Treatment planning conventional, model based, non-guided, semi-guided
- Based on the diagnostic provisional set-up, a surgical guide template can be fabricated in order to facilitate proper positioning of implants in bone.
- Surgical guide templates can be conventional model based or cone beam computer tomography based.
A surgical guide template is used during surgery as an aid for proper positioning of the implant in the bone. There are three design concepts based on the amount of surgical restriction offered by the surgical guide templates:
- non-limiting design;
- partially guided design: the first drill used for the osteotomy is directed using the surgical guide template;
- completely guided design.
In general, the non-limiting and semi-guided designs are conventional model based, whereas the completely guided design is based on cone beam computer tomography and planning software.
The non-limiting design is based on a cast and wax-up and mostly a vacuum-formed template has been made with an open space at the occlusal part of the future restoration. This design provides only an indication, without angulation, to the surgeon as to where the proposed prosthesis is in relation to the selected implant site (Figures 1 & 2).
The partially guided design is also based on a cast and wax-up and an acrylic resin matrix is made over the occlusal part of the remaining dentition, including the future position of the implant-supported restoration. A hole is driven into the acrylic resin in line with the desired position and angulation of the implant in relation with the future restoration. Acrylic resin is removed at the labial or palatal/lingual side, leaving an half-open tube for position and angulation of the first drill. The first drill used for the osteotomy is directed using the surgical guide template, and the remainder of the osteotomy and implant placement is then finished freehand by the surgeon, still giving some flexibility.
Figure 1: Non-limiting surgical guide template situated on cast Figure 2: Non-limiting surgical guide template