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CERECDOCTORS.COM
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QUARTER 1
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2014
Fig. 1: Preoperative panoramic
radiograph
Fig. 2: Preoperative clinical view of
the hopeless maxillary dentition
Fig. 3: Guided surgery treatment plan-
ning in Invivo Anatomage software
Fig. 4: Surgical guide fabricated by
Anatomage
the conversion of a patientwith a
hopeless dentition in one or both arches
to a patient with an implant-supported
reconstruction can pose significant
challenges for the involved clinician(s).
These challenges can be partially
addressed by precision in implant place-
ment via a guided implant surgery
approach, which accurately transfers
the pre-operative planning and pros-
thetically driven implant position to the
surgical field. The result is a less inva-
sive surgical procedure with a more
predictable outcome. The tooth-mucosa-
supported guided surgery technique
with sequential extractions and the
mini-implant supported guided surgery
technique are two such techniques and
are highlighted with corresponding case
examples in this, the second part of an
article series on the subject.
INTRODUCTION
Replacing missing or hopeless teeth
with dental implants is a highly
effective and predictable treatment
modality. And, implant-retained recon-
structions are considered the ideal
type of restoration for fully edentulous
arches. However, the conversion of a
hopeless dentition to a functional and
esthetic implant-supported reconstruc-
tion remains clinically challenging.
This clinical challenge is related to the
complexity of the surgical and restor-
ative procedures necessary to overcome
the pre-existing or developing alveolar
ridge atrophy and the loss
of occlusal stability with
the
often-accompanying
loss of the vertical occlusal
Guided Surgery in
Fully Edentulous Cases
Part II: The Hopeless Dentition
C A S E S T U D Y
| | |
B Y FA R H A D E . B O LT C H I , D . M . D . , M . S .
dimension. This loss of landmarks can
result in the surgical difficulty to achieve
a correct, three-dimensional position of
the implants in the alveolar ridge as it
relates to the correct prosthetic position
of the implants.
Part I of this article series outlined
how the utilization of advanced digital
and imaging technologies, coupled
with guided implant surgery, can lead
to predictable outcomes in the treat-
ment of severely atrophic, fully edentu-
lous arches with dental implants. The
second part of this article series will
highlight two different guided surgery
techniques, which allow the accurate
placement of dental implants in relation
to the desired final prosthetic outcome
in cases requiring the conversion of
a hopeless dentition to an implant-
supported reconstruction.
CASE STUDY 1:
TOOT
H-MUCOSA-SUPPORTED GUIDE
WITH
SEQUENTIAL EXTRACTIONS
This p
atient is a 64-year-old female with
a lon
gstanding history of a neglected
and fa
iling dentition. The initial clinical
and p
anoramic radiographic evaluation
reveal
edmultiple root tips in themaxilla
and m
andible (Figs. 1-2).
All
of the maxillary teeth, along with
the m
andibular root tips, were consid-
ered h
opeless. A preliminary treat-
ment
plan was devised to extract all of
the re
maining maxillary teeth and the
mand
ibular root tips with immediate
placem
ent of sixmaxillary implants. This
would
be coupled with immediate loading
of the
maxillary implants via a provi-
sional
screw-retained hybrid denture, if
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