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Implant planning with standardised spacers
The application of intraoperative positioning aids in the form of implant drilling templates allows those who are new to implantological procedures, and also experts, to work confidently when carrying out targeted prosthetic oriented implant insertion. As an alternative to drilling templates produced for dentistry, the IDC system is suitable for use as an individually adjustable, prefabricated template system.
A user report from: Dr. Neugebauer, Dr. Karapetian, Dr. Lingohr, Univ. Prof. Zöller (Cologne)*
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It has been shown that for an optimum supply when there is an adjacent row of teeth, a distance of 1.5 to 2 mm must be maintained between the implant and the tooth. The bone level between the implants seems to be the most stable when there is a distance of at least 2 to 3 mm. These distances primarily need to be considered during the implant planning and the implementation of the implants in the operations.
During the implant planning, there are requirements not just for the positioning of the implant, but also for the influence of the selected implant diameter which can vary between 2.8 and 6.5 mm and sometimes even up to 7 mm in the different systems. For the user, this means that it must usually be chosen to carry out the initial pre-drilling with a 2 mm spring bur under consideration of the final implant diameter.
This means that e.g. in order to achieve a distance of 3.0 mm with implants of 3.0 and 3.4 mm, a distance of 6.2 mm is required between the central points. However, a targeted distance of 3 mm between 4.5 and 5.5 mm implants requires a distance of 8 mm for the respective position of pre-drilling. This therefore shows that the combination of different diameters means that a relatively complex mathematical procedure is needed to determine the exact position of these implant elements.
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left: Centring hole in the case of bone defect in region 014 with spacer B and selection of the spacer block for prosthetic oriented position in region 015. right: Inclusion of spacer 2 with distance gauge and contra-angle handpiece.
left: Fixing of distance gauge 2 in region 015 with pin in position 014. right: Implant insertion with a distance of the width of two premolars to the terminal column in position 015.
W&H's use of the IDC system is one possible solution. The company uses a distance gauge during the initial pre-drilling with the surgical contra-angle handpiece which uses a spring mechanism to allow movement of the bur through a spacer to provide an initial centring hole. The spacers for the centring hole are supplied in three diameters meaning that a distance of 2 mm between the tooth and the implant can be achieved for the respective implants.
This initial centring hole is suitable for allowing distance drilling to be carried out with another spacer with a pin. As a result, it is possible to prepare the respective implant to implant distance for several implants. By showing the distances in a table, it is possible to select the respective implant diameter which is optimally suited for the existing horizontal bone supply. This means that optimum use can be made of the bone supply according to the prosthetic conditions.
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* Source: Implantology Journal of the DGZI (German Association of Dental Implantology).
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