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Abstract
Surgical guide not only provide diagnosis and treatment plan, but even location and direction of implantation. Surgical guide could be divided into non-limited design, partially limited design, and completely limited design. Partially limited design is easily manufactured and inexpensive but less accuracy, compared to completely limited design. From this approach, partially limited design may be particularly effective in patients who present with a single missing tooth or partially edentulous teeth. Completely limited design is anatomically accuracy, esthetical and functional, optimized treatment for prosthetic and biomechanical perspective, and also minimizes discomfort for post-treatment. The purpose of this study is to review previous studies of various surgical guides and applying in clinic.
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Fig. 1.
Case of #22 implant placement using nonlimiting design surgical template. (A) Missing tooth of #22 was seen in panoramic view of pre-surgery. (B) Surgical template made by clear vacuum formed matrix on the cast. (C) Try in the template to the patient's mouth. (D) Implant was placed properly in panoramic view of post-surgery.
Fig. 2.
Case of implant placement on both side of maxillary molar by using resin stent. (A) The patient has maxillary partial edentulous molar area on both side, therefore treatment plan was set by four implants and fixed prosthesis. (B) Resin template was fabricated with cast and pouring resin. Put the template on the surveyor and drilling in the appropriate implant path with long shank round bur. (C) The implant drill hole was formed for appropriate path and direction. (D) Holes were filled with Gutta percha for CT taking. Appropriate direction and position for anatomical condition was checked by cone beam CT. (E) The stent was used as guide for drilling position and direction in implant surgery. (F) Four implants were placed in good direction and position on both side of maxillary molar area.
Fig. 3.
Case of implant placement in #22 by using thermo-plastic polymer guide (Dentium Thermo-plastic stent;Dentium Korea). (A) Left maxillary lateral incisor was missing and planned to treat with implant. For the stent making, cast model was drilled in appropriate position and direction and inserted guide pin. (B) Thermo-Plastic stent form before shaping. (C) Put the stent into hot water for shaping. (D) The polymer guide was made appropriately and applied onto plaster cast. (E) Position the polymer guide to the surgical site and drilling for implantation. (F) By using simply made surgical guide, the implant fixture was placed in well direction and position.
Fig. 4.
Case of full maxillary rehabilitation by implants with Nobel Guide Surgical Kit (Nobelbiocare, USA). (A) Because of severe chronic periodontitis, all remaining maxillary teeth were planned to extract. Rehabilitation of maxillary defect with eight implants and fixed prosthesis was planned. (B) Conventional resin template was made. The patient was delivered template, and taken panoramic radiography and cone beam CT for the position and direction of implant placement. CT images was loaded by NobelGuideTM software and reconstructed on 3D. The diameter of fixture and position of implant placement was decided by using remain bone and noninvasion of anatomical structure. (C) NobelGuide stent which is set the position and direction was made by analysis results. (D) Locate the surgical stent using surgical index. Stable the stent with anchor pin. (E) Tailored drill guides are available for each drill diameter to lead the guided drills through the surgical template. (F) Eight implants were placed in maxilla by using NobelGuide stent with flapless surgery. (G) Implant coping was inserted for prosthesis making, taken panoramic radiograph and impression. (H) Maxilla was rehabilitated by implant supported fixed prosthesis.
Table 1.
Classification of Guide template
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