It’s not an exaggeration to say that digitization is driving recent changes in trend in dentistry. To realize digital dentistry, a clinic needs an intraoral scanner to generate data, a 3D printer, a milling machine, and so on. In line with the recent rapid dissemination of intraoral scanners, various clinical techniques based on intraoral scans have been introduced to the fields of prosthesis and restoration as well as implants, and their use in clinical practice continues to expand. In this article, we are going to discuss digital guided implant surgery using intraoral scanners.
The field of digital dentistry has been mostly focused on the restoration sector, but in the implant sector, digital guided implant surgery is widely used for both prosthetic restoration and in the surgical stage. In the workflow for applying digital guided implant surgery in the clinical setting (Figure 1), a CBCT digital image is taken to obtain three-dimensional information of alveolar bones and teeth, and either a conventional impression is taken or an intraoral scanner is used to obtain information regarding the appearance of the teeth and gingiva. Then, the DICOM file of the CBCT and the STL file of the surface scan data are merged in a planning program. After establishing an implant placement plan, the surgical stent, a device that guides drilling and implantation as planned, is designed and manufactured.
Figure 1. Workflow of Digital Guided Implant Surgery
Impressions may be taken to obtain information on the appearance of the teeth and gingiva, but intraoral scanners can be the solution to deformations of impressions and errors in modeling.
Figures 2-6. An initial photograph of a digital guided implant surgery patient, scan files using an intraoral scanner, and planning for digital guided implant surgery. Surgical stents, custom abutments, and temporary crowns were created based on scan data.
Figures 7-10. After the extraction of upper central incisors on both sides using a digital guided surgery system (MegaGen R2GATE), 2 implants were placed and immediate loading was carried out using a PMMA bridge and zirconia abutment prepared in advance.
Figure 11. Clinical photograph after 12 weeks after surgery. No gingival recession was found after digital guided surgery using flapless method.
Figure 12. Clinical photographs after setting the final prosthesis. The final prosthesis was manufactured after obtaining impressions at the abutment level.
As seen in the above case, the guided surgery was carried out exactly as planned and the attachment of pre-made temporary crowns was made easy thanks to the reliable accuracy of scan data using an intraoral scanner.
Medit has recently released a wireless intraoral scanner. Maintaining the performance of its existing intraoral scanner in a wireless form has many advantages in a clinical setting. When scanning for guided surgery, limitations in scan rage due to movement restrictions of wired intraoral scanners were overcome by moving the equipment. Wireless intraoral scanners have the advantage of being free from such restrictions. This especially stands out in case of hypermobility of the remaining teeth in the scan area.
Figure 13, 14. Immediate implant placement via digital guided surgery after maxillary and mandibular anterior extraction was planned for a patient suffering from tooth mobility in the maxillary and mandibular anteriors. Using Medit’s wireless intraoral scanner made it easy to scan hypermobile anteriors.
Figure 15, 16. Panorama after surgery and clinical photograph after application of temporary teeth. Implants for the maxillary and mandibular anteriors were placed as planned and the long span temporary teeth, manufactured based on scan data, are well-fitted.