3D Implant Planning: A Case Study

According to the Centers for Disease Control and Prevention (CDC), 42.2% of adults 30 years or older had total periodontitis in the United States. Periodontal disease is the main cause of tooth loss in adults. Rehabilitating patients suffering from tooth loss has many options. Fixed implant-supported restorations are one of the leading treatment options that offer significant improvements to the lives of those suffering from tooth loss.

SMART 1 Cementable

Implant-supported fixed restorations begin with careful planning and require successful implant placement. Ideal implant placement ensures both successful esthetic and prosthetic outcomes.

The use of three-dimensional (3D) implant positioning software has made a significant impact on providing proper implant positioning. These programs help with preoperative planning by taking into consideration both functional and prosthetic parameters leading to successful implants.

A 3D map can then be transferred into the form of a surgical guide to be used at the time of surgery to ensure proper implant positioning, including depth and angulation.

A surgical guide can provide the following:

In the case of fixed implant-supported restorations, the planning and placement of implants have an improved outcome over traditional freehand dental surgical procedures.

Case Study

The following case presented with the patient showing signs of periodontitis (see above image). The dental exam ultimately revealed that the patient needed complete extraction of her natural dentition. It was decided that this patient would benefit from implant-supported fixed restoration.

The treatment plan involved placing 12 fixation Surgikor implants. This would entail six implants in the maxilla and six implants in the mandible.

An implant guide for both the upper and lower implant placement was created by Dr. Aaron Paz using Surgikor’s scan implant guide. This requires the use of a cone-beam computed tomography scan (CBCT) of the patient.

This data is used to provide the best possible positioning of the implants both in terms of the patient’s oral anatomy and the restorative plan. Each detail is designed in the 3D implant positioning software, including the implant’s location, depth, and angulation.

The design software created a virtual 3D model of both the maxillary and mandibular arch.

Once the treatment and design were approved, the surgical guide was fabricated. The surgical guide is produced using a 3D printer. The guide is made from a photopolymer resin. Titanium drill sleeves are placed manually into the guide, which will have an adaptation area that is unique to the patient’s oral anatomy.

With the case designed and the guide produced, the next step is to perform the surgery. Dr. Sam Harouhi performed the surgery using the surgical guide. Multi-unit abutments were placed using extensions to verify the angulation (see image below).

Immediately following surgery, the case was digitally scanned using scan abutments. This scan was then sent to Burbank Dental Lab for fabrication of a PMMA temporary fixed implant-supported restoration. The PMMA temporary was returned for insertion within 48 hours.

PMMA (polymethyl methacrylate) Temporary

This case was done using a digital workflow. The PMMA temporary was designed according to the treatment plan and characterized to ensure the esthetic criteria for this case were met.

PMMA restorations from Burbank Dental Lab provide the following benefits:

Implant-Supported Restorations

The next step for a case like this is to fabricate a final implant-supported prosthesis. This further ensures a stable long-term solution to the patient’s tooth loss. The benefits of fixed implant-supported restorations include:

In addition, there are other options to evaluate when deciding on restoring the final implant-supported case.

The other restorative options include:

SmartComposite Hybrid

• Easy to polish and repair intraorally
• When compared to acrylic, the composite hybrid is less likely to chip
• Lightweight
• Wears at about the same rate as a natural tooth
• Very durable

ZIRMAX M

• Zirconia offers the strongest option
• Zirconia is the least likely to chip of all the materials
• Patients often remark that this feels the most like natural teeth.
• Well over ten years of clinical success

Porcelain fused to metal hybrid

• This is the most expensive option
• Offers the best esthetics
• Is the most versatile of the options
• Requires the least vertical of any other hybrid option.

This case had a great result and provided the patient with much-needed improved oral health. Her smile was improved, as was her overall ability to function. Guided surgery offers superior implant results. The implants are placed with precision, eliminating the chances of causing damage to facial structures.

Burbank Dental Lab has completed thousands of fixed implant-supported restorations. Call or chat with us today regarding your next implant case.

Burbank Dental Lab would like to thank Pinhas Rahav of Surgikor Implants for the photos and notes for this case study.