What is a surgical template in dentistry. Surgical implantation template - a unique solution to complex problems

With the advent of dental implantation, dentists have received an excellent tool for solving the problem of missing teeth. Medical practice, accumulated over many years, has shown excellent long-term results of the method (when the implants are installed correctly). Along with this, statistics of complications associated with planning errors preceding the dental implantation operation were also accumulated, the most unpleasant of them are:

In this article, we will describe each of these situations in more detail.

So, dentists and engineers faced the task of eliminating such complications. As a result of research and the application of modern technologies, a technique has appeared that made it possible to carry out accurate 3D planning of the upcoming operation for installing implants - ImplantGuide. Its better known names are implantation by templates, navigation implantation, sometimes it is a little incorrectly called implantation without incisions or bloodless dental implantation.

1. The classical method of placing implants

Classic implant placement protocol

Consider the case when dental implantation is carried out only on the basis of data obtained from an orthopantomogram (OPTG).

From the OPTG snapshot we get information:

• by the contrast of a 2-dimensional image about the presence of bone in the proposed place of implant placement;
• the approximate height of the bone (the fact is that the picture is taken at an angle)

From the OPTG snapshot we don't get full information:

• the real distance from the bone crest to the mandibular canal or maxillary sinus;
• about the real bone profile in section.

Thus, using only a snapshot of OPTG, the doctor receives about 50% of the necessary information (conditionally), and the patient must rely solely on the experience and qualifications of the surgeon performing the implantation. A doctor's mistake can lead to the following:

Cross-sectional sections show that the apical part of the implant is in the mandibular canal and damages the nerve.

2) Now let's consider the case when, in preparation for implantation, the doctor has at his disposal a Computer Tomogram (CT) of the patient

Because from CT it is possible to obtain all data on the volume of the bone in all planes and sections, then the completeness of the information, conditionally estimate at 75%. Where is the remaining 25%? Our experts believe that 25% is a prosthetics plan thought out in advance and modeled in a 3D program. Let us recall the main purpose of implant placement - restoration of dentition defects. Each implant has the function of supporting the future crown, as well as supporting the bridge for its canvas.

Improper installation of the support, and the structure loosens, loses strength, as a result, the bridge collapses, and in the case of teeth, re-implantitis and other complications develop

Of course, an experienced orthopedist can mentally imagine how exactly 1, 2, 3 or 4 teeth will be located in the dentition, but what to do when there are more missing teeth? And if the orthopedist has only an approximate idea of \u200b\u200bwhat the teeth will look like in the end, then how can the surgeon understand where he should place the implants?

Nevertheless, let's assume that the orthopedist is experienced and, having a CT scan on his hands, he made a markup for implantation for the surgeon (indicated on the CT the exact location of the implants).

Now it's up to implantation.
As an illustrative example, imagine a photograph of a dental model showing the dimensions and positions of the holes to be drilled.

The surgeon must perform the task of the orthopedist, working "by eye". Not so easy, right? If the holes are drilled with a deviation of only 1-2 millimeters, the treatment plan that the orthopedist conceived will not be implemented, and the model will be thrown into the trash.
In real life, it is more difficult, the surgeon works in cramped conditions, his blood pressure may drop, and maybe the patient involuntarily moves. In the best case, the orthopedic structure will not be installed perfectly, in the worst case, the patient's health will be harmed.

The photo shows a case when the implants were installed "in the wrong direction". How to use prosthetics now? But the conditions made it possible to set them at the right angle.

Another clinical case: with missing 45 and 46 teeth, one implant was installed. at the time of its installation, due to bone deformation, the distance between teeth 44 and 47 was only 12.5 mm. There is a lot of space for one tooth, but little for two. This is the case when the surgeon performed the implantation without prior orthopedic planning. In such a situation, the orthopedist can no longer change anything, so he is forced to prosthetics "as he can".

The specialists of our clinic believe that the most important part of dental implantation restoration is a properly developed strategy. In its absence, the probability of error is very high, which is what happened. The exhausted patient subsequently contacted us with complaints about the unsatisfactory appearance of the teeth and inconvenience in use. Sadly, correcting the situation will require the removal of the previously installed implant.

So, the successful installation of implants by the standard method, often 100% depends on the qualifications of an orthopedist and an implant surgeon, patient's patience and other factors. The cost of an error can be both a “curve” (in other words, you cannot name) the final design, and harm to the patient's health.

How can these complications be avoided? A new development of Russian scientists, implantation by templates, the Implant-Guide technology, comes to our aid.

