A modified surgical template with dual

function
Cláudia A. M. Volpato, DDS, PhD,a Diego K. Vasconcellos, DDS,
PhD,b Luis Gustavo D. Garbelotto, DDS, MSc,c Rafael Manfro,
DDS, MSc,d and Mutlu Özcan, DDS, DMD, PhDe
School of Dentistry, Federal University of Santa Catarina,
Florianópolis, Santa Catarina, Brazil; North Minas United
College/FUNORTE, Florianópolis, Brazil; Center for Dental and
Oral Medicine, University of Zürich, Switzerland
This article describes a modified the correct 3-dimensional (3D) posi- 2. Fabricate a clear plastic tem-
surgical template to guide the posi- tioning of the implant.6,7 plate in 2-mm thick, clear, soft ethyl-
tioning of an implant immediately After immediate implant place- ene vinyl acetate (Pro-Form; Dental
after tooth extraction and secure ment, an interim crown can provide Resources Inc, Delano, Minn) on the
the immediate placement of an in- patients with rewarding and rapid es- cast with the interim crown. Cut the
terim crown. The placement of den- thetic results. When an interim crown acetate sheet by following the buccal
tal implants immediately after tooth can be made by copying the emer- gingival contour. Keep the guide open
extraction is a popular treatment gence profile of a correctly located but on the palatal surface around the
option, which has been reported to hopeless tooth, it facilitates the main- crown to enable surgical access.
have high success rates.1-4 This tech- tenance of the postextraction gingival 3. Extract the tooth by using an
nique enables clinicians to shorten architecture, minimizing possible dam- atraumatic technique (Benex Control
treatment time and possibly pro- age to hard and soft tissues after tooth - Root Extraction System; Meisinger,
vide an interim crown at the time of extraction.8 However, it is important Düsseldorf, Germany) (Fig. 1). After
implant placement. In addition to to ensure that the interim crown does extraction, place the surgical guide to
shortening the surgical procedures, not contact the opposing dentition in direct the positioning of the implant.
the immediate placement and pro- maximal intercuspation or during ex- Note that the open palatal surface of
visional restoration of a dental im- cursive mandibular movements.9,10 In the guide will enable surgical access,
plant is purported to better preserve this article, a surgical guide that can and the buccal outline will assist prop-
the gingival and bone architecture, correctly guide implant placement as er 3D implant positioning (Fig. 2).
resulting in greater comfort and pa- well as the correct placement of an in- 4. After implant placement (Flash
tient acceptance.2,4,5 terim crown is described. 3.5 × 13 mm; Conexão, São Paulo,
However, successful immediate Brazil), attach the corresponding pro-
implant placement depends on sat- TECHNIQUE visional abutment to the implant to
isfactory patient selection, treatment fabricate the interim crown. Evaluate
planning, and atraumatic tooth ex- 1. Make stone casts of the maxil- whether adequate occlusal space ex-
traction. This enables adequate pri- lary and mandibular arches. Remove ists for the crown and the abutment.
mary stability and correct implant the tooth to be extracted from the If not, unscrew the component (Abut-
location in a site that has preserved cast and make an interim crown from ment 166211; Conexão) and shorten
the natural architecture of soft and heat-polymerized polymethyl meth- it. Condense a small piece (approxi-
hard tissues. For this purpose, surgi- acrylate (New Outline; AnaxDent mately 5 mm) of polytetrafluoroeth-
cal guides have been used to ensure GmbH, Stuttgart, Germany). ylene tape (PTFE; New Age Industries

a
Adjunct Professor, Department of Dentistry, Federal University of Santa Catarina.
b
Adjunct Professor, Department of Dentistry, Federal University of Santa Catarina.
c
Visiting Professor, Department of Dentistry, Federal University of Santa Catarina.
d
Chairman of Postgraduate Implant Dentistry, North Minas United College/FUNORTE.
e
Professor and Head, Dental Materials Unit, Center for Dental and Oral Medicine, University of Zürich.
(J Prosthet Dent 2013;110:232-233)
The Journal of Prosthetic Dentistry Volpato el al
September 2013
1 Atraumatic tooth removal.
3 Guide and interim crown.
Inc, Willow Grove, Pa) in the screw
hole to prevent acrylic resin from
sticking to the head of the screw.
5. Place the interim crown in the
previously fabricated surgical guide.
With a brush-bead technique, fill the
crown with colored autopolymerizing
acrylic resin (Duralay; Reliance Den-
tal Mfg Co, Worth, Ill). Position the
assembly intraorally (Fig. 3). Keep the
surgical guide in place until the acrylic
resin polymerizes. Then, remove the
acetate guide, access the abutment
screw with a round diamond rotary
instrument (H 261 E; Komet, Rock
Hill, SC), remove the crown, and cre-
ate the appropriate emergence profile
with acrylic resin (Duralay; Reliance
Dental Mfg Co).
6. Replace the crown to verify
whether the gingival architecture is
preserved. In the event of excessive
pressure, reduce the emergence pro-
file. Finish and polish (Acrylic Polish-
Volpato et al
233
2 Surgery assisted with guide.
4 Result after placement of interim crown.
er; Komet) the crown, especially in the 6. Schneider D, Marquardt P, Zwahlen M, Jung RE.
A systematic review on the accuracy and the
transmucosal area (Fig. 4). clinical outcome of computer-guided template-
based implant dentistry. Clin Oral Implants Res
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Corresponding author:
implants in the anterior maxilla: 3-year results
Dr Cláudia Ângela Maziero Volpato
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145 Prefeito Antenor Mesquita St
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E-mail: claudiamvolpato@hotmail.com
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2009;102:211-5.
Copyright © 2013 by the Editorial Council for
The Journal of Prosthetic Dentistry.