Tandimplantater – Guided Implant

Metoder og risici

Traditionel metode

Der er naturligvis altid fordele og ulemper ved tandimplantater. Fordelene taler for sig selv, men det er en omstændig proces, der kræver tid, og typisk tager det op til 6 måneder for implantatet og kæbeknoglen at vokse sammen. Denne sammenvoksning kaldes osseointegration. Læs mere >her<

Med traditionel metode indsættes implantat ved en operation, hvor hele området frilægges. Derefter sys området sammen, og der afventes opheling af implantat typisk ½ år, førend aftryk til abutment og krone tages og fremstilles. Helingsprocessen påvirkes imidlertid negativt af tobak, dårlig mundhygiejne, ukontrolleret diabetes, stråle-/ kemo-/ steroid- terapi, hvorfor behandling med implantat frarådes i disse tilfælde.

Indsættelse af tandimplantater foretages som en kirurgisk operation, og en kirurgisk operation vil altid være forbundet med en række generelle risici. Disse generelle risici omfatter infektion, mulige skader på nervevæv og kraftig blødning under eller efter operativt indgreb.

Med digital 3D scanning af tandsæt og kæber kan sandsynlighed for risici nedsættes.

Med digital 3D scanning af tandsæt og kæber kan planlægning visualiseres virtuelt i 3D og reducere omfang af operation.

Implantat, abutment og temporær krone bliver special fremstillet efter den foretagne 3Dscanning med 3Shape scanner og 3D CBCT.

Princippet giver mulighed for kort efter operation at indsætte midlertidig krone (3D printet krone), således at der ikke er en “tom plads” i tandrækken. Efter ½ år fremstilles permanent krone (MK krone). 

Princippet med minimal operation har altså den fordel, at indgrebet er minimeret. Opheling af tandkød og indheling af implantat er derfor fremskyndet, men der skal fortsat udvises forsigtighed og respekt om det krævende miljø, som mundhulen altid vil være, lige gyldigt hvor godt forberedt implantatet indsættes. Derfor anbefales lige efter operation med indsættelse af implantat, at der indsættes healing abutment (se nedenfor), som er designet specifikt efter den aktuelle scanning af tandkød i området.

Guided Implant

Den ovennævnte metode kaldes Guided Implant, og jeg bruger Azento systemet med de gennemprøvede implantater fra DentsPly Sirona ASTRA Implant System. Jeg har brugt ASTRAs implantater siden 1992.

Kæbeknogle (de indre konturer) 3Dscannes med CBCT scanner, og tandsæt (de ydre konturer) scannes med digital 3D scanner. Begge dele sker i klinik på Ulrikkenborg Plads. Sammensættes (stitching (1)) de to 3D scanningstyper i 3D, kan den helt nøjagtige position af implantat vælges.

Med Implant Planner 3D software kan operation visualiseres og planlægges, og implantat, abutment og temporær krone special fremstilles custom made. Metoden er præcis og reducerer omfanget af kirurgi.

Abutment

Healing og permanent

Abutment kaldes forbindelses delen mellem selve implantatet og tandkronen. Abutment fastsættes på implantat med en skrue.

Abutment systemet anvendt i forbindelse med Azento Guided Implant/ASTRA Implant System er navngivet Atlantis.

Udformning mod tandkød er med Azento Guided Implant custom made. Dvs. at abutment er special fremstillet efter 3D scanning. Hermed fremstilles abutment nøjagtigt efter tandkødets overflade det pågældende sted, hvor implantat planlægges indsat.

Viser situationen under indsættelse af implantat, at det ville være klogt at afvente en ophelingsperiode, indsættes hygiejnisk ophelings abutment – healing abutment (se foto ovenfor). Er vurderingen, at der kan indsættes permanent abutment + krone, indsættes i stedet dette. En af mange fordele ved Azento Guided Implant er, at vælges en ophelingsperiode med healing med healing abutment er udformning mod tandkød nøjagtig ens med det permanente abutment, hvorved der opnås en harmonisk opheling af tandkødet, og udformning af tandkød efter opheling passer nøjagtig til det permante abutments facon, der mod tandkødet er identisk med healing abutment.

