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Table of Contents
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 60-63

Computed tomography guided mock up driven designing of implant surgical guide: A novel technique

1 Department of Prosthodontics, KLE VK Institute of Dental Science, KAHE (KLE University), Belgaum, Karnataka, India
2 Department of Prosthodontics, KIMS, Bellary, Karnataka, India

Date of Submission09-Nov-2020
Date of Decision04-Mar-2021
Date of Acceptance07-May-2021
Date of Web Publication10-Jun-2021

Correspondence Address:
Dr. Santosh Nelogi
House #1, 1.I.G. Phase III, Adarsh Nagar, Gulbarga, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdi.jdi_30_20

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Prosthodontic implant rehabilitation remains one of the most complex restorative challenges because of the most usual troubles with regard to the lack of adequate treatment planning. Position, angulation, implant diameter, and length of an implant need to be determined before the surgical procedure is planned. This article briefs about the novel technique of presurgical mock up of implant site and evaluation of implants – Position, angulation, and complexity of procedure on the study model.

Keywords: Implant mock-up, implant surgical guide, implants

How to cite this article:
Nelogi S, Nelogi M, Rachana K B. Computed tomography guided mock up driven designing of implant surgical guide: A novel technique. J Dent Implant 2021;11:60-3

How to cite this URL:
Nelogi S, Nelogi M, Rachana K B. Computed tomography guided mock up driven designing of implant surgical guide: A novel technique. J Dent Implant [serial online] 2021 [cited 2021 Nov 29];11:60-3. Available from:

   Introduction Top

Prosthodontic implant rehabilitation remains one of the most complex restorative challenges because of the most usual troubles with regard to the lack of adequate treatment planning. Position, angulation, implant diameter, and length of an implant need to be determined before the surgical procedure is planned.

A review through the literature[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] reveals several implant surgical guide for the placement of an implant, but the techniques mentioned do not guide the surgeon to perform presurgical mock-up evaluation with drill to the full depth of an implant site at determined angulation. They only mention about the placement of the implant and provide little or no information about the diameter of implant and abutment angulation required at proposed implant site.

Surgical guides made-up with the data obtained from panoramic or peri apical images to a degree based on two-dimensional imaging, which offer little or no information about the diameter of implant and abutment angulation required at proposed implant site.[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26]

Computed tomography (CT) has frequently been used as an imaging system for presurgical assessment for implant positioning.[17],[27],[28],[29],[30],[31],[32] The evaluation of available bone offers improved determination of the bone density and the localization of anatomical structures, it provides information about the trajectory of implant placement.[19]

With the progression of implant, imaging system software-guided implant position is frequently employed to direct the surgeon in placing the implant in the planned position with the proper angulation.

Even though useful, CT-guided surgical guide turns to be expensive and not feasible for all patients.

The next coherent step is to construct a surgical guide that in blend with a CT. This would illustrate the tangible implant site and the path of the implant position. The purpose of this article is to describe novel surgical guide fabricated by with the help of a CT as an alternative.

   Materials and Methods Top

  1. Make maxillary and mandibular over extended impressions with elastomeric impression material (Aquasil Ultra Soft Putty; Aquasil Ultra LV Wash; Dentsply International, Milford, Del) and pour casts with Type III dental stone. (Kalastone; Kalabahi ltd, Mumbai, India)
  2. The diagnostic CT scans of the patient are subjected for dolphin implant planer (or any implant planner), precise and appropriate placement of a dental implant with proper angulation is planned.

