Why Is the Location of Dental Implants Crucial?
To obtain the best possible esthetic results for dental implants, the most crucial factor that is considered by the dental implantologist or a maxillofacial surgeon is that of placing the dental implant at the accurate location or the exact site of implantation in the jaw. This location as well as the bone width, density, and surgical template guide fabrication is done by the dental operator or implantologist before the implantation procedure through a thorough pre-operative assessment or evaluation of the patient. Further, the patient's local and systemic risk factors also are considered by the operator, to obtain the best functional results and by exercising caution to prevent possible complications both during the implant surgery and post-operatively.
Hence it can be said that one of the first considerations by the dental operator is regarding the implant position that would tend to have a significant impact on the patient's esthetics. Further patients would also have their own esthetic expectations from dental operators, from the procedure of dental implantation. In the case of anterior implants that are a major influencer of the patient smile line and gingival display to some extent, esthetics are of utmost importance to some patients, for which the dental operator takes several precautions and instructs the dental laboratory or the prosthetic technicians to fabricate the esthetic smile line needed.
How Can Implant Position Be Determined?
Ideally implant position is always determined by the operator and the dental technician pre-operatively, in the traditional diagnostic cast method. A diagnostic cast is fabricated through a wax-up. However, these traditional wax-up and diagnostic cast methods for analyzing the patient's jaw preoperatively had a few drawbacks such as a lack of information about the patient's bone volume or density. However, over the last three decades, with the advent of three-dimensional or 3D imaging techniques such as cone-beam computed tomography (CBCT) systems, it is easier for dental operators to preoperatively study, analyze, and then obtain the ideal prosthetic parameters for the dental implant patient.
For example, in the traditional diagnostic wax-up methods, the dental implant specialist or surgeon would not usually be able to decipher the exact anatomic information about the patient's soft tissues. With the CBCT radiographic imaging techniques that can give a sectional and in-built detailed analysis of the area to be implanted pre-operatively, the operative work becomes easier for dental implant specialists because detailed information exists about the patient's hard and soft tissues at the region of dental implantation.
The most recent development in implant dentistry currently over the last few years is the ascent of computer-assisted template-based dental implants. Computer-assisted templates have become increasingly popular as a pre-operative means for both analyzing and determining the exact implant position for the operator to deftly place the implants. Further current research associates computer-based templates with a higher dental implant success both in terms of favoring osseointegration or bone implant fusion (BIC) as well as in facilitating prosthetic success. Research also shows that compared to traditional wax up and diagnostic casts that are used to study and analyze the patient cast preoperatively, through the advent of both CBCT as well as computer-assisted surgical templates for dental implants, patients have reported greater esthetic satisfaction post-implant surgery.
Who Is Contraindicated for Computer Guided Template Based Implants?
Patients who are generally contraindicated for oral surgery, as per the information given by the American Society of Anesthesiologists (ASA) include:
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Patients who have a history of irradiation in the head and neck area less than one year prior to the dental implantation.
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Patients who may be suffering from psychiatric problems.
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Patients with a history of alcohol or drug abuse.
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Pregnant and nursing patients.
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Individuals with a history of untreated periodontitis (swelling in the gums).
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Individuals with poor oral hygiene or motivation.
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Patients who are immunocompromised or systemically debilitated, may not be able to follow up with the dental implantologist or operator.
What Are the Steps Included in Computer Guided Template Based Implants?
Technological developments have completely changed the procedure of implant implantation using computer-guided templates. Using DICOM data from CBCT or CT (computed tomography) scans of the patient's jaw is one such innovation. After that, these pictures are transformed into stereolithographic files (STL), which may be created using anatomical information or intraoral scans. As an alternative, optical scans of dental casts that were traditionally produced in clinical settings can also be utilized for this reason. By converting the STL files, surgical guides are produced precisely using high-resolution 3D printers and contemporary CAD-CAM technologies, such as stereolithography. Dental implant implantation is made easier by the precise fit of these guides within the patient's mouth. The surgical template that was preoperatively developed is stabilized in the patient's mouth by the dental implantologist during the surgery.
This guarantees that the teeth implantation procedure will take place properly. The implantologist can precisely install dental implants in the jaw by using the surgical template as a guide. This will produce the best results in terms of placement accuracy and patient happiness. These technological developments improve patient experiences and clinical results in addition to increasing the effectiveness and precision of the implant insertion procedure.
Conclusion
The accuracy of a computer-guided template-based implant usually depends firstly on the data acquisition of the patient's hard and soft tissues. Then the surgical guide for implant osteotomy drilling would be fabricated, approximately locating the site of implantation pre-operatively. It is to be noted that not all dental patients or edentulous patients would be suitable cases for dental implants. Even though these are gold-standard prosthetic replacements close to the natural teeth in terms of both functionality and esthetics, there are certain exclusion criteria for individuals who can get dental implants. Further, the same would be applicable even if the challenging edentulous patient is getting their implant rehabilitation by the operator, but they would not be suitable or eligible for computer-assisted template-based implant placement.
Rather in such complicated cases, if the patients opt for dental implants, the dental operator or implant specialist would instead opt for the traditional flap surgery technique that gives direct access to the site of implantation.