Referencer

Den publicerede litteratur understøtter brugen af ​​Guided Implant til en forudsigelig og kontrolleret implantat kirurgi metode.

• Højere nøjagtighed sammenlignet med frihåndskirurgi (3–8)
• Sikker og forudsigelig operation kan anvendes alle steder i munden (2,4,12,18–28)
• Minimalt invasiv behandling er mulig (16,34,36)
• Reduceret tid i tandlægestolen kan opnås (37)
• Opretholdt patienttilfredshed ved årlige opfølgninger (38,39)

1. Egbert N, Cagna DR, Ahuja S, Wicks RA. Accuracy and reliability of stitched cone-beam computed tomography images. Imaging Sci Dent. 2015 Mar;45(1):41-7 Abstract in Pubmed 
2. Stokbro K, Aagaard E, Torkov P, Bell RB, Thygesen T.
   Virtual planning in orthognathic surgery. Int J Oral Maxillofac
   Surg 2014;43(8):957-65. Abstract in PubMed
   3. Vercruyssen M, Cox C, Coucke W, et al. A randomized
   clinical trial comparing guided implant surgery (bone- or
   mucosa-supported) with mental navigation or the use of
   a pilot-drill template. J Clin Periodontol 2014;41(7):717-23.
   Abstract in PubMed
   4. Vercruyssen M, Coucke W, Naert I, et al. Depth and lateral
   deviations in guided implant surgery: An rct comparing
   guided surgery with mental navigation or the use of a pilotdrill template. Clin Oral Implants Res 2015;26(11):1315-20.
   Abstract in PubMed
   5. Shen P, Zhao J, Fan L, et al. Accuracy evaluation of
   computer-designed surgical guide template in oral
   implantology. J Craniomaxillofac Surg 2015;43(10):2189-94.
   Abstract in PubMed
   6. Arisan V, Karabuda CZ, Mumcu E, Ozdemir T.
   Implant positioning errors in freehand and computer-aided
   placement methods: A single-blind clinical comparative
   study. Int J Oral Maxillofac Implants 2013;28(1):190-204.
   Abstract in PubMed
   7. Park C, Raigrodski AJ, Rosen J, Spiekerman C,
   London RM. Accuracy of implant placement using precision
   surgical guides with varying occlusogingival heights:
   An in vitro study. J Prosthet Dent 2009;101(6):372-81.
   Abstract in PubMed
   8. Lin YK, Yau HT, Wang IC, Zheng C, Chung KH. A novel
   dental implant guided surgery based on integration of
   surgical template and augmented reality. Clin Implant Dent
   Relat Res 2015;17(3):543-53. Abstract in PubMed
   9. Edelmann AR, Hosseini B, Byrd WC, et al. Exploring
   effectiveness of computer-aided planning in implant
   positioning for a single immediate implant placement.
   J Oral Implantol 2016;42(3):233-9. Abstract in PubMed
   10. D’Haese J, De Bruyn H. Effect of smoking habits on
   accuracy of implant placement using mucosally supported
   stereolithographic surgical guides. Clin Implant Dent Relat
   Res 2013;15(3):402-11. Abstract in PubMed
   11. Cassetta M, Giansanti M, Di Mambro A, Stefanelli LV.
   Accuracy of positioning of implants inserted using a
   mucosa-supported stereolithographic surgical guide in
   the edentulous maxilla and mandible. Int J Oral Maxillofac
   Implants 2014;29(5):1071-8. Abstract in PubMed
   12. Cassetta M, Di Mambro A, Giansanti M, Stefanelli LV,
   Cavallini C. The intrinsic error of a stereolithographic surgical
   template in implant guided surgery. Int J Oral Maxillofac
   Surg 2013;42(2):264-75. Abstract in PubMed
   13. Arisan V, Karabuda ZC, Ozdemir T. Accuracy of two
   stereolithographic guide systems for computer-aided
