Missing teeth can be an issue from both a cosmetic and a quality of life aspect. Here at Downtown Dental Syracuse we invest in the latest technology that is available and Dental Implants are an area where we are truly leading the field in Syracuse.
We asked Dr Tyler Mead DDS to discuss a case that illustrates how our new 3D Guided Implants system improves a patients experience and results here at our offices in Downtown Syracuse.
Dental implants are an ideal solution for patients who have teeth missing. We recently had a patient present to us who had two teeth missing, teeth 30 and 31 the lower right molars) and they wanted to replace them with dental implants.
At Downtown Dental we practice what is known as restoratively driven implantology, meaning, the implants are placed at a location that is ideal for where the final tooth crowns SHOULD BE. Previously, implants would be placed in the middle of the jaw bone, but that doesn’t always allow for ideal placement of the tooth and can lead to biomechanical deficiencies.
The following stages outline how we guided the patient through the process of their implants from the initial discussion to the final surgery where the implants were installed.
Step 1: CAD-CAM Tooth Design
At our office the vast majority of our all porcelain crowns are designed, milled and finished in one visit, using the Cerec CAD-CAM system by Sirona.
Images of the patients lower jaw were taken, including the area where the teeth are missing. The teeth are then designed where the crowns are to be placed when the case is finished, according to the patients bite and other spatial parameters.
Step 2: Cone Beam CT (3D x-ray) Imaging
Using our Orthophos SL cone beam CT machine( seen below), by Sirona, we are able to take 3D CT images that allow us to see an exact replica of a patients teeth, jaws, and pertinent anatomy in 3 dimensions. And don’t worry, Cone Beam CT is a fraction of the radiation that medical CT’s expose a patient to! Conventional 2 dimensional radiography leaves us with a lot of missing information.
What about that missing information in the 2D images? Well the 3D image gives us a lot more than we would usually see in a traditional 2D image!
The white portion is cross section of the patients jaw
The blue outline is of the proposed tooth from CAD-CAM.
The yellow outline is of the gum tissue from CAD-CAM.
The orange outline is of the implant. You can see it is offset to the right to be in proper alignment with the future crown. If it was centered, it was not be in the most appropriate location for restoratively driven implantology.
The purple circle is the nerve and artery that run through the jaw. This was traced and outlined because it must be avoided. You can see it running through the entire jaw on the previous slide.
The red outline is the submandibular region. This cannot be seen on 2D images and cannot be violated when placing an implant.
Step 3: Integration.
You may have noticed that both the Cerec and Orthophos SL are made by Sirona. Because of this, the images of the lower teeth and the proposed crowns can be integrated into the 3D xray to allow for digital placement of the implants according to where the teeth will ultimately be, while still placing the implants in a safe location within the jaw! This saves time and gives us the most accurate picture we can have of a patients mouth.
Below is a picture of the integrated CAD-CAM model and 3d xray.
Step 4: Surgical Guide Fabrication
The integrated files are e-mailed to a certified guide fabrication lab.The guide is then designed and is either milled or 3D printed and mailed back to us.
Step 5: Surgery – How does the guide work?
The guide is inserted into the patients mouth and a stable and accurate fit is confirmed prior to start of the procedure. The patient is anesthetized after confirmation of fit. A set of keys (above right) are placed into the metal guide sleeves of the guide (below right). Drills with the same diameter as the hole in the key are passed through to the prescribed depth. Since they are the same diameter, the drills are guided to an exact location in 3 dimensions. Different keys with different diameters are placed into the guide with each corresponding drill, until the final drill diameter is reached. The implants are then inserted and if stitches are even needed, they are placed.
Step 6: Guided Surgery Complete
Two precisely, accurately, and safely placed dental implants with the final teeth location kept in mind are now in the patients jaw. 3D images are not usually taken at the end of the procedure, but the beauty of guided surgery is we know the implants are right where they should be.
The patients crowns will be fabricated on CEREC and placed in the mouth in 3 months after the implants have healed.
Hopefully this has given you some idea of the process a patient goes through when receiving dental implants here at Downtown Dental Syracuse. Our investment in 3D guided implants gives you a Precise, Accurate, and Safe solution.