Article
Implant-supported prostheses are an option to replace missing teeth. A systematic review reported the survival rate of dental implants at 10 years was 96.4%.1 Although dental implants have high survival rates, the overall success of implant treatment depends on both aesthetic and functional outcomes. Correct implant placement influences the position and shape of the final restoration. Previously, dental implant placement was dictated by the quality and quantity of bone and protocols for placement reflected this. This bone-driven implant placement approach sometimes resulted in malpositioned implants causing aesthetic, biological and technical complications. Aesthetic complications include elongated implant crowns and disharmony of the soft tissue profile including the absence or reduction of interdental papillae.2 These complications can be caused by incorrect planning and can be reduced by an awareness of the need for prosthetically driven implant placement.
Planning for implant placement is enhanced by the use of cone beam computed tomography (CBCT) in conjunction with a diagnostic wax-up of the proposed restoration. From these diagnostic tools, a suitable surgical guide for placement can be made. The surgical guide, which is fabricated with radiopaque markers will allow the surgeon to verify the three-dimensional relationship of the implant in the mesiodistal (sagittal), corono-apical (transverse) and bucco-lingual (coronal) planes to the proposed restoration.3 Despite the advantage of using surgical guides, the conventional method of free-hand implant placement is still widely used. A systematic review reported that both guided and free-hand implant placement resulted in high implant survival rates. The number of implant failures, such as occurs when implants are not osseo-integrated or are aesthetic failures, were three times greater for those placed free hand than those with guided placement.4
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