Implant Placement

March 17, 2023

By Dr. Fass

Technology has really changed the way we approach cases today, especially complicated ones. But many of the techniques that are used are related to techniques that may be familiar to many other common pursuits such as woodworking or machining.

When planning the case, a 3-D x-ray is taken, similar to a CAT scan, and a computer then can generate a model that can be manipulated on the screen.  Much like a physical model used by engineers or architects, the final case can be planned down to the last detail as to size, depth and any obstacles in the way. Implants must be placed 100% in healthy bone to be successful and these images ensure that this is the case.

Once the implants are put into the model, the computer can generate the plan for a mouthguard to fit the remaining teeth precisely.  A 3-D printer then creates this device in hard plastic. It has holes and stops exactly where the implants are to be placed. Any woodworker recognizes this as a drill jig. The surgeon drills through the holes, and they are at the precise depth and angle as the computer planned. The drill is an electric driven device with precise torque control. No guesswork here. The implants are then screwed in to the very precisely sized holes with, yup, a torque wrench. While you garage mechanics measure in foot pounds with your wrenches, we measure in Newton centimeters (Ncm). All very calculated and little room for error.

Once the healing is done, the case can be completed with whatever attachments were planned. The attachments are screwed into the implants, again using small torque wrenches so as not to over or under tighten the screws. For the final restorations, we sometimes use a pre-operative scan or impression if there are elements of the original dentition that we want to copy. The computer can then precisely copy any original details that we want, much as the technicians used to do all by hand.

As technology continues to advance, we are sure to see more improvement in our profession. But you can bet that many of the advances will be recognized by those familiar with simpler techniques from earlier times.

This article was published on 03-17-2023 in The Altamont Enterprise.