3D Implant Planning
Implantology is not just the teaching of implanting a screw into bone, but starts with a very carefull planning. It goes a long way from lost or anatomically non-existant bone and the correct placement of te implant to the construction of a finished prosthesis.
The first step in planning an operation is done with a digital panoramic x-ray that makes the necessary measurements on at least one recording layer. If you use analogue, regular x-ray methods, you can take relative measurements at best, but those usually yield a higher rate of failure. Panorama recordings project everything on a single layer and can not represent spatial relations.
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3D DVT: A quantum leap in diagnostics and planning
Using a recording from out 3DDVT (Digital Volume Tomograph), a computer tomograph of the latest generation, we are able to creat a three-dimensional, virtual image that let’s us detect all anatomical structures of the oral cavity and get a perspective measurement of their relation. A thorough analysis like this, the rate of failure can be minimized.
Furthermore, we can measure the density of the bone that is later used for an implant with the help of the CT’s program. This way, we can assess how high the stability of the implant will be and whether a possible treatment to compress the bone (condensation) is necessary. Likewise, the lower jaw can be almost hollow, this can be safely recognized through a CT.
Our patients can view the planned result before the operation and see how we would like to achieve this.
Attention: Facial nerve!
It is important to know that the bone of the lower jaw contains an important branch of the facial nerve that runs from the back to the upper part up to the height of the molars. Only a 3D CT shows precisely how much bone is covering the nerve. In the front, between the two nerve exits, there’s usually no risk injuring a nerve when an implant is used.
What the attending physician has to watch for
The most limiting factors in the maxilla are the extent and location of the nose and sinuses. Implantation in the upper central incisors is only possible with sufficient distance to the nasal cavities. Implantation is easier on the position of the upper lateral incirors and canines. Starting with the upper secod premolars, it is important to observe the form, etent and the possible splitting of the maxillary sinus. The bone can be very thin at these points. If a patient has lost all his teeth, the jawbone loses it’s function, begin to regress and start getting thinner and flatter.
The right number and layer of implants
Upon complete loss of teeth, we recomment to allocate at least 2 implants in the lower jaw and 4 in the upper jaw. A web or pushbuttons can be affixed to them that can carry a removable prosthesis. For fixed dentures, we recommend 4 to 6 in the lower jaw and at least 6 implants in the upper jaw. This of course depends on the bone quality, the strength of the muscles of masticulation and the number of teeth that have to be replaced (10 to 14 teeth). The positioning of the implants is determined by several factors: First, the implant has to be in an area with enough bone density that is free from nerves. Secondly, it must be placed in a way that the masticatory forces, which act on the visible part of the replacement (the “superstructure”), can be channeled stable (axial) into the jawbone.
Computer navigation in implantology – The technology of the future
With the help of a computer tomograph and a program that was specifically developed for the three-dimensional display of the jaw, we can plan and carry out operations faster then ever before. If bone grafting is not necessary, we acn place a hole three millimeters big into the mucosa of the jaw by a so-called “punch”, which makes an operation without bigger cuts possible. With careful preparation, such an operation doesn’t take as long, gets minimized (minimally invasive) and becomes more accurate.
Drilling template for the highest precision
This way, we can prepare a so-called drillig template that is placed on the surrounding teeth, the mucosa or the bone and has tubular rails for guiding the implant drill. Using these templates, we can reproduce the direction and depth of the drill holes for the implants with millimetric precision according to the three-dimensional computer image.
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