Dental Team Luzern - Clinic Dr. Schulte

Implants

New surgical procedures

Computer guided implantation

Our latest generation cone beam scanner – precise 3D-images with low radiation exposure

Computed tomography permits the preparation of true to scale three dimensional images (3D) of the facial bones. With special software (e.g. Med3D®, NobelGuide® or Smop®) it is now possible to select the suitable implants virtually on the computer screen and place them in the optimal position. Sensitive anatomical structures, such as sensory nerves, can be made visible and damage to them can be avoided. In addition, the precise imaging permits optimal use of the patient's available bone which in some cases makes bone augmentation unnecessary.

 

Virtuelle Implantation am Computer 3-D-Schablone

Virtual implantation on the computer and 3D-template

The digital data obtained in this virtual implantation are then used to prepare a three-dimensional template made of plastic or titanium. This drilling template is placed in the patient's mouth during the implant operation. Drill sleeves in the template guide the bone drill during the implantation and ensure that the implants are placed exactly in the ideal position planned on the computer. The benefit for the patient is that the gums often do not have to be opened (no swelling, practically no pain after the procedure). A further advantage of template guided implantation is the possibility of preparing an exactly fitting provisional bridge before the implant placement. This means that ideally the patient can go home with fixed, functional teeth shortly after the implant placement. In order not to raise false expectations and give you honest information we should, however, mention that at the present time computer guided template implantation is not possible or appropriate in all cases. We always use this particularly safe and gentle method if it brings the patient concrete benefit.

Example from our practice

Full-mouth reconstruction with computer guided implantology

This 84-year-old woman could no longer cope with her old, poorly fitting dentures and came to us for advice about fixed tooth replacement on implants. On account of the patient's advanced age we wanted to offer her the least traumatic, minimally invasive procedure possible.

Computergeführte ImplantationComputergeführte ImplantationComputergeführte Implantation

Computergeführte Implantation

First we obtained a CT scan with X-ray films placed in the upper and lower jaws (cone beam volumetric tomography (CBVT) with particularly low radiation exposure) in order to perform a three-dimensional analysis of the available bone. The evaluation of these X-rays showed that there was sufficient bone mass for immediate implant placement without bone augmentation using the All-On-4-method.

The planning of the optimal positioning of the implants in the bone and the determination of the diameter and length of the implant were performed virtually on the computer using the Med3D® software. The digital data thus obtained were sent to a specialised dental laboratory which fitted the X-ray templates with highly precise drill sleeves which serve to guide the drilling and the implants into exactly the previously planned correct position during implantation.

Computergeführte ImplantationComputergeführte Implantation

Then the operation could be performed with local anaesthesia. The remaining pivot teeth were removed. Then the templates were fixed in the mouth, the implant drilling performed through the drill sleeves, and the implants placed in the planned position, again using the template. The great advantage of the computer guided implantology is that it is no longer necessary to first open the gums with a scalpel and expose a large area of bone. As the implant position has already been planned on the computer the drilling can be performed minimally invasively through the closed gum tissue and the implants placed in the drill holes. According to the all-on-4 method, four implants were placed in each jaw.

Computergeführte ImplantationComputergeführte Implantation

Computergeführte ImplantationComputergeführte Implantation

The operating time was thus considerably shortened to about 45 minutes per jaw. The swelling and pain normally observed after major implant operations were almost entirely absent, there was no bleeding or bruising either.

As the implant positioning had already been decided preoperatively (before the operation), the dental technician was able to make the provisional restorations before the implant placement. These bridges were screwed onto the implants immediately after the operation (immediate loading).

The patient was able to leave our practice with fixed tooth replacement on implants. The definitive All-On-4 bridges were fitted after three months.

Computergeführte ImplantationComputergeführte Implantation

Computergeführte Implantation Computergeführte Implantation

↑to table of content

Piezo-Surgery

Piezo Chirugie Gerät

Piezosurgery is a novel bone surgery technology developed by Prof. Tomaso Vercellotti that also opens up new horizons for dental implantology. Specially developed surgical instruments that utilize microvibrations at ultrasound frequencies allow extremely atraumatic bone cutting with minimal damage to tissue. The biggest advantage of Piezosurgery compared with the conventional scalpels, drills and burs used for cutting bone is its selective cut. This means the instrument cuts easily through hard tissue (bone) while soft tissue such as nerves, blood vessels or gum tissue remains undamaged even if it comes into direct contact with the tip of the instrument. Another advantage of Piezosurgery is that there is practically no bleeding, the bone is not traumatized and wound healing is therefore much better. We use this innovative technology mainly for taking bone grafts, for the sinus lift procedure and for all operations in which there is a danger of injuring nerves or blood vessels.
Further information on Piezosurgery

 

↑to table of content

PRP: Growth factors from the patient's blood

A recent development in implantology is the administration of factors which stimulate bone growth. The aim of this strategy is to accelerate integration of the implants into the bone and thus shorten the often tedious healing phase (with provisional bridge or dentures) following implant placement.

The platelet rich plasma (PRP) obtained from the patient's blood contains high concentrations of a number of growth factors in addition to the platelets. These growth factors lead to good bone regeneration and help achieve faster and better wound healing particularly in high-risk patients (e.g. diabetics, smokers). In our practice we use the automatic PCCS system from the company 3i to obtain the PRP. The system requires only 60 ml of the patient's blood to prepare the concentrate.

↑to table of content

Zygomatic and pterygoid implants
Immediate rehabilitation of the atrophic upper jaw

Zygoma Implantate

Zygoma implants and pterygoid implants are an interesting alternative to bone grafting in the case of severe bone loss in a toothless upper jaw. Special very long (about 50 mm) implants are anchored in the zygomatic bone or the pterygoid bone and used to support a fixed implant bridge. The bone volume of the zygomatic / pterygoid bone remains quite stable even when there is bone loss in the region of the jawbones. One can either combine two to four normal implants at the front with two zygoma implants or use four zygoma implants (two on each side), if necessary combined with two pterygoid implants. The bridge which is screwed onto the implants is then fitted using the All-On-4 method. If there is severe bone loss in the upper jaw, zygoma implants are the only means of providing immediate fixed tooth replacement without extensive bone grafting. The stress and risk of the operation are far less than in the case of major bone augmentation. Further advantages are the drastically shortened treatment times due to the possibility of immediate loading of the implants and the considerably lower cost as no bone grafting and no hospitalization are necessary.

 

Example from our practice

Zygomatic Implants

Zygoma-Implant Zygoma-Implant Zygoma-Implant

This 56-year-old patient consulted us because she had serious problems with her poorly fitting removable upper dentures. The X-ray and CT scan showed massive bone loss (atrophy) in the upper jaw so that placement of implants would have required prior major bone augmentation. For this bone graft we would have had to take bone from the hip. This is quite a stressful procedure for the patient. After the bone graft patients have to remain in hospital for a few days and there is often some difficulty walking in the first weeks after the operation due to the bone removal from the hip. In addition, in the initial phase not even provisional dentures can be used so as not to jeopardize the integration of the grafted bone. Then, for about nine months after the procedure, only a provisional removable full denture can be worn. It should also be mentioned that such large bone grafts have a relatively high failure rate of about 15-20%.

After thorough discussion of all the options, our patient therefore decided on zygoma implants. In an outpatient operation under general anaesthesia we removed the remaining teeth from the upper jaw and stably anchored four zygoma implants, two on each side, in the zygomatic bone. On the very same day we were able to install a fixed provisional bridge on the implants (immediate loading). Three months later the definitive prosthetic rehabilitation was performed (see pictures below).

Zygoma-Implant Zygoma-Implant Zygoma-Implant

Here you can access further scientific information on zygomatic implants and pterygoid implants

↑to table of content