Complete Edentulism Treated with Flapless Computer Guided Implant Placement

Introduction
One of the most beneficial services available to the edentulous patient is the placement of enough implants to be able to have a completely implant supported prosthesis. The effectiveness and predictability of this type of prosthesis is well established in the literature and in practice throughout the world. In order to make the transition to a fixed prosthesis more convenient, same day conversion to a fixed temporary restoration can be utilized. This additionally avoids the potential damage of wearing a mobile removable full denture over the healing implants and the need for a second full arch surgery to uncover the integrated implants 4 to 6 months after placement. By placing 6 to 8 implants equally spaced around the edentulous arch, all of which have measurably good to excellent primary stability and by having the patient maintain a soft diet through the critical first 2 months of bone healing, the cross arch stability achieved with a temporary fixed prosthesis will be adequate to allow integration of the implants even under immediate loading.

With cone beam computed tomography (CBCT) and third party 3D software it is possible to perform flapless computer guided implant placement which offers many advantages including less bleeding, more predictability, less post-op discomfort, shorter surgery time and shorter healing time. Once the surgeon has done several computer guided placements utilizing flaps with high quality computer designed and generated guides, he/she will quickly understand that the accuracy of this computer guided approach overcomes the perception of this being a blind procedure. The surgeon visualizes the patient’s anatomy and proposBetics in advance using third party software from 3D Diagnostix Inc.
(3DDX) and places the implants virtually using the software. The surgical guide fabricated from this virtual plan by 3DDX will predictably put the implant in the exact location as designed in the software and, in this sense; it is not a blind procedure. This type of planning and surgery makes the overall treatment more predictable with implants placed in the most ideal prosthetic positions possible consistent with adequate boney support for the healing implants.
Case Study
By: Dr. Dwight Pate, D.M.D, PA

A 62 year old Hispanic male presents to Implant Educators for treatment of complete edentulism with implants in hopes of having a fixed prosthesis that eliminates palatal coverage. His medical history is significant for mild hypertension, hypothyroidism, high cholesterol and gout well controlled with amlodipine, levothyroxine, simvastatin, and allopurinol respectively. His also reports taking a prophylactic dose of 81 mg aspirin daily and denies history of any cardiovascular events.

His existing denture is well fitting with a good smile line and occlusal plane. These are important factors to consider when planning the conversion of an existing denture to an immediate fixed temporary. Not only will the temporary fixed hybrid be maintained in the same position as presented preoperatively in the denture, but the tissue surface of the existing denture will be duplicated in the fabrication of the guide by 3DDX; hence the fit of the guide is dependent on the fit of the existing denture. If the existing denture is inadequate pre-operatively, the starting point is to fabricate a well fitted, well designed denture.