Tag Archives: Surgical Planning

Case of the Month: No Bone Solution™ Computer Guided Implant Surgery Protocol for Prosthodontic Rehabilitation of the Severely Atrophic Maxilla

Thomas J. Balshi, DDS, PhD, FACP, Glenn J. Wolfinger, DMD, FACP, John J. Thaler, James R. Bowers, Stephen F. Balshi

The Journal of Implant and Advanced Clinical Dentistry, Volume 1, No. 2, April 2009.

Background: Prosthodontic rehabilitation of the severely atrophic maxilla presents significant challenges to the restoring dental team. Inadequate bone quantity often necessitates time dependent augmentation procedures that considerably delay delivery of the final dental prostheses. This case report demonstrates a newly developed specialized  computer guided dental implant surgery protocol for prosthetic rehabilitation of the severely atrophic maxilla: the No Bone Solution.™

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Guided Implant Placement and Immediate Prosthesis Delivery Using Traditional Brånemark System Abutments: A Pilot Study of 23 Patients

Balshi SF, Wolfinger GJ, Balshi TJ

Implant Dent. 2008 Jun;17(2):128-135.

*Chief Operating Officer, CM Prosthetics; Director of Biomedical Engineering & Research, PI Dental Center, Institute for Facial Esthetics, Fort Washington, PA. †Prosthodontist, PI Dental Center, Institute for Facial Esthetics, Fort Washington, PA. ‡Founder and Prosthodontist, PI Dental Center, Institute for Facial Esthetics, Fort Washington, PA.

PURPOSE:: The aim of this study is to demonstrate the accuracy and clinical precision of a guided surgery protocol by using traditional Brånemark System abutments in conjunction with a prefabricated all-acrylic provisional prosthesis that is immediately installed after implant placement. MATERIALS:: All presurgical methods in this treatment follow the standard NobelGuide protocol with the exception of the laboratory phase. Once the master cast is retroengineered from the surgical template, traditional Brånemark System abutments were secured onto the implant replicas (master cast) and an all-acrylic provisional prosthesis was constructed at the abutment level. The typical abutments used with this protocol, adjustable Guided Abutments, were not used. RESULTS:: Twenty-three patients were treated in this pilot study. Via the surgical template, all implants were placed to the desired depth as planned in the virtual implant planning program. After the traditional Brånemark Abutments were installed, the provisional prosthesis was delivered and occlusion verified. The prosthesis fit was checked at abutment level clinically and radiographically. CONCLUSION:: This report shows the extreme accuracy of this guided surgery protocol. If each step of this protocol is followed precisely, it is possible to deliver a prefabricated prosthesis built to traditional Brånemark System Abutments, which is extremely favorable for long-term patient and prosthesis management.

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Surgical Planning and Prosthesis Construction Using Computer Technology and Medical Imaging for Immediate Loading of Implants in the Pterygomaxillary Region

Stephen F. Balshi, MBE / Glenn J. Wolfinger, DMD, FACP / Thomas J. Balshi, DDS, PhD, FACP

Int J Periodontics Restorative Dent 2006;26:239 247.

This report describes a protocol that uses computerized tomography (CT), computer-aided design/computer-assisted manufacture (CAD/CAM) technology, and the Internet to plan placement of anterior and posterior dental implants and construct a precise surgical template and definitive prosthesis, which is connected at the time of implant placement. This procedure drastically reduces surgical treatment time and the recovery period. Patients with an edentulous arch had a denture with radiopaque markers constructed for CT scans of the appropriate jaw. The CT images, with acquisition slices of 0.5 mm, were transferred into a three-dimensional image-based program for planning and strategic placement of dental implants. After implants were virtually placed on the computer, the surgical treatment plan was sent to a manufacturing facility for construction of a surgical template and the prosthesis. Special surgical guide components were also manufactured for placement of implants in the pterygomaxillary region. The manufactured surgical components, surgical template, and definitive prosthesis were then delivered to the clinical site. Implant placement surgery was performed using the surgical template, without a flap, and the prosthesis was delivered, achieving immediate functional loading. Minor occlusal adjustments were made. The total surgical treatment time required was less than 60 minutes. Postoperative symptoms, such as pain, swelling, and inflammation, were minimal. Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows precise placement of implants. CAD/CAM technology using the three-dimensional images allows for fabrication of the surgical guide and final prosthesis. This is a significant advancement in implant dentistry and prosthodontics.

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Surgical planning and prosthesis construction using computed tomography, CAD/CAM technology, and the Internet for immediate loading of dental implants

J Esthet Restor Dent. 2006;18(6):312-23; discussion 324-5.

Balshi SF, Wolfinger GJ, Balshi TJ.
CM Ceramics USA, Mahwah, NJ, USA. balshi2@aol.com

This report describes a protocol that uses computer technology and medical imaging to virtually place anterior and posterior dental implants and to construct a precise surgical template and prosthesis, which is connected at the time of implant placement. This procedure drastically reduces patient office time, surgical treatment time, and the degree of post-treatment recovery. Patients with an edentulous arch or a partially edentulous area had a denture with radiopaque markers constructed for computed tomography (CT) scans of the appropriate jaw. The CT images, having acquisition slices of 0.4 mm, are transposed in a three-dimensional image-based program for planning and strategic placement of dental implants. After virtual implant placement on the computer, the surgical treatment plan is sent to a manufacturing facility for construction of the surgical template. The manufactured surgical components and surgical template arrive on the clinical site. From the surgical template, the dental laboratory retro-engineers the master cast, articulates it with the opposing dentition based on a duplicate of the scanning denture, and creates the prosthesis. Using the surgical template, minimally invasive surgery is performed without a flap, and the prosthesis is delivered, achieving immediate functional loading to the implants. Minor occlusal adjustments are made. The total surgical treatment time required is typically between 30 and 60 minutes. Postoperative symptoms such as pain, swelling, and inflammation are dramatically reduced.

CLINICAL SIGNIFICANCE: Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows the clinician to precisely place implants. Computer-aided design/computer-assisted manufacture technology using the three-dimensional images allows for fabrication of the surgical template. This is a significant advancement in implant dentistry and promotes interdisciplinary approaches to patient treatment. The implant surgeon and restorative dentist can agree upon implant locations and screw access locations prior to the surgical episode.

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