A complete denture, worn and volume can be modified to allow ac- dibular implant-retained overden-
validated by a patient, constitutes a cess for the contra-angle handpiece ture. This duplicate is used, at first,
reference for evaluating the implant and improve operating site visibility as a radiographic guide to validate
treatment feasibility for mandibular during implant surgery. In situations or modify the implant planning. As
implant-retained overdentures.1 Clini- of highly resorbed edentulous man- a radiographic guide, it allows for
cal evaluation of prosthesis quality is dibular residual ridges, the radio- the visualization of the following in-
essential for preoperative diagnosis graphic guide is an essential tool, formation: planned implant axis,
and treatment planning.2 The use of during the radiographic analysis, for prosthetic volume, emergence site,
a complete denture duplicate as a ra- selecting optimal implant sites in re- available prosthetic space for the at-
diographic guide or surgical template duced bone volume, compatible with tachment components, and mucosal
is described in the literature.3,4 The implant placement according to the thickness. Analysis of the computer-
duplicate denture provides advan- prosthetic design. ized images enables the clinician to
tages over using the patients existing Three-dimensional (3-D) diagnos- select optimal implant sites and to
complete denture. First, the use of a tic and treatment planning systems confirm or modify the implant axis
duplicate removes the risk of alter- are available and can also assist clini- according to prosthetic and anatomic
ing or weakening the original denture cians in determining the best implant requirements. Secondly, the radio-
when creating reference landmarks location and prosthetic planning.7-9 graphic guide is then transformed
(drilling, grooves). Also, the original Fixing the stereolithographic surgical into a surgical template. During sur-
dentures esthetic appearance and template onto the bone ensures accu- gery, this removable surgical template
surface texture are preserved when rate implant placement.10-11 However, offers flexibility without compromis-
radiopaque materials, such as gutta- the anchor pins used to fix this tem- ing access to the implant sites. Once
percha or zinc oxide cement, which plate may be difficult to place in an osseointegration of the implants is
serve to indicate ideal implant lo- atrophic mandibular residual ridge. achieved, the template is finally con-
cations, are used.5 Alternatively, a Moreover, the software and stereo- verted into an occlusally adapted
barium sulfate-based radiopaque lithographic surgical template present custom tray, which is a duplicate of
duplicate enables visualization of the substantial costs, and the use of each the complete denture worn by the pa-
essential elements required for im- requires experience and computer tient.
plant planning, directly from the ra- skills.12-13 Advantages of the technique de-
diographs.6 Transforming the radio- This article describes a simple pro- scribed include its cost effectiveness
graphic guide into a surgical template cedure for making a multipurpose and the use of equipment and materi-
provides additional benefits, facilitat- duplicate of the patients complete als commonly found in dental offices.
ing surgery. The duplicates prosthetic denture to plan and fabricate a man- The use of a single guide allows the
a
Assistant Professor, Department of Prosthetic Dentistry.
b
Associate Professor, Department of Oral Surgery.
c
Associate Professor, Department of Prosthetic Dentistry.
Wulfman et al
54 Volume 103 Issue 1
clinician to refer to recorded pros-
thetic data at each step of implant
treatment.
TECHNIQUE
5 Prosthetic information appears on CT-scan images: prosthetic volume, bone volume, potential
implant axis, and mucosal thickness.
from the radiographic images, and sur Seine, France) with an internal surgical template for 30 minutes in a
confirm or modify the implant axes, diameter of 2.1 mm in the selected chlorhexidine solution (Eludril; Pierre
considering anatomic requirements positions (Fig. 6) to serve as drilling Fabre Medicament, Castres, France).
(Fig. 5). guides for the 2-mm twist drill during 9. Raise the mucoperiosteal flaps
surgery. to expose the bone. Place the surgical
Fabrication and use of the surgical 8. Remove the buccal and lingual template on the denture-bearing area
template flanges in the anterior portion of the and maintain firmly by applying digi-
surgical template to allow use of surgi- tal pressure on the first molar area.
7. Drill the guide according to the cal instrumentation and maintain vis- Use the template to guide the 2-mm
planned implant position and orien- ibility of the surgical site. Modify the twist drill through the cortical bone
tation with a 3-mm twist drill (Twist acrylic resin at the occlusal level so as for each implant site. Remove the
Drill, 3 mm, 25013; Nobel Biocare to avoid contact between the contra- surgical guide and place a direction
AB). Incorporate steel tubes (215 610 angle head and the surgical template indicator (Branemark System Direc-
002; Weber Mtaux et Platiques, Ivry during drilling (Fig. 7). Disinfect the tion Indicator 28976; Nobel Biocare
Wulfman et al
56 Volume 103 Issue 1
6 Tubes with 2.1-mm internal diameter in selected im- 7 Surgical template with modifications of acrylic resin
plant site. base and incisal surfaces.
Objectives: The literature demonstrates that conventional luting of metal-based restorations using zinc phosphate
cements is