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CE - Computer Guided Small Implants 11/19/09

IMPLANT PERIODONTAL LECTURE SERIES Part III  
          Utilizing Small Diameter Implants and Computer Guided PrecisionThree-Dimensional Implant Placement in the Lower Anterior and Lateral Spaces and for Temporary Retention
 Kenneth Abe, D.D.S.


Date:          November 19, 2009

                  C.E. Units 3.0     Hilton Garden Inn, 840 East El Camino Real, Mt. View CA 94040


Recently there has been increasing interest in CT three-dimensional implant diagnosis and placement. Dr. Abe has been using computer guided precision three-dimensional implant placement on virtually all implants since 1993.  He also has been placing implants flaplessly on virtually all implant patients since about 1995. The advantages and importance of three-dimensional implant diagnosis for long and short term success will be reviewed. Some surgeons use CT or tomogram computer planning but do not directly transfer it to the patient clinically. It was once said that “the most brilliant treatment plan is useless unless it is carried out clinically.” The need to link what is planned on the computer to placing the implant in the mouth is critical. Dr. Abe will review different computer guided implant placement systems along with their advantages and limitations

The mandibular anterior and maxillary lateral areas are traditionally the most difficult areas to place implants. Until recently the size discrepancy between the smallest implants, the size of the roots and the limited space available have been a major problem  This size discrepancy results in aesthetic compromises or prevents placement. As a result, the mandibular anterior area is traditionally restored with an implant supported bridge. The space limitations of the area forces placing implants too close together to allow for integration. The limited space in the maxillary lateral and mandibular spaces, also frequently prevents implant placement in single spaces for the same reasons. Small diameter implants have solved these problems.

 


                               

    Pre-Extraction               Extractions-Immediate Small Diameter Implants Placed     Separate Crowns Placed


Until recently, the smallest diameter implant available was 3.25mm. Small diameter implants are defined as implants with diameters smaller than 3.25mm.  Small diameter implants have allowed placement in areas of limited space. In the lower anterior region even small diameter implants frequently cannot be used to replace teeth “tooth for tooth”. An innovative approach has now solved this problem. The combination of precision CT guided implant placement and Zimmer angled and straight small diameter implants allows replacement of the lower anteriors with 4 separate independent implants rather than an implant supported bridge. They are easier to restore and allow the patient to floss normally, making maintenance easier. They is also superior aesthetically, avoiding the fused “tombstone” look of bridges due to the need to place one and a half teeth on each implant abutment. Small diameter implants also can be used for single tooth replacement, in the lower anterior and maxillary lateral areas, which will have an emergence profile equal to the natural teeth.

The use of mini-implants (implants less than 3mm in diameter) can be used as temporary anchorage for intern restorations while implants and site preparation occurs. This allows for patients to lead a normal life without compromising esthetics during treatment. Cases will be reviewed utilizing these mini-implants for temporary retention and small diameter implants in areas of limited space.