dental implants C D A J O U R N A L , V O L 4 9 , Nº 3
Dental Implants: An Update on Guided Surgery for Full-Mouth Reconstruction Rishi Jay Gupta, DDS, MD, MBA; Justin Young, DDS, MD; and Michael Lee, DMD, MS
abstract Background: This article describes the intricate steps and processes required to plan and execute dental rehabilitation utilizing guided implant surgery through case scenarios presented for dentate and edentulous patients. Case description: With the advent and progress in digital technology in dentistry and oral and maxillofacial surgery, it is now possible to restore even the most complex cases to full function. Implant dentistry is a wellresearched and established treatment modality for replacing the dentition, and the various studies supporting the intricate steps and outcomes will be highlighted through showcasing various implant cases. Practical implications: This article provides the necessary knowledge and insight for a dental practioner to understand the nuances and pitfalls in preparing for a guided surgical case. Key words: Surgical guide, stereolithography (SLA), cone beam computed tomography (CBCT), dual scan protocol, mandibular reconstruction, additive manufacturing, 3D printing, 3D intraoral scanning, guided surgery
AUTHORS Rishi Jay Gupta, DDS, MD, MBA, is the section chief, oral and maxillofacial surgery, dental service, at the San Francisco VA Health Care System. He is an assistant professor, department of oral and maxillofacial surgery, at the University of California, San Francisco and practices in a private practice. Dr. Gupta is a fellow of the American College of Surgeons. Justin Young, DDS, MD, is an adjunct clinical instructor, department of oral and maxillofacial surgery, at the University of the Pacific, Arthur A. Dugoni School of Dentistry.
He practices dental implantology and oral surgery at a private practice in San Francisco. Michael Lee, DMD, MS, is a staff prosthodontist, dental service, at the San Francisco VA Health Care System. He practices prosthodontics at a private practice in San Francisco. Conflict of Interest Disclosure for all authors: None reported.
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mplant dentistry has significantly evolved over the past decades due to the advances in digital technology. Traditional methods used in the surgical planning of dental implants were laborintensive processes involving wax-up of teeth or duplication of the denture with fabrication of a radiographic guide that would eventually be converted to a surgical guide. The role of this analog or surgical guide is to serve as the communication tool to allow for the restorative dentist to convey their desired implant placement with the surgeon. Time spent fabricating the surgical guide may ultimately be wasted as the desired implant positioning proposed by the dentist could conflict with in vivo anatomical considerations. This results in the surgeon “freehanding”
implant surgery to accommodate the desired restorative position while not violating the anatomic boundaries in an attempt to prevent aborting the procedure and revising the surgical plan. Stereolithography-generated guided surgery has revolutionized the approach to planning and delivery of implant dentistry.1 One of the main advantages of the stereolithography-generated guided surgery protocol addresses exactly these issues because both the restorative dentist and the surgeon have the opportunity to collaborate in the planning phase virtually and prior to the surgical date. The guided surgical protocol provides enhanced accuracy and predictability from the proposed virtual implant positioning to the actual surgical placement. Subsequently, this technique M ARC H 2 0 2 1
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