What Factors Determine the Stabilization of Implants in the Jaw Bone?
In the placement of a dental implant, the implant dentist needs adequate visualization at the implantation site in the jaw bone for both functional and esthetic success. However, the implant position is not guided just by the operator's visualization or tactile ability but also by accuracy during the placement. The most critical radiographic tool that serves the purposes of visualization and accuracy is the cone-beam computed tomography or the CBCT software.
With the advent and recent advances in computer-aided virtual design software, the dental surgeons can gain a clear understanding of three major crucial factors needed for the dental implant to be stabilized in the jaw bone:
-
The bone shape.
-
The implant selection according to the width and height after CBCT and preoperative implant assessment or treatment of remaining dental issues restoratively and prophylactically.
-
Implant placement design and study before the implant surgery.
What Are the Navigation Systems Used in Implant Positioning?
The main two types of computer-guided navigation systems that offer an advantage over manual implant surgery are:
-
Static computer-guided system.
-
Dynamic navigation systems.
A digital radiographic template or a surgical template as well is manufactured primarily taking the help of these computer-guided navigation systems before implant surgery. The dual advantage is that the computer-aided manufacturing technology or computer-aided design technology (CAD or CAM) provides both positional accuracies.
At the same time, implant placement is also associated with no risks during the surgical procedure of dental implantation, primarily because the safety protection is provided with this template that helps the operator understand depth control during placement into the jaw bone. Most operators prefer to use physical drill stoppers and the surgical computer fabricated template through these navigation systems to maintain influential implant positions and increase safety during the procedure.
According to recent modern implant dentistry research, the evidence is that the computer-generated guides fabricated this way are more accurate than the normal or the conventional surgical guides. As a result, these guided templates can increase the success of a dental implant placed correctly without risks after CBCT assessment and help the operator achieve their ideal prosthetic goals without any significant errors.
What Are the Benefits of Using a Surgical Template?
The CAD surgical templates have been successfully used for freehand operator-oriented implantation or computer-guided flapless surgeries. Any implant angular deviations can be avoided during the placement. Not only the accuracy of the implant position, but evidence shows that good patient factors that influence implant success like good maxillary stabilization, increased supporting area, and correct fixation of the surgical guide all are responsible for an implant to be accurately positioned in the jaw.
In the following clinical situations, these templates offer even better results:
-
Complex cases of alveolar bone defects.
-
In thin alveolar ridges.
-
Completely edentulous patients who require multiple implants for complete restoration and functionality.
-
Long-term edentulous patients in whom anatomic structures altered slightly over time (such as nerves, sinuses, or the thin bone of the anterior maxillary region) increase surgical difficulty without a surgical guide.
-
In grade 3 and grade 4 jaw bone, wherein the inserted implants need proper stabilization post-placement.
-
In patients with soft tissue defects or periodontal diseases, especially smokers, chronic alcoholics, etc.
What Factors Affect Implant Positioning and Fixation?
Though the debate on the freehand or manual operator method of dental implantation versus the computer-guided flapless surgical implant methods has been ongoing amongst researchers and implant dentists over the last few decades, in either of the forms or techniques adopted, it is essential to maintain the correct implant angulation during surgery. This depends upon the operator's tactile skills in freehand implantation post the study of the surgical area by CBCT and preoperative assessment.
The accuracy depends on two factors:
-
The deviation in the implant location.
-
The angular positioning of the implant.
Thus accuracy can be affected by various factors locally, such as the movement of the patient's head, which can result in more deviation than expected. Research shows that the gingival or the soft tissue biotype is significantly impacted in smokers. Smoking is not only associated with bone loss and peri-implant tissue inflammation or loss but also with long-term implant failures because of the thickened gingival biotype.
Similarly, in patients with limited mouth opening, poor salivary control, or in periodontally or systemically diseased patients where the blood field during implantation offers a lot of visual obstacles, it is crucial to eliminate these patient-related issues during the surgical procedure to guide the implant into its correct position as planned preoperatively.
Other factors are challenging clinically to the operator, especially more so in freehand implantation. The soft tissue thickness of the patient and the bone density at the implantation site are pivotal factors that influence an implant's integration, the drilling accuracy of the operator, and even the final position of the implant deviation.
Two different templates can be fabricated, namely:
-
Partial surgical template.
-
Total surgical template.
Though not many significant differences have been observed by clinicians using either of the templates, what matters to maintaining the correct implant position is the stability of the template during surgery. Some operators recommend using fixation screws that need to be tightened during the surgical procedure to maintain stability.
Conclusion
The surgical template design is focused upon as the primary key factor for guided implant placement, be it freehand or computer-guided. It has been frequently observed in clinical practice that coronal, apical, or angular errors that creep up during the procedure with the interplay of these various patient issues can be significantly lessened or limited to an extent with the use of the surgical template. Also, implant patients always need to be followed up by the implant dentist post-implantation for regular check-ups at three to six monthly intervals to help maintain dental implant health successfully in the long run.