Preparation of mock up model

  1. Using the pin index system, removable die of the proposed implant site is prepared [Figure 1]
  2. The trajectory of the planned implant cross-sectional image of proposed implant site print out is taken on clear cellophane sheet without any magnification error [Figure 2] and is then delineated on to the respective removable dies of the proposed implant site through a conversion procedure [Figure 3]
  3. The central line delineated on to the respective removable dies of the proposed implant site at the time of planning of implant to determine the correct implant angulation. For every implant site, the vertical configuration of line presents the original spot, close to which position and angulation of implant is planned
  4. Mockup osteotomy done on die according to marked bony architecture
  5. Analyzing rods are aligned with the long axis of the marked bony architecture, which centered over the outline representing the location, diameter of implant, and angulation for implant placement [Figure 4]
  6. The vertical alliance of analyzing rod presents the original position of implant at that particular situation [Figure 3] and [Figure 4]
  7. At this angulation of analyzing rod, the round stainless steel tube of length 6 mm and with inner diameter of 2 mm is positioned over the analyzing rod, lightly contacting the cast [Figure 5]. When tube position and required abutment angulation is conformed, autopolymerizing acrylic is added incrementally to stabilize the tube
  8. When resin is polymerized, the surgical guide is recovered carefully from the mold to evade any damage or alteration of angulation of the stainless steel tube and sterilized by using cold sterilization [Figure 6].
Figure 1: Die with mock up osteotomy site for implants

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Figure 2: The trajectory of the planned implant cross-sectional image of the proposed implant

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Figure 3: Proposed implant delineated on to the respective removable dies

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Figure 4: Analysing rod in position along the long axis of predicted implant location

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Figure 5: Analysing rod with a tube of inner diameter 2 mm

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Figure 6: Implant surgical guide

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   Discussion Top

A prosthetically guided implant placement often takes the help of radiography and surgical guides for implant placement.[33],[34] Some surgical guide provides data regarding the mesiodistal location of the implant, but no data on its angulation, others provide data on the location and angulation but not the depth. With the progression of computer engineering and software-guided implant placement is frequently employed to guide the surgeon in positioning the implant in the planned spot, at the proper depth, and with the proper angulation, which is not workable for most of the patient.

Surgical guides based on the practical planning information assures of precise guidance for implant positioning. Petersson et al.[35] and Weinberg[36] documented that preoperative CT was necessary in approximately two-thirds of patients for proper implant orientation even after panographic evaluation.

The surgical stent mentioned in this article helps the surgeon to perform presurgical mock up on the model and shows detailed three-dimensional relationships with the proposed implant site, also guides the surgeon to maintain predetermined angulation at the proposed implant site preventing any fenestration during surgery and ensures that the implant is correctly oriented with respect to the planned restoration.

The surgical guide with detailed three-dimensional position of stainless steel tube functions as a precise surgical osteotomy guide. The osteotomy prepared in the bone with surgical guide has the same orientation as the mock-up osteotomy in the mold and is coherent with the planned prosthetic angulations.

The stent also allows the pilot drill to be placed up to the required length along one specific path, avoiding the risk of change in angulations in subsequent drilling and thereby reducing the inadvertent eccentric enlargement of the implant site. The novel technique consists of mock up osteotomy on cast, which helps the restorative dentist to know the desired abutment angulation required for the placement of esthetic restorations.

The above-mentioned technique can be used for single or multiple implant placements. In multiple implant placements, this technique helps the operator to ensure parallelism between the implants and achieves the desired inclination of implant in accordance to the bony architecture.

During the cross-sectional imaging, if a variance is established between the premeditated prosthetic angulation and the residual bone, angulation, the analyzing rod is changed and the stainless steel tube is reoriented.

The implant placement planned in concurrence with CT imaging is a comparatively economical way to assess bone quality and at the same time, provides data about the trajectory for the placement of the dental implant in three dimensions.

The advantage of this technique is that it is simple and easy to fabricate and uses the material that are inexpensive and readily available. When the surgeon uses this surgical guide for placement of implant, the implant is placed as per the predetermined position and hence helps the restorative dentist in planning the restoration. Since the implant location and the desired abutment angulation are known, a provisional restoration can be fabricated and then that it can be cemented at the time of surgical operation if an immediate provisional restoration is preferred.

   Conclusion Top

The assembly of surgical guides in concurrence with a CT scan makes the provision of dental implant placement a more exact and reliable routine, provides information involving the trajectory for the location of the dental implant. The novel surgical guide mentioned in the article allows for evaluation not only of available bone height and width, but also the angulation and would describe the actual implant site and angulation on removable die and provide data about the trajectory of the position of the dental implants.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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