Burkhardt Felix, Strietzel Frank Peter, Bitter Kerstin, Spies Benedikt Christopher
Int J Comput Dent. 2020;23(1):73-82.
Accurate implant placement in the bone is key to successful implant treatment. Once inserted, it can be difficult to correct the orientation of the implant axis, especially of a one-piece implant. Prosthetic-driven digital implant planning in combination with fully guided implant surgery can offer additional safety in such cases.
The patient presented with a wide, edentulous interdental space extending from sites 13 to 16, which was to be restored with three one-piece zirconia implants supporting a zirconia fixed partial denture comprizing a cantilever to the mesial aspect. Digital planning based on DICOM (Digital Imaging and Communications in Medicine) and intraoral surface data was performed to ensure optimal positioning. Guided implant placement was executed using a contra-angle handpiece with special attachments and a compatible, sleeveless drill guide. Impressions of the implants for the final restoration were acquired using an intraoral scanner. Reflection-related errors were compensated for by using the given digital abutment geometry. The DICOM and STL datasets were superimposed and used as the basis for fabricating a monolithic zirconia restoration through a subtractive milling process. The final restoration was adhesively cemented.
By using a prosthetic-driven implant planning strategy, it was possible to place the one-piece ceramic implants without an available implant manufacturer's guide-based solution. This was accomplished using a contra-angle surgical handpiece with special attachments and a compatible drill guide. This approach is particularly recommended for the placement of one-piece implants, which otherwise require irreversible abutment grinding for the adjustment of the implant axis orientation after placement. To increase the precision of the digital impressions of the implants, the ideal abutment geometry was imported and superimposed onto the scan data. The results demonstrate that the proposed method can dispense with the need for gingival retraction when acquiring impressions for implants of this type in the future.
在骨内准确植入种植体是种植治疗成功的关键。一旦植入，很难纠正种植体长轴的方向，尤其是一体式种植体。在这种情况下，修复驱动的数字化种植计划结合完全引导种植手术可提供额外的安全性。
患者存在从13至16位点延伸的宽大无牙间隙，拟用三颗一体式氧化锆种植体支持一个向近中侧有悬臂的氧化锆固定局部义齿进行修复。基于DICOM（医学数字成像和通信）和口内表面数据进行数字化规划，以确保最佳定位。使用带有特殊附件的弯机头和兼容的无套筒钻导向器进行引导种植体植入。使用口内扫描仪获取种植体的最终修复印模。通过使用给定的数字化基台几何形状来补偿与反射相关的误差。将DICOM和STL数据集叠加，并以此为基础通过减材铣削工艺制作整体式氧化锆修复体。最终修复体采用粘结固位。
通过采用修复驱动的种植计划策略，在没有种植体制造商基于指南的可用解决方案的情况下，也能够植入一体式陶瓷种植体。这是通过使用带有特殊附件的弯机头手术器械和兼容的钻导向器实现的。对于一体式种植体的植入，特别推荐这种方法，否则在植入后需要进行不可逆的基台磨削来调整种植体长轴方向。为提高种植体数字化印模的精度，导入理想的基台几何形状并将其叠加到扫描数据上。结果表明，所提出的方法在未来获取此类种植体印模时无需牙龈退缩。
