With increasing success of placing dental implants due to better biocompatibility and technique, patients

are increasingly accepting dental implants to restore edentulous regions of the oral cavity. Along with
increasing acceptance, practitioners must be acutely aware of the axial orientation and encroachment upon
maxillofacial anatomy to prevent patient postoperative discomfort and/or paresthesia.

Radiographic imaging preoperatively and postoperatively is necessary to perceive the safe placement of the
dental implant and hard tissue augmentation if necessary. It is common practice for practitioners to use
two-dimensional imaging and panoramic images to assess the quantity and quality of hard tissue for
placement of implants. Although panoramic images may provide enough information for placement of
single implants with plenty of hard tissue, it is not enough information when quality and quantity of hard
tissue is in question. In fact, the American Academy of Oral and Maxillofacial Radiology recommends
three-dimensional imaging for assessing preoperative placement of dental implants.

Patients can obtain three-dimensional imaging through medical computer tomography and conebeam
technology at Carolina OMF Imaging. Images produced by these means provide radiographic views in any
direction as well as three-dimensional volume renderings. Using this three-dimensional data, SimPlant
uses implant icons that are manipulated on two-dimensional and three-dimensional images to orient the
implant before the surgical procedure. Finally from this treatment plan, a prosthetic device with guided
sleeves orients the operator during preparation of the hard tissue for implant placement.

In short, Materialise has produced software called SimPlant to provide implant placement planning using
conebeam technology images and surgical guided prostheses to safely place dental implants. The following
provides examples of how this process is accomplished.

First, three-dimensional information is acquired from the patient using either medical computer
tomography or conebeam technology (Carolina OMF Imaging uses conebeam technology) in the form of
Digital Imaging and Communications in Medicine (DICOM) data. Figure 1 is an example of a panoramic
image created using conebeam technology.

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Figure 1. Panoramic image created using conebeam technology.

This data is converted to a format using SimPlant software called SimPlant Master. [Carolina OMF
imaging will do this for you.] The imaging data is then placed on a CD for the dental implantologist to use
on his or her computer to place implant icon(s) onto the two-dimensional and three-dimensional images.
Implants from different manufacturers can be chosen, quality of bone can be detected, and marking of the
mandibular canal are just a few of the many features of this software. Please contact Carolina OMF
Imaging for a demonstration of the potential of this software. Figure 2 is an example of the SimPlant
environment.

Figure 2. SimPlant planner environment.

Once the implant treatment plan is completed, plaster models of the patient’s dentition and a copy of the
treatment plan are sent to Annapolis, Maryland where Materialise will fabricate prostheses with the
appropriate metal sleeves to create the openings in the hard tissue to receive the dental implant(s). The
term used by Materialise for this prosthesis is called a SurgiGuide. As shown in Figure 3, SurgiGuide can
be a tooth-borne, tissue-borne, or bone-borne prosthesis to be used during surgery.
Figure 3. Diagramatic representation of SurgiGuide types.

Figure 4 is an example of SurgiGuides to be used for placement of five dental implants. Notice that each
SurgiGuide has a different diameter sleeve.

Figure 4. SurgiGuide Stents.

The following four figures (Figure 5, 6, 7, and 8) are examples of a surgical procedure using a tissue-borne
stent to place dental implants using SurgiGuide. Remember, a three-dimensional scan of the patient,
treatment planning using SimPlant Planner, and creation of the SurgiGuide stent has taken place before the
surgical procedure.

Figure 5. Preoperative view of implant placement of the anterior maxilla.

Figure 6. Gaining surgical access to the maxilla.

Figure 7. Preparing access through the SurgiGuide.

Figure 8. Placement of healing abutments.

The following figures (Figures 9, 10, 11, 12, and 13) demonstrate surgical placement of dental implants
using the tissue-borne SurgiGuide without reflection of the soft tissue.

Figure 9. Preoperative view of the edentulous maxilla.

Figure 10. The SurgiGuide is placed over the edentulous ridge and preparation of the implant access is
created directly through the gingiva.
Figure 11. This is an example of a tissue-borne SurgiGuide using "tacking screws" to keep the SurgiGuide
in place.

Figure 12. The dental implants are placed in each access opening.
Figure 13. Healing abutments are placed.

Please call and visit Carolina OMF Imaging for further discussion on how this technology can benefit
you and your patients for successful dental implant experiences.

Phone: (919) 534-7000

Radiographic imaging courtesy of Carolina OMF Imaging

Clinical images courtesy of Dr. Vrielinck