Treatment process starts with careful diagnostics and planning the final version of a prosthetic reconstruction. The main assumption of the entire treatment with implants is fabricating a prosthetic reconstruction screwed onto implants. According to current literature, this solution is most beneficial for patients in biological terms as it decreases the risk of possible peri-implantitis.
The majority of clinical situations, which happen to implantologists all over the world while they engage in implant procedures, involve bone atrophy. It is associated with natural processes of bone resorption that appear with age, and accelerated resorption after teeth loss. Often, the amount of residual bone, despite the atrophy, is sufficient to place a dental implant. However, in most cases the angle of implant placement makes it impossible to perform a screw-on work. At implant prosthetic stage, an implant is cemented. Current literature shows that peri-implantitis is a serious problem. Most of the cases involve cement, and to be more precise, cement retained in the area around the implant that causes inflammation, bone atrophy, and in consequence, a premature loss of the dental implant.
The above-described complications do not regard screw-retained implants, which require dental implants to be ideally positioned at surgical stage, and consequently, a sufficient volume of osseous tissue to achieve that.
Diagnostic procedures and design
During the first stage, a design of future screw-retained prosthetic reconstruction is prepared. Diagnostics involves:
- CT scans of osseous tissue at sites of the planned implant prosthetic reconstruction performed with CS 8100SC 3D system;
- Intraoral scan of the prosthetic base with CEREC – AC Omnicam Connect intraoral scanner;
- Taking intra- and extraoral photos with specialist photo equipment;
- If needed, conducting neuromuscular deprogrammation with the Kois Deprogrammer, made in our on-site laboratory in order to determine the so-called CR – centric relation in temporomandibular joints.
All obtained data is used to create a design of the future screw-retained implant prosthetic reconstruction. The first stage involves a wax design (link do wax up) and an implant template made from acrylic or PMMA. Both the wax design being a prototype of the final reconstruction shape, and the surgical template with holes indicating sites for implant placement are made by using a special laboratory milling machine from CEREC, i.e. inLab MC XL. Holes in the template will correspond with holes in the final screw-retained prosthetic work. Their position will remain outside the visible, aesthetic zone. Final reconstruction design is of key importance already at the diagnostic stage in order to fabricate a screw-retained prosthetic work and position dental implants properly.
Thanks to these preparations, it is possible to place sites for implants in space, and determine proper angles of placing the implants. This technique is called Prosthetic-Driven Implant Planning, and its advantages are widely described in literature.
Determining amount, site, and angle of placing particular implants in the future screw-retained reconstruction at the diagnostic stage will provide necessary information with regard to the demand of osseous tissue constituting a bone bed for the placed implants. This data will be entered into Carestream Dental CBCT software, in which places of particular implants are plotted onto an existing osseous volume. Thanks to that, an analysis and determination of the demand for additional osseous tissue augmentation are possible.