Techniques for the use of CT imaging for the fabrication of surgical guides.

Implant dentistry has evolved into one of the most predictable treatment alternatives for partially and completely edentulous patients. The initial excitement about successful osseointegration has allowed clinicians to offer an extended set of treatment alternatives that include single tooth replacement to full mouth reconstruction. Pioneering protocols of the early 1980s relied on a two-stage surgical approach that allowed for the biological aspects of osseointegration to be achieved at the cellular level, insuring long-term success. These procedures often required extended periods of time to complete. Through strategic marketing and word of mouth, demand for implant-related treatment continues to grow and has compelled clinicians to search for new and improved methods to deliver such care within a shorter time period without sacrificing accuracy. As treatment protocols have progressed, implant manufacturers have met the challenge of providing surgical and prosthetic components to maximize outcomes in function and esthetics. However, as with any surgical intervention, problems can arise. Often, difficulties related to poor surgical or prosthetic outcomes can be directly linked to the diagnostic and treatment-planning phase. Proper treatment planning should consist of a thorough assessment of the intraoral hard and soft tissue via direct examination, periapical and panoramic radiography, mounted study models, and (when required) a diagnostic wax-up of the desired result. Most dental students who were trained during the last 25 years in the United States were not taught how to adequately diagnose or plan a dental implant case. Other available diagnostic tools for preoperative assessment can include two-dimensional cephalometric or tomographic films (analog or digital), tissueor bone-mapping techniques to assess underlying bone geometry, and drilling into stone models to simulate intraoral implant positioning. Recently, emphasis has shifted from relatively arbitrary implant placement in good available host bone (assessed by the surgeon at time of surgery) to placing implants with consideration of the final prosthetic outcome, soft tissue management, emergence profile, and tooth morphology. The goal of implant dentistry is not the implant; it is the tooth that we replace. To facilitate accurate translation from the desired plan to the surgical reality, templates or surgical guides should be used.