Implantology with a three-dimensional offline-navigation system is performed in this video by Professor Markus Hürzeler, Munich/Germany. He shows an implant insertion in the lower edentulous jaw with immediate provisional loading. The precisely fitting surgical navigation template with 5 millimetres guidance tubes guarantees a safe and ideal prosthetic implant placement due to the virtual set up and backward-planning on the computer according to a radiographic computerized tomography (CT) scan.
A radioopaque and precise LEGO stone as reference marker integrated in the radiographic template is required for the referencing of the software with the data. The snap block enables the precise calibration of the computerized implantation system. Guttapercha markers are inserted in the radiographic template as a three-dimensional reference for the planning software and the correct spatial relationship during the implantology procedure. A crestal incision with one vertical midline incision to release the tissue is carried out in the keratinized gingiva being split in a mucoperiosteal full-thickness flap to the buccal and lingual side. The preoperative CT-diagnostic and the 3D-planning software on the computer enable a minimally invasive elevation of the soft tissue with less postoperative discomfort and complications due to a shorter healing time.
The edge of the crestal bone is grinded down in the frontal region without losing the distal stabilisation of the template setting. The drilling direction and the depth are applied according to the surgical template holding the virtual planning information and transferring the implant position to the surgical site. The insertion direction of the pilot bur is determined through the guide sleeves in accordance to an ideal prosthetic implant positioning. Free-handed surgery is performed with the dental implant drill increasing the width of the implantation bed. 5 Implants are placed with supra-crestal position on the buccal and infra-crestal position on the lingual side.
The implants are inserted with a low torque of 40 Ncm on the total measured length under avoidance of any pressure. The implantology procedure takes place without water cooling for a good blood supply in the implant bed for optimal osseointegration. The last implant on the left side presents no primary stability. Due to that the immediate loading protocol of the implantology procedure is changed intraoperative. Hürzeler gives advices how the primary stability can be accomplished in such cases and how the pre-made provisional restoration can be integrated and placed after all. Gore-Tex sutures are stitched around the prosthetic abutments before provisionalisation and nodded meticulously for optimal approximation of the wound margins due to a better healing outcome.
See more examples with guided implant surgery for safe and predictable treatments on Dental-Online-College in the category Implantology.