   implant placement: A computed tomography-based
   clinical comparative study. J Periodontol 2010;81(1):43-51.
   Abstract in PubMed
   14. Testori T, Robiony M, Parenti A, et al. Evaluation of
   accuracy and precision of a new guided surgery system:
   A multicenter clinical study. Int J Periodontics Restorative
   Dent 2014;34(suppl):s59-s69. Abstract in PubMed
   15. Cassetta M, Di Mambro A, Giansanti M, Stefanelli LV,
   Barbato E. Is it possible to improve the accuracy of implants
   inserted with a stereolithographic surgical guide by reducing
   the tolerance between mechanical components? Int J Oral
   Maxillofac Surg 2013;42(7):887-90. Abstract in PubMed
   16. Cassetta M, Di Mambro A, Di Giorgio G, Stefanelli LV,
   Barbato E. The influence of the tolerance between
   mechanical components on the accuracy of implants
   inserted with a stereolithographic surgical guide:
   A retrospective clinical study. Clin Implant Dent Relat Res
   2015;17(3):580-8. Abstract in PubMed
   17. Koop R, Vercruyssen M, Vermeulen K, Quirynen M.
   Tolerance within the sleeve inserts of different surgical
   guides for guided implant surgery. Clin Oral Implants Res
   2013;24(6):630-4. Abstract in PubMed
   18. Schneider D, Schober F, Grohmann P, Hammerle CH,
   Jung RE. In-vitro evaluation of the tolerance of surgical
   instruments in templates for computer-assisted guided
   implantology produced by 3-d printing. Clin Oral Implants
   Res 2015;26(3):320-5. Abstract in PubMed
   19. D’haese J, Van De Velde T, Elaut L, De Bruyn H.
   A prospective study on the accuracy of mucosally supported
   stereolithographic surgical guides in fully edentulous
   maxillae. Clin Implant Dent Relat Res 2012;14(2):293-303.
   Abstract in PubMed
   20. Van Assche N, Quirynen M. Tolerance within a
   surgical guide. Clin Oral Implants Res 2010;21(4):455-58.
   Abstract in PubMed
   21. Al-Harbi SA, Sun AY. Implant placement accuracy
   when using stereolithographic template as a surgical
   guide: Preliminary results. Implant Dent 2009;18(1):46-56.
   Abstract in PubMed
   22. Arisan V, Karabuda ZC, Piskin B, Ozdemir T. Conventional
   multi-slice computed tomography (ct) and cone-beam
   ct (cbct) for computer-aided implant placement. Part
   ii: Reliability of mucosa-supported stereolithographic
   guides. Clin Implant Dent Relat Res 2013;15(6):907-17.
   Abstract in PubMed
   23. Cassetta M, Stefanelli LV, Giansanti M, Di Mambro A,
   Calasso S. Accuracy of a computer-aided implant
   surgical technique. Int J Periodontics Restorative Dent
   2013;33(3):317-25. Abstract in PubMed
   24. Cassetta M, Giansanti M, Di Mambro A, Calasso S,
   Barbato E. Accuracy of two stereolithographic surgical
   templates: A retrospective study. Clin Implant Dent Relat Res
   2013;15(3):448-59. Abstract in PubMed
   25. Cassetta M, Di Mambro A, Giansanti M, Stefanelli LV,
   Barbato E. How does an error in positioning the template
   affect the accuracy of implants inserted using a single fixed
   mucosa-supported stereolithographic surgical guide? Int J
   Oral Maxillofac Surg 2014;43(1):85-92. Abstract in PubMed
   26. Stubinger S, Buitrago-Tellez C, Cantelmi G.
   Deviations between placed and planned implant
   positions: An accuracy pilot study of skeletally supported
   stereolithographic surgical templates. Clin Implant Dent
