Giovanni de Almeida Prado Di Giacomo, DDS, MS (São Paulo, BRAZIL)
Associate Researcher of CenPRA (
Private practice, São Paulo, Brazil
Abstract:
Presurgical planning is essential to obtain esthetic and functional implant, and a variety of techniques is presently available. The ideal position of the implants, the optimization of biomechanics and esthetic results are our target. A match integrating clinical and radiographic data can make our search more predictable.
Multiplanar computerized tomography (CT) is the most frequent used aid in treatment planning and various software programs enable precise, preoperative evaluation of the patient’s 3-dimentional anatomy for implant placement. Different methods have been proposed to transfer the planned implant to the placed implant. Computer aided rapid prototyping of surgical guide transfers the 3-dimentional image to surgical site in a more accurate way. This rapid prototyping technology was developed for the use of industries to assure the high quality of their products. This technology has as its main objective the detection of errors during the stages of product development, which leads to a significant reduction of the costs and further problems in production with tangible benefits in efficiency and quality.
Several authors have emphasized the accuracy of rapid prototyping surgical guides using the CAD/CAM systems and these systems led to an improvement compared to the traditional surgical guides. In the last years, some surgical guides were created based on CAD/CAM systems proposing a surgical planning in 3D environment. These systems enhance prosthetic data, which are images of the teeth done by the radiographic template, and the bone anatomic disposal data. This process may lead to more functional and esthetic results.
Our study intends to access the use of surgical templates manufactured by the rapid prototyping technique for implant placement. The assessment was made through the overlap of implants’ images in the planning provided by SimPlant software and the implants’ images (post-operatives) produced by computerized tomography (CT). Based on diagnosis waxing, radiopaque templates were made to bound the missing elements in the CT exams. The data of these exams were filed in CDs and these files were converted from the tomography language (DICOM – Digital Imaging and Communications in Medicine) into the SimPlant software language, and the virtual surgical plannings were made. We received the surgical templates made by the rapid prototyping technique. After the surgical flaps opening, they were stabilized through their extensions on the crowns of remnant teeth or alveolar ridge. Six surgical templates were used in 21 implants were placed. The images obtained with the post operatives CTs were overlapped to the planning. The distance between the coronary part of the implant and the same part of virtual implant (planning) and the angle formed between the two long axes, was assessed. Based on these results, we can conclude that the system appears safe and permits better tuning between the prosthetic yearning and surgical viability. Some prosthetic clinical results will also be presented.
Now-a-days some systems are being developed in Brazil. We have been working on these CAD/CAM systems in order to improve this kind of technology on experimental basis for implant planning using the ImplantViewer software. Another one (InVesalius) is being developed by CenPRA, which is one of the pioneers in Brazil for medical images processing.