3D implantation planning and navigation implantation according to individual templates

To obtain the remaining 25% of the data, when planning implantation, during CT, we use special radiopaque templates. Already at this stage, using templates, we predict future orthopedic constructions. The template is somewhat reminiscent of a removable denture that rests on one's own teeth.

Now we get additional data from the CT scan: the shape and appearance of the future orthopedic construction allow us to choose the best direction for the implant placement, and information on the thickness of the mucous membrane in the implantation zone will enable us to predict the adhesion of the gums to the crown.
So, already before implantation, we choose the surgical protocol and the optimal implantation technique. We know for sure, and do not decide "on site" what type of incision will be made (straight, beveled or WITHOUT AT ALL), what protocol we will use (one-step or two-step), what to prepare in advance (for example, a healing abutment or a plug). Is implantation possible with immediate loading, etc. Based on the table of implants, we will prepare the necessary implants and drills in advance for the correct operation.

This technology allows us to virtually plan and replay the implantation based on the location and type of the future prosthetic construction.

At the end of the calculation, an implant template is made, into which special titanium guide sleeves are installed, along which the doctor will accurately place the implants.

Let's consider in more detail the stages of planning prosthetics on implants according to technology ImplantAssistant and ImplantGuide

The result of the work is a safe operation and an aesthetic end result. Photos of our works -.

Let's compare schematically the standard protocol of classical implantation with the planning protocol using the Implant-Guide technology used in our clinic.

The diagram shows that with the standard approach to implantation, an important stage is skipped - the planning stage.

What's the difference in price?

The difference in price is the cost of making radiopaque and implantation templates. To estimate, for one jaw, regardless of the number of implants installed, it will be necessary to pay an additional 26,000 rubles. to the planned cost of the implantation operation.
Often, when it comes to the simple case of installing one implant, we can do without making templates. The implant template is used when installing 2 or more implants, then the price increase will be 13,000 per implant. If there are even more implants, the cost of the template ceases to play a significant role in the cost of treatment.

So, what are the advantages of the "ImplantGuide" technology

• Complete understanding between the orthopedist, surgeon, dental technician in choosing the best design, the ability to connect other specialists before and at the stage of implant treatment;
• Optimal placement of the implant as a support for the future orthopedic construction;
• Selection of the optimal individual operating technique for each clinical case;
• Precise positioning of the implant in the planned location;
• 2-5 times reduction in the time of dental implantation operation;
• Minimal trauma, pain and swelling after surgery, reducing the likelihood of dental complications;
• 100% predictable and guaranteed final aesthetic result;
• Ability to install implants without incisions (bloodless implantation method);
• Allows you to make verified and safe operations.

Dental implantation is one of the most innovative areas of artificial organ restoration.

Huge funds are invested in the development of advanced technologies all over the world, dozens of projects are opened every year.

The results of the work are the opportunity for each patient to find their ideal solution to eliminate the problem, based on anatomical, clinical and material capabilities.

One of these devices, a surgical template, will be discussed in this article.

Appointment

According to leading experts in the field of dentistry, surgical templates are the future of implantation.

Outwardly, this design resembles a boxing mouthguard, with the only difference being the presence of holes of the same diameter. They are needed in order to indicate to the doctor as accurately as possible the area where it is necessary to implant the implant.

The device is identical to the contours of the patient's jaw row, which is a prerequisite for its most dense overlap and the elimination of the smallest inconsistencies in the drilling process.

The system is a piece product and is made for each person individually, taking into account the anatomical features of the structure of the jaw apparatus.

The main purpose of the template is to ensure the most accurate insertion of the future copy of the tooth.

In the process of manufacturing the structure, lightweight materials are used - acrylic, medical plastic, polymer components.

Indications

The use of a surgical template is justified in the following situations:

• absence of a large number of fragments of the jaw row - in the presence of large voids, it is difficult for the dentist to orientate himself and insert the implant as accurately as possible;
• lack of anterior teeth - the use of a template will allow the operation to be performed at a high aesthetic level;
• the need for drilling at a wide angle in places where clinical anomalies of the jaw structure are revealed;
• pre-production of temporary prosthesis;
• need for flapless surgery.

Contraindications

There were no direct contraindications that exclude the use of a template during the implantation process, with the exception of indirect factors that cast doubt on the advisability of carrying out the implantation procedures itself, in principle.

This includes severe chronic diseases at any stage of progression, oncological diagnoses, heart failure.

However, there are some limitations, which, under certain factors, can become an obstacle to using the template:

• macroglossia, accompanied by nausea and poor opening of the mouth;
• dense structural content of mucosal tissues in the focus of its support zone;
• implantation of the implant at an angle;
• accessibility of the angled end head;
• problems with fixing the device;
• too large patchwork fragments when using the construction on the bone - everything is determined by the professionalism of the surgeon.

Material

Depending on the component from which these structures are made, and the technology of production processes, they are classified as follows:

1. Aryl - the device is very similar to a standard removable denture with a gingival base. First, the doctor makes an impression, then gives it to the laboratory, where the model is cast. The models are especially popular due to their low cost in comparison with analogues.
2. Transparent - externally, they are almost invisible due to a special production technology using a vacuum former. They are distinguished by special softness, while being reliable and durable.
3. Plastic- for their manufacture, only medical polymer plastic is taken, which has higher rates of flexibility and strength.
4. CAD / CAM technology - the latest type of digital modeling. It is unique and has no analogues in the world.

   These are ultra-precise, modern models with increased rigidity, the presence of a "tunnel", which significantly increases their field of application and perfectly withstand high temperatures.

   This is considered an important condition for compliance with sterility standards. It is the most expensive design due to the complexity of the manufacturing process.

Views

To perform the procedure of dental orthopedic prosthetics, several types of templates are used:

• bone-supported - fixed with special microscrews during the operation. Its main function is to follow the procedure as accurately as possible in case of fragmented or complete toothlessness, relying on the residual bone area.

  This guarantees the utmost precision in device placement. The manipulation itself involves the use of soft tissue patchwork elements;

• with fixation on supporting adjacent healthy organs - the model is attached directly to the elements located in the dental arch during surgery.

  It is the ideal solution for patients with fragmented loss of parts of the jaw, with one or more teeth. It is justified in cases where, for a number of indications, the use of flapless or other alternative techniques is unacceptable;

• on the mucous membranes of the gums - the frame is carefully attached to the soft tissues of the oral cavity. Suitable for those patients who have a complete absence of teeth on one of the jaws. Recommended for non-invasive surgery.

In addition, structures are classified by subspecies:

• for pilot drill - are made only with this functionality for a standard drill of a surgical kit of almost any prosthetic design.

  The method completely eliminates additional costs for tools and additional templates. This is their main advantage, achieved through the versatility of the design features of the model. Its diameter is 2 mm;

• for each drill and turnkey - this type is necessary when trying to go through all diameters while drilling under template correction.

  In such a situation, you need to either make devices of different diameters, or order a single layout, turnkey. The keys are inserted into the product, thereby changing the size of the inlet;

• for the full protocol in the format - the ideal and most reliable option for navigational artificial restoration of lost organs.

  If it is available, all the manipulations of the doctor before the final procedure (implantation of the system) are carried out using a template, which several times minimizes the risks of medical error.

Primary requirements

A quality surgical template should have the following characteristics:

• high strength factor;
• have good rigidity;
• its design features should imply the presence of a passage that allows not only to set the correct position of the model at the time of prosthetics, but also to fix the implant at the required angle of inclination;
• repeat the jaw relief as accurately as possible;
• firmly fixed on the supporting organs or gums.

Manufacturing process

The manufacturing process of the product assumes an integrated, team approach of a group of doctors - a dentist, an orthopedist, a specialized practicing surgeon.

Manufacturing is carried out in several stages.

Preparatory

It assumes a general diagnosis of the state of the oral cavity, obtaining an estimated clinical picture of pathology, a multifaceted computed tomogram.

It will be required in order to select not only the optimal prosthesis, but also determine the positioning of the implant.

Making a copy

The impression of the jaw impression should be done even if the organs are completely edentulous. This is one of the essential procedures in any kind of prosthetics.

Volumetric modeling

Scanning of the taken impression model is carried out, and, based on diagnostic information, a 3D version of both jaw rows of the patient is formed.

A unique computer program independently simulates the tactics of the operation, determines the fragments of the localization of future prostheses, sets them the correct angle of inclination and projects the future orthopedic "creation".

At this stage, the patient will be able to see what the result of the planned procedure will be.

Making a template

It is done either in a special laboratory, or using cad / cam tools and equipment.

In the first case, the dental technician does everything by hand, which requires some experience and professionalism.

In the second, everything is done using a computer and a 3D printer.

Benefits

Few of the qualified, practicing implant surgeons do not use surgical templates in the process of prosthetics.

The use of the product allowed the doctor to perform operations several times more accurately and with better quality, which was not always possible to achieve even by experienced specialists with experience.

Moreover, the template not only simplified the work of the doctor, it minimized the risk of complications in the process of carrying out orthodontic manipulations.

Operation using the device is considered to be more gentle and less traumatic, since it eliminates the need to make extra soft tissue incisions.

It has a design and certain advantages not only for the doctor, but also for the patient. These include:

• almost computerized accuracy of implantation;
• a more favorable prognosis for denture rejection;
• reducing the time of the surgical intervention - the surgeon is relieved of the need to calculate in detail the positions of attachment in the oral cavity
• minimal tissue trauma during manipulation, since gum dissection is not performed using templates. At the site of implantation, only a puncture is made;
• the rehabilitation process is shorter, the recovery is easier, without pain and complications, such as mucosal edema, redness, inflammatory focal manifestations, sinus perforation;
• even at the preliminary stage of preparation for prosthetics, the patient will be able to see the result, since it has already been modeled on the monitor;
• 3D technologies give a chance to fix the crown part of the tooth immediately after the implantation of the implant, which saves time and allows you to leave the dentist with new "teeth";
• the ability to simultaneously implant several prosthetic structures in one operation.

disadvantages

There were no direct flaws in the design; only the following indirect disadvantages can be distinguished:

• the manufacturing process of the device takes some time, usually 2-3 days, which somewhat removes the patient from the end of the prosthetics;
• additional material investmentsassociated with the manufacture of the product.

Experts' opinions

The opinions of specialists in the field of implantation about the use of surgical templates are practically unanimous.

Successful outcome of dental prosthetics Is a complex of a number of factors that affect how the procedure will proceed.

The success criterion will be not only preliminary preparation and selection of the optimal implant, but also a competent approach to the operation, its planning and the availability of the necessary equipment at hand to help in the work.

This, in their opinion, is the device considered in this article.

Allowing the ideal positioning of the artificial organ, the template makes it possible to quickly calculate all stages of the operation without distracting the surgeon's attention to unnecessary manipulations.

Thus, the very course of the procedure is already a visible advantage of the device. With it, there was no need to dissect the mucous membrane, which several times reduces the risks called "human factor".

This gives the doctor self-confidence and additional psychological comfort.

Besides, with full adentia the use of the system is not only justified, it is more than necessary.

The video provides additional information on the topic of the article.

Imagine a mouthguard that athletes wear over their teeth to prevent injury. The template for dental implantation looks like it. This is something like a stencil, made using impressions from the jaw, which is necessary to carefully plan the location of future artificial roots and crowns. In those places where the patient is planning to install implants, there are sleeve holes in the stencil. Before starting work, the surgeon-implantologist applies a template to the operation area, thus getting the opportunity to act with high accuracy when placing the implant in a computer-calculated place at a given angle and at a given depth.

Application of surgical templates for dental implantation

Making a surgical template for dental implantation is not always necessary. If we are talking about the absence of one or two teeth, and not the front, there will be no special need for such technology. However, in the case of complex prosthetics, when it is necessary to install several implants, it is not easy to do without a template. If the adjacent teeth do not serve as reference points, it is problematic to determine the optimal place for placing the implant on the eye.

Surgical templates are also used for implantation in the anterior part of the dentition. In this case, aesthetics are extremely important; how the patient's smile will look depends on the precision of the surgeon's work.

In case of bone atrophy in a patient, the art of a prosthetist in some cases helps to avoid bone grafting: using a template, implants can be placed in places that can withstand the load. Surgical templates are also used when placing implants for prosthetics on bar structures.

Indications for use

• Absence of three or more teeth in one jaw row.
• The need to replace anterior teeth with implants.
• Revealed clinical anomalies of the jaw structure, which imply the need to drill at a large angle.
• The need for a flapless, minimally invasive surgical solution.
• Installation of a fixed or conditionally removable beam structure.
• A temporary crown will be placed on the implant immediately after placement.
• The patient has bone atrophy and implants must be guided into the jaw processes that lead to other bones.

Making templates for implantation

Surgical templates differ from each other in both the manufacturing method and the material. So, acrylic templates in their appearance resemble a conventional removable denture with a gingival base and holes for pins; they are made in the laboratory using an impression from the patient's jaw. Transparent, soft and at the same time very durable templates made of polymer plastic are made in a vacuum former. And the most accurate templates for implantation owe their origin to digital modeling, or rather to such a type as CAD / CAM technology.

Pros and cons of surgical templates

• More favorable prognosis of the operation: the human factor is minimized, the accuracy is maximum.
• The operation takes less time: the positions on which the implants need to be placed are already calculated and marked.
• The invasiveness of the operation is reduced: when using the template, the surgeon does not cut the gum, but immediately pierces it in the place indicated on the template.
• Consequently, healing is also faster. The risk of inflammation and edema after implantation is minimized.

• Making a template for implantation takes some time; this can be unnerving for those who want to quickly end and forget about medical procedures. Typically, the template is made in two to three days.
• If it is decided that the patient needs a patterned implantation, the price to be paid for new teeth may increase. True, this does not always happen: for example, when the use of a template allows you to refuse augmentation of bone tissue, this, on the contrary, reduces the cost of prosthetists' services.

What is the cost of a template implantation?

The cost of the template may fluctuate depending on the material, manufacturing technology and the number of guides. So, a surgical template made of acrylic, provided that less than three implants are planned to be installed, can cost from 6,000 rubles, and a template made on a three-dimensional printer using the latest computer technologies for installing more than three implants will cost from 30,000 rubles. This amount must be added to

Navigation (Surgical) Templates Is a pad with guide cylinders for precise positioning of implants in the oral cavity in accordance with the planned position on the computer by computed tomography.

Benefits:

• Safe implantation in all situations.
• Preparation of ideal conditions for prosthetics.

• Minimal trauma, high accuracy.
• Reducing the number of possible complications.

Types of navigation templates

Bone-supported. This type of templates is best done using MSCT, because it best conveys bone relief. As a rule, during surgery with such templates, it is necessary to fold back large areas of soft tissue. Such templates were made at the dawn of navigation implantation and are now used extremely rarely or out of necessity.

• Teeth-based. This type of template, like the next one, is the most common today. To perform this work accurately, a CBCT and an impression / model of the jaw are required. Further, in laboratory scanners, the model is scanned and after that the three-dimensional model of the jaw obtained with CT is combined with the three-dimensional model of the scanned plaster model. Thus, we get an accurate relief of the teeth for creating templates.
• Based on the mucous membrane. This type of template, as well as with a support on teeth, is also often used, but mainly with complete edentulousness or a small number of remaining teeth. True, in this case, an additional stage appears - the creation of a radiopaque template, which allows, with complete adentia, to see the relief of the mucous membrane on CT, the proposed place of future teeth and makes it possible to correctly plan the future operation.

Production time: 4 days

In dentistry, a surgical template is a digital stencil with holes for inserting implants. With its help, prostheses are mounted in the correct place, carefully selected on a computer, at the right angle to a certain depth.

Prices for making a surgical template

Examination on diagnostic models of jaws (surgical template) 5750 P

Surgical Template Specialists

Past'yan Andrey Albertovich

1994-1999 - Ukrainian Medical Dental Academy (UMSA).

1999-2000 - Clinical internship: Clinic of Maxillofacial Surgery Dr. Flussenger, Friedrichshafen.

2000-2001- Clinical internship at UMA of postgraduate education named after Shupika, Kiev "Department of ChLH".

What is a surgical template for?

With the help of a surgical template, the specialist most accurately positions the placement of the prosthesis during its installation, 100% does not allow mistakes that are often found in classical dental prosthetics.

When is a template needed?

In dentistry, a template is required in the following cases:

1. when there are no teeth on the lower and upper jaw. The specialist does not have a guideline for better understanding the placement of teeth in the patient's jaw for implant attachment;
2. if you need to restore frontal teeth that are not there. Here, the manufacture of a surgical template is essential for ultra-precise implant placement. Excessive requirements are imposed on the front teeth in terms of aesthetics.

Several videos on surgical templates

Types of templates for dental implantation

Today, Moscow clinics offer several types of surgical templates, which differ from each other in the materials used and production methods:

• acrylic (similar to a denture with a gingival basis);
• polymer;
• transparent (created in a vacuum former);
• surgical templates created with digital CAM | CAD.

Manufacturing sequence

Making a surgical template for dental implantation involves a number of sequential steps:

• Stage 1.

  preparation of the oral cavity for implantation, diagnostic work. The places in which the implants will be installed are planned, and what kind of smile will be;

• Stage 2.

  creation of an impression of hard tissues of the jaw. Thanks to him, the sites for the implantation of titanium implants will be determined;

• Stage 3.

  placement of implants in the designated holes.

Photos with examples of surgical templates

Benefits

The advantages of placing implants when using a surgical template include the following:

• precise implantation of the missing tooth, eliminating errors;
• installation of prostheses using a surgical template allows you to get a high aesthetic smile;
• the template serves as an assistant for a doctor who needs to install an implant in a patient with bite pathology.

There are no downsides to the surgical template for implantation, except that the relatively high cost of the procedure due to the use of computer modeling and a 3-d printer. In this case, the cost depends on the manufacturing method, materials used and some other factors.