9. Newman MG, Flemmig TF. Periodontal considerations of implants and implant associated microbiota. J Dent Educ 1988;52:737-44. 10. Meffert RM. Endosseaus dental implantology from the periodontist’s viewpoint. J Periodontol 1986;57:531-6. 11. Shulman LB. Surgical considerations in implant dentistry. J Dent Educ 1988;52:712-20. 12. Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25. 13. Schnitman PA, Schulman LB. Recommendations of the Consensus Development Conference on Dental Implants. J Am Dent Assoc 1979; 98:373-7. 14. Kreutz RW, Carr SJ. Bilateral oronasal fistulas secondary to an infected maxillary subperiosteal implant: report of a case. Oral Surg Oral Med Oral Path01 1986;61:230-2. 15. Gammage DD, Bowman AE, Meffert RM. Clinical management of failing dental implants: four case reports. J Oral ImplantolI989;15:124-31.

rajectory

surgical

Eric D. Adrian, DMD,a John William A. Krantz, DDSC U.S. Army DENTAC, Atlanta, Ga.

16. Yard RA, Netti CA, Bender PJ. Dental implant night guard. J PROSTHE~DENT 1987;58:71l. 17. Maxson B, Sindet-Pedersen S, Tideman II, Fonseca RJ, Zijlstra 6. Multicenter follow-up study of the transmandibular implant. J Oral Maxillofac Surg 1989;47:785-9. 18. Meffert RM. The soft tissue interface in dental implantology. J Dent Educ 198&52:810-l. 19. Kapnr KK. Emphasis. Advances in dentistry: implants. J Am Dent Assot 1986;113:872-9. Reprint requests to: DR. DONALDKRAMER DEPT.• FDENTALONCOLOGY,BOX~ UNI~.OFTE~ASM.D.ANDERSONC.~N~ERCENTER ~~~~HOLCOMBEBLVD. HOUSTON,TX 77030

guide stent for implant R. Ivanhoe,

DDS,b

Fort Gordon, Ga., and Emory University,

placeme

and School of Postgraduate

Dentistry,

This article describes a new implant placement surgical guide that gives both implant location and trajectory to the surgeon. Radiopaque markers are placed on diagnostic dentures and a lateral cephlometric radiograph is made that shows the osseous anatomy at the symphysis and the anterior tooth location. The ideal implant location and trajectory data are transferred to a surgical stent that programs the angle and location of the fixtures at time of surgery. The stent has the additional benefit of acting as an occlusion rim, a mouth prop, and tongue retractor. Use of this stent has resulted in consistently programming the placement of implant fixtures that are prosthodontically ideal. (J PROSTHET DENT 1992;67:68791.)

he success of any implant system is highly dependent on the degree of cooperation between the surgeon placing the implants and the prosthodontist constructing the prosthesis. Lack of communication may result in fixture placement that compromises esthetics and function and may not be usable. The prosthodontist should treatment plan the proposed implant patient and convey to the

The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Department of the U.S. Army. aLieutenant Colonel, U.S. Army, DC, Assistant Chief, Removable Prosthodontic Service, Fort Gordon, Ga. bAssociate Professor, Department of Prosthodontics, Emory University, School of Postgraduate Dentistry. cColonel, U.S. Army, DC; Chief, Removable Prosthodontic Service, Fort Gordon, Ga. 10/1/3x362

TIIEJOWRNAL

OF PROSTHETIC DENTISTRY

surgeon (I) the type of final restoration, fixed or removable, (2) the number and approximate location of the fixtures, and (3) the fixture angulation. Various stents have been suggested to aid the surgeon, but many have proved impractical.1-4 ing protruding pins as paralleling guides interfere with rotary instrumentation and cannot provide placement guidance in the mouth-open, surgical position. Stems using holes to locate fixtures5 are impractical because they give the surgeon no leeway in buccal-lingual placement to avoid mandibular concavities, and they give no angular information. In frustration, surgeons have resorted to “eye-balling” fixture placement relative to the maxillary anterior ridge, which often leads to lingually tipped fixtures. Tbe angle between a line drawn from the anterior maxillae to the mandibular ridge becomes more acute as the mandible is opened. This change in angulation tends to lead the

687

Fig.

1. Lead foil adapted to teeth.

Fig.

3. Lateral

Fig. 4. Implant ig. 2. Foil strip on intaglio

surface.

surgeon into placing the fixtures on a lingual inclination. This lingual inclination results in a prosthesis that has the anterior teeth cantilevered forward at a distance from the fixtures, creating a difficult framework design and hygiene problems. This article will describe a technique for a splint that can be used at the jaw position used in the surgical phase that gives position and angulation guidance, but does not interfere with the surgical technique.

1. Make preliminary and final casts of the edentulous arches. Make record bases and modify occlusal rims to satisfy esthetics

Trajectory surgical guide stent for implant placement.

This article describes a new implant placement surgical guide that gives both implant location and trajectory to the surgeon. Radiopaque markers are p...
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