ConeBeam orthodontic practice: where to begin?
Dr Keyvan Davarpanah
3D planning and guided implant placement in the partially edentulous orthodontic patient before starting orthodontic treatment.
This paper presents an unconventional protocol that reverses the therapeutic chronology of classical orthodontic treatment of the partially edentulous patient, with or without orthognatic surgery. It drastically eases and shortens treatment.
Materials & Methods
To achieve global rehabilitation, patients displaying partial edentulism and malocclusion are proposed orthodontic treatment and dental implant placement. Unfortunately, implants cannot be placed before completion of the orthodontic treatment because exact final location cannot be determined before orthodontic termination.
Reversion of treatment chronology consists into placing the implants in their final position before beginning orthodontics. This can be done by, 1) anticipating the final position of involved teeth, 2) anticipating implant position in the anticipated skeleton, 3) placing the dental implants accordingly with a precise surgical guide. Two modules of the Simplant Pro Crystal software were integrated; one deals with computer guided implant placement (Simplant), the other with maxillofacial guided surgery (Simplant OMS).
Steps of the protocol are the following:
1) 3D tomographic acquisition
2) scan of the orthodontic models before and after set-up
3) preview of the ortho-surgical simulation by superposing the initial and final set-up models
4) simulate implant position taking into account the skeletal changes following orthodontic surgery
5) prepare a tooth-supported stereolithographic stent to place the implants
6) place implants in anticipated final position, to serve the purpose of absolute anchorage and prosthetic rehabilitation
7) place the orthodontic hardware, start treatment during osseointegration
8) after 8w of healing, orthodontic attachments are placed on the implants to take advantage of absolute anchorage.
Results & Discussion
When orthodontic treatment is involved, even the most skilled surgeon cannot properly anticipate the position of implants placed to suit the future skeleton and teeth situation. Integration the simulation software was mandatary. Five patients are now under treatment with this reversed protocol. The benefit of this protocole is to, 1) reverse the therapeutic sequences, 2) introduce absolute anchorage, 3) decrease overall treatment time.