British Journal of Oral and Maxillofacial Surgery (2005) 43, 36—39

The ‘Chesterfield stent’: an aid to the placement

of midpalatal implants
A. Majumdar∗, D. Tinsley, J. O’Dwyer, P.T. Doyle,
J. Sandler, P. Benson, S.J. Davies

Department of Maxillofacial Surgery & Orthodontics, Chesterfield and North Derbyshire Royal Hospital,
Calow Road, Chesterfield S44 5BL, UK

Accepted 9 August 2004

Available online 27 October 2004

KEYWORDS Summary A palatal endosseous implant is a valuable adjunct to orthodontic treat-

Palatal; ment. Its insertion is considerably simplified by the use of a stent that was designed
Endosseous; in our department and that we describe here.
Orthodontic treatment © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by
Elsevier Ltd. All rights reserved.

Introduction The overall diameter is 3.3 mm and lengths of

Implantology is rapidly becoming an established
part of overall dental treatment plans and is also in-
creasingly being integrated into orthodontic treat-
ment.
Implant-assisted orthodontics started gaining
popularity in the early 1990s. The use of palatal en-
dosseous implants is a recent development and the
first clinical experiences were reported in 1996.1
The ‘‘Orthoimplant’’ system is a temporary mid-
palatal implant for orthodontic anchorage. It is
a single, solid, endosseous screw implant with a
self-tapping thread, which has a sandblasted, large
grit, acid-etched surface and a smooth transmu-
cosal neck that allows transmucosal healing.
4 and 6 mm are available.1 The orthoimplants are
designed to be implanted in the median palatal
area in the premolar region at an angle of about
60◦ to the occlusal plane.1 The placement of mid-
palatal implants is part of an ongoing randomised
controlled trial being undertaken jointly by the
maxillofacial and orthodontic departments at the
Chesterfield Royal Hospital to compare midsagit-
tal, palatal, implant-assisted anchorage with rein-
forced anchorage using head gear. The ‘Chesterfield
stent’ was designed as a template to guide the sur-
geon. It has proved to be invaluable in establish-
ing the appropriate site and angulation of the mid-
palatal implant.

* Corresponding author. Present address: Maxillofacial Unit,
Luton and Dunstable Hospital NHS Trust, Lewsey Road, Luton
LU4 0DZ, UK. Tel.: +44 776 742 5543.
E-mail address: amajumdar@rcsed.ac.uk (A. Majumdar).
Technique
We make a comprehensive evaluation of the pa-
tient and the models and radiographs to establish

0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2004.08.013
Chesterfield stent 37

Figure 1. Lateral cephalogram with assessment stent in place and final surgical stent on model with the parallel pin.

the site and the length of the implant needed. has one or two stainless steel tubes incorporated
This is crucial to avoid mistakes in implantation in the acrylic in the midline of the palate in the
and problems during orthodontic treatment. An as- premolar region. These tubes have varying angula-
sessment stent is designed in the laboratory and tions of 60◦ —75◦ to the occlusal plane. The stent

Figure 2. Surgical stent with parallel pin providing surgeon with important visual landmark for angulation of the twist
drill.
38 A. Majumdar et al.

Figure 3. Further modification of surgical template with trimming of anterior part as outlined for improved access.

Figure 4. Radiograph showing appropriately sited and angulated midpalatal implant.

Chesterfield stent
is inserted to fit on the upper arch and a lateral
cephalogram is taken with the assessment stent in
place (Fig. 1). The radiograph with the stent is ex-
amined and the optimal position and angulation of
the proposed orthoimplant is decided. The assess-
ment stent is then modified in the laboratory to
make the final surgical stent. This entails removal
of the steel tubes and creation of a window in the
acrylic at the proposed site of insertion of the im-
plant. In addition, a metal wire pointer is attached
to the acrylic plate at the desired angle of the im-
plant (Fig. 1). This acts as a parallel pin and pro-
vides an important visual landmark to the surgeon
to establish the angle of the orthoimplant twist drill
(Fig. 2).
Results
Twenty-five patients had midsagittal palatal en-
dosseous implants inserted under local anaesthe-
sia in the maxillofacial unit at the Chesterfield and
North Derbyshire Royal Hospital between August
2001 and January 2003. There were 17 female pa-
tients (age range 12—38 years) and 8 male patients
(age range 12—15 years). Only four implants failed
to osseointegrate and the operation was repeated
and was successful. Most of the failed implants were
early cases and the operation site healed unevent-
fully.
We have modified the stent further to
make it more surgeon-friendly, with improved
39
access to the twist drill and the coolant
(Fig. 3).
Discussion
Other methods of fabrication of surgical templates
for palatal implants have been described,2,3 but
they are complex and are not easy to work with,
causing difficulty in access for the twist drill and the
water coolant during preparation of the implant’s
bed. In addition, these designs do not incorporate
the parallel pin guide that is vital to ensure the
correct angulation of the implant in the anterior
maxilla. We have found that the Chesterfield stent
is simple to construct. It is easy to work with during
operation and ensures precise location and angula-
tion of the implant and predictability of its place-
ment (Fig. 4).
References
1. Wehrbein H, Merz BR, Diedrich P, et al. The use of palatal
implants for orthodontic anchorage. Design and clinical
application of the orthosystem. Clin Oral Implants Res
1996;7:410—6.
2. Martin W, Hefferman M, Ruskin J. Template fabrication for
a midpalatal orthodontic implant: technical note. Int J Oral
Maxillofac Implants 2002;17:720—2.
3. Tosun T, Keles A, Erverdi N. Method for the place-
ment of palatal implants. Int J Oral Maxillofac Implants
2002;17:95—100.