone volume is doubtful
Dr. Claeys and Lth. Kint concluded that when using a SurgiGuide, based on a computer based treatment plan, the placing of the implants is more accurate and predictable and the surgery is more simple.
Dr. Th. Claeys: Maxillo-facial surgeon - St.Elisabeth Ziekenhuis - Zottegem Dr. J. Kint: Prosthodontist - dental treatment under general anesthesia - St.-Elisabeth Ziekenhuis - Zottegem