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By Dr Luana O'Connor BSc Stomatology, MSc Implantology
September 2012

Multiple Implants with Dental Implant Template Guide and Sheutz Dental Impla 3D Software

Patient 'V', age 40, presented with an upper arch containing one remaining tooth, at position 14, a right upper pre-molar. When discussing the possible options with the patient we looked at the using of a denture. This was quickly set aside as the patient had issues with this type of prosthetic due to the following reasons: the patient has a severe gag reflex, the age of the patient meant long term there would be severe shrinkage of the bone adjacent to the denture, and dentures even when well placed can be uncomfortable. Finally the patient associated dentures with people much older than himself so I have to take into account the patients mental wellbeing.

Patient 'V' returned for a second consult after I suggested that the way to proceed would be for him to have five dental implants placed to be followed by a fixed prosthetic bridge. The patient agreed with this after considering the costs involved for him and the time required placing the implants with the prescribed six month waiting period before I can fix the prosthetic bridge.

When examining Patient'V's upper arch it became obvious to me that the placing of the dental implants would not be easy as the upper arch structure was damaged from previous root extractions which made the gum and underlying bone structure uneven and indicated that placing dental implants in the traditional 'blind' method would not be conducive to a successful operation. When discussing this with Patient 'V' I explained the ideal option was for us to use Sheutz Dental Impla 3D Software for the planning and placing of the five dental implants. I explained to Patient 'V' there would be an extra step in the process of getting the implants done but I knew with the use of Sheutz Dental Impla 3D Software we would achieve greater accuracy for the placing of the dental implants. This would also enable us to use a Dental Implant Template Guide (DITG) when actually placing the five dental implants with all the correct angulations and depths pre-decided before we even began the surgery.

The first step to using the Sheutz Dental Impla 3D Software is to create a CT Scan Template Guide (CTSTG). We took the impression of Patient 'V' upper arch and sent this to a Sheutz Dental approved lab for the creation of the CTSTG. We need the CTSTG to be in place in Patient 'V's' mouth when the CT Scan is done as the CTSTG has markers imbedded in it which will react differently when the CT Scan is done so when we get the results of the CT Scan we can input them into the Sheutz Dental Impla 3D Software and begin planning the placing of the five dental implants. This is the extra step that I explained to Patient 'V' would occur because if we were not going to use the Sheutz Dental Impla 3D Software we would not need the CTSTG to be created.

When I received the results from the CT Scan, on a CD and in a printed book format, I uploaded the CD information to my computer where the Sheutz Dental Impla 3D Software was installed. Once I combined the images with the Sheutz Dental Impla 3D Software I was able to begin the placement planning for the five dental implants and the ideal angulation to maximise the presented and suitable bone in Patient 'V's' upper arch. Once this process was finished I sent the Sheutz Dental Impla 3D Software plans for the five dental implants to the Sheutz Dental approved laboratory in Hungary for them to create the DITG.

The information I provided the laboratory with also included the diameter and depths of the proposed dental implants so the laboratory could create the right sleeve widths in the template. Once the information had been received by the laboratory I had a call from them to confirm that my placement plans for the dental implants was suitable and the DITG would be created and despatched back to me.

Upon receiving the Dental Implant Template Guide (DITG) from the Sheutz Dental approved laboratory I was able to see that the placing of the implants was as I had decided using the Sheutz Dental Impla 3D Software. When you receive the DITG the holes that have been milled by the laboratory seem overly large but the reason for this is that you have to place the correct sleeve that corresponds to the Sheutz Dental Implant you have chosen as the ideal dental implant for placement. Once you place the sleeves into the DITG you will find you are provided with the exact angulations and depth control that is required for the dental implants to be placed successfully in the patients mouth.

When using a DITG it is suggested, and I agree from experience, that the dental implant method that is used is the 'flapless' dental implant procedure. The DITG is created in such a way that if you resected the gum the DITG will not sit properly in the patient's mouth so you would not be able to place the dental implants correctly. Now placing dental implants using 'flapless' procedure was new to me but I would find that it would be extremely simple with the use of a DITG when performing the 'flapless' surgery.

The DITG was anchored into place by utilising the remaining tooth in the mouth of Patient 'V'.

Placing DITG

Then using an 'O' shaped scalpel and proceeding through the holes milled in the DITG I removed a circular piece of the gum through to the level of bone creating a clear and unobstructed access entry point for the dental implant to enter.

Tightening Sleeve In Situ

Once this was done I placed the correct sized sleeves into the holes milled into the DIG and began placing the dental implants through the sleeves which have holes for the dental implant to slide through. When placing dental implants in the traditional 'semi-blind' method you have to gauge depths and angulations by your own eye. When using the DIG this part of the dental implant procedure is removed from the dentist's purview as all the hard work had already been done in the pre-planning phase of the dental implant procedure. I found when using the DIG I was more confident when placing this many dental implants but I also discovered that the use of the DIG increased the rapidity of the dental implant procedure which is great for the patient.

Placing dental implant through the sleeve

When reviewing how the dental implant procedure went with Patient 'V' I came to the conclusion when placing multiple implants that will require them to rely on each other, as in this case they will anchor the prosthetic brdge, the use of Sheutz Dental Impla 3D Software is an essential tool for any modern clinician to be knowledgeable of. With the use of Sheutz Dental Impla 3D Software I was able to plan the placement of the dental implants with a higher degree of accuracy, have a DIG created which enable me to deliver the dental implants into the patient far more accurately and finally it has proven to be a reduced stress procedure for both myself and the patient.

Dental implants placed
I could see that the dental implants were placed with more accuracy than if they were placed in the traditional method. The time involved in the actual placing of the dental implants was shortened considerably which is great for the patient as it far less traumatic for them and their gums. I came away from the dental implant procedure feeling highly confident in the quality, accuracy and the safety of the dental implants.

When patients present with requirements for single dental implants' I think the use of a CT Scan for the clinician to use as a guide is suitable. When a patient presents requiring three or more dental implants that will rely on each other I feel the that Sheutz Dental Impla 3D Software will definitely enhance the placing of the dental implants from both the clinicians view and the patients'.

Finished smile with crowns placed. A whole new smile!

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