Dental Implants

Computer guided treatment planning and

implant placement

John Beumer III DDS, MS

Allesandro Pozzi DDS
Robert Faulkner DDS
Division of Advanced Prosthodontics, UCLA
This program of instruc1on is protected by copyright . No por1on of this
program of instruc1on may be reproduced, recorded or transferred by any
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storage or retrieval system, without prior permission.
Computer guided treatment
planning and surgery
Computer guided planning and surgery
Computer guided treatment planning will be the
standard of care within the next few years
Computer guided planning and surgery
Deni1on selec1on of implant sites and placement of
dental implants employing surgical templates
developed with CBCT scans and soCware programs.
Free hand drilling
Previous method

Free hand drilling uses the

template to iden1fy the posi1on
of the implants.

The clinician decides the

angula1on and depth of the
osteotomy prepara1on.
Disadvantages of free hand implant placement
Catastrophic
mistakes
made in
posi1on and
angula1on
Misaligned implants Implants posi1oned interproximally

Labially inclined implants Buccally inclined implants

 Advantages of computer guided
treatment planning and surgery
Visualize poten1al implant sites in 3D in rela1on
to the proposed prosthesis
Precise implant placement
Less risk of compromising adjacent vital
structures
Prefabrica1on of the prosthesis, abutments and
immediate loading
Enables apless surgery
 Advantages
Visualize poten1al implant sites in 3D
in rela1on to the proposed prosthesis
 Advantages
Enables apless surgery
Less postsurgical morbidity (pain, swelling etc.)
Advantages
BeSer implant distribu1on
paSern for more favorable
biomechanics
 Advantages
Select an implant of proper Length and diameter
 Advantages
Precise implant placement
Implants can be precisely
placed in tooth posi1ons as
opposed to interproximal
posi1ons
 Advantages
Less risk of compromising
adjacent vital structures
Inferior alveolar nerve
Branches of the lingual
artery

Courtesy Dr. N. Barakat

 Advantages
Less risk of compromising adjacent vital structures
Maxillary sinus
Anterior pala1ne foramen
 Advantages
Prefabrica1on of the abutments, prostheses
 Computer guided implant placement
Two types
Fully guided surgery - implies that the surgical
templates with their drill sleeves (bushings) control
the posi1on, angula1on, diameter as well as the depth
of the implant osteotomy sites
Computer guided planning and surgery
Indica1ons Fully
guided approach
Edentulous pa1ents

 Fully guided implant placement
2 Piece surgical template

Provides more exibility during placement of the

implants-soC 1ssue manipula1ons, bone graCing etc.
 Fully guided implant placement
2 Piece surgical template

Used to
Ensure the implants are perfectly parallel to one another
Perform the desired alveoloplasty prior to implant placement
Computer guided planning and surgery
Fully guided approach
Used less frequently in par1ally edentulous
pa1ents
Lack of mesial distal space
Lack of interocclusal space

 Computer guided planning and surgery
Fully guided approach
Used less frequently in par1ally edentulous
pa1ents
Lack of mesial distal space
Lack of interocclusal space
Disadvantageous when bone or soC 1ssue graCing is
necessary
Verica1on and altera1on of apical coronal posi1on is
dicult

 Disadvantages
Lack of exibility during surgery
SoC 1ssue and bone graCing is more dicult
Coronal - apical posi1on is dicult to visualize
and control
 Computer guided implant placement
Two types
Semi-guided surgery - employs the same treatment planning
soCware programs as fully guided surgery, but the drill sleeves
(bushings) incorporated within the surgical templates are designed
to accommodate the 2-3 mm twist drills and as a result, control only
the posi.on, and angula.on of the ini)al osteotomy.
 Computer guided planning and surgery
Indica1ons - Semi-guided approach
Par1ally edentulous pa1ents
Posterior quadrants with limited interocclusal space
The esthe1c zone
Apical - coronal posi1oning and
angula1on is cri1cal
Permits bone and soC 1ssue graCing

 Semi-guided implant placement
When soC 1ssue procedures or bone graCing are
an1cipated during surgery
Pa1ents with thin periodontal biotype frequently
require soC 1ssue supplementa1on and bone graCing
 Semi-guided implant placement
When exibility is required during surgery
The esthe1c zone
Apical coronal posi1oning
GraCing
Combined fully guided and semi-
guided implant placement
 Combined fully guided and semi-
guided implant placement
Posterior implants placed with fully guided approach
Anterior implants placed with a semi-guided approach
 Combined fully guided and semi-
guided implant placement
The 1lted implants were placed using fully guided technique
The anterior implants were placed with a semi-guided
technique
Fully guided or semi-
guided approach?
Interocclusal space
Mesial distal space
The need for bone or
soC 1ssue graCing
 Issues to consider
Interocclusal space Limited mesial distal space

Requires a minimum of 40
mm in the anterior region
vVisit ofr.org for hundreds of
addi1onal lectures on Complete
Dentures, Fixed Prosthodon1cs,
Implant Den1stry, Removable
Par1al Dentures, Esthe1c Den1stry
and Maxillofacial Prosthe1cs.
vThe lectures are free.
vOur objec1ve is to create the best
and most comprehensive online
programs of instruc1on in
Prosthodon1cs
v Visit ofr.org for hundreds of
addi1onal lectures on
Complete Dentures, Implant
Den1stry, Removable Par1al
Dentures, Esthe1c Den1stry
and Maxillofacial Prosthe1cs.
v The lectures are free.
v Our objec1ve is to create the
best and most comprehensive
online programs of instruc1on
in Prosthodon1cs