Clinical Application of Stereolithographic Surgical Guide With a Handpiece Guidance Apparatus: A Case Report
The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants.
Figure 1. Clinical view of edentulous mandible. Figure 2. (a) Positions of the implants in the cross-sectional images. (b) Three-dimensional model of the lower jaw with implant planning. Figure 3. Handpiece guidance apparatus. Figure 4. Base part of the surgical guide system. Figure 5. Orientation of the tube and holes of the system. (a) Triangular tube. (b) Triangular pin. (c) Drilling hole.
Figure 6. Optical laser scan of the handpiece. Figure 7. Handpiece guidance apparatus that was virtually designed according to the scan data. Figure 8. Adaptation of the surgical guide to the jaw bone with osteosynthesis screws. Figure 9. The drilling procedures as performed into the drill holes. Figure 10. Implants inserted through the stereolithography surgical guide system using a torque-controlled surgical handpiece.
Figure 11. Intraoral view of the patient immediately after surgery. Figure 12. Panoramic view of the patient after a 3-month healing period. Figure 13. Intraoral view of the patient with ball abutments after a 3-month healing period.
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