   Relat Res 2014;16(4):540-51. Abstract in PubMed
   27. Valente F, Schiroli G, Sbrenna A. Accuracy of computeraided oral implant surgery: A clinical and radiographic
   study. Int J Oral Maxillofac Implants 2009;24(2):234-42.
   Abstract in PubMed
   28. Van de Wiele G, Teughels W, Vercruyssen M, et al.
   The accuracy of guided surgery via mucosa-supported
   stereolithographic surgical templates in the hands of
   surgeons with little experience. Clin Oral Implants Res
   2014;E-pub Oct 16, doi:10.1111/clr.12494. Abstract in PubMed
   29. Vercruyssen M, Cox C, Naert I, et al. Accuracy and
   patient-centered outcome variables in guided implant
   surgery: A rct comparing immediate with delayed
   loading. Clin Oral Implants Res 2016;27(4):427-32.
   Abstract in PubMed
   30. Kang SH, Lee JW, Lim SH, Kim YH, Kim MK. Verification
   of the usability of a navigation method in dental implant
   surgery: In vitro comparison with the stereolithographic
   surgical guide template method. J Craniomaxillofac Surg
   2014;42(7):1530-5. Abstract in PubMed
   31. Ruppin J, Popovic A, Strauss M, et al. Evaluation of
   the accuracy of three different computer-aided surgery
   systems in dental implantology: Optical tracking vs.
   Stereolithographic splint systems. Clin Oral Implants Res
   2008;19(7):709-16. Abstract in PubMed
   32. Sarment DP, Sukovic P, Clinthorne N. Accuracy of implant
   placement with a stereolithographic surgical guide. Int J Oral
   Maxillofac Implants 2003;18(4):571-7. Abstract in PubMed
   33. Somogyi-Ganss E, Holmes HI, Jokstad A. Accuracy of
   a novel prototype dynamic computer-assisted surgery
   system. Clin Oral Implants Res 2015;26(8):882-90.
   Abstract in PubMed
   34. Abboud M, Wahl G, Guirado JL, Orentlicher G.
   Application and success of two stereolithographic surgical
   guide systems for implant placement with immediate
   loading. Int J Oral Maxillofac Implants 2012;27(3):634-43.
   Abstract in PubMed
   35. Aboul-Hosn Centenero S, Hernandez-Alfaro F.
   3d planning in orthognathic surgery: Cad/cam surgical
   splints and prediction of the soft and hard tissues results
   – our experience in 16 cases. J Craniomaxillofac Surg
   2012;40(2):162-8. Abstract in PubMed
   36. Arisan V, Bolukbasi N, Oksuz L. Computer-assisted
   flapless implant placement reduces the incidence of surgeryrelated bacteremia. Clin Oral Investig 2013;17(9):1985-93.
   Abstract in PubMed
   37. Arisan V, Karabuda CZ, Özdemir T. Implant surgery
   using bone- and mucosa-supported stereolithographic
   guides in totally edentulous jaws: Surgical and postoperative outcomes of computer-aided vs. Standard
   techniques. Clin Oral Implants Res 2010;21(9):980-88.
   Abstract in PubMed
   38. Van de Velde T, Sennerby L, De Bruyn H. The clinical and
   radiographic outcome of implants placed in the posterior
   maxilla with a guided flapless approach and immediately
   restored with a provisional rehabilitation: A randomized
   clinical trial. Clin Oral Implants Res 2010;21(11):1223-33.
   Abstract in PubMed
   39. Vercruyssen M, van de Wiele G, Teughels W, et al.
   Implant- and patient-centred outcomes of guided surgery,
   a 1-year follow-up: An rct comparing guided surgery
   with conventional implant placement. J Clin Periodontol
   2014;41(12):1154-60. Abstract in PubMed