Predictable Precision Implant Placement Using Dynamic Surgical Guidance: a Five-month Follow-up - Case study
The following case was performed at the Pacific Dental Convention’s Live Surgical Stage held March 8th, 2018 in Vancouver, BC.
Tooth number 46 had a root canal treatment that was restored with a full gold crown. The patient presented with a fistula in the buccal furcation region. Upon probing, depth was greater than 10mm and a PA of the area showed a lesion from the apical third of the mesial root up to the furcation. Clinical and radiographic findings were consistent with a root fracture.
The following treatment options were discussed with the patient:
- Extract tooth #46 and place an immediate implant if: bony socket is healthy AND primary initial stability is achievable.
- Extract tooth #46 and develop the site for future implant placement: socket debridement grafting, and develop soft tissue zone of keratinization.
It was also recommended to have implants placed in sites 46, 47, and 36 to allow for bilateral posterior rehabilitation and function. Five months prior to the Live Surgical Stage, tooth number 46 was atraumatically extracted.
By using real-time surgical navigation and pre-planning the ideal implant position with the final prosthesis in mind, we are able to predictably position the implant atraumatically with proper positioning for both function and aesthetics. As well, surgical time is reduced, which is always positive for the patient. With real-time surgical navigation there are no surgical guides and irrigation is managed in the same fashion as with conventional free-hand surgery. Therefore, implant preparation is predictable and prepared in a precise manner, feeling the bone quality throughout the procedure.
During the fourth month post-extraction appointment, a CBCT scan was taken using a fiducial. The fiducial is a marker used to register the patient’s position within a 3D planning software. The planned case is used in conjunction with Inliant, a real-time surgical navigation system (the system consists of a fiducial, planning software, computer, surgical grade monitor, handpiece and cart).
Using the Inliant System allows the clinician to see the drill’s position (large green dot in the centre of the target), angulation (smaller white circle in the middle of the large green dot) and depth (green stem seen under the target) while preparing the implant site, visualized on a monitor, all in real-time. Following the live surgical presentation, a CBCT scan was taken with the patient wearing the same Inliant fiducial used for the pre-op surgical scan and surgery. This allows for the comparison of the implant placement against the actual pre-operative 3D plan.
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