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
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
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
32. v Visit
ffofr.org
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hundreds
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33. v Visit
ffofr.org
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Complete
Dentures,
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Den1stry,
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Dentures,
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v Our
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instruc1on
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Prosthodon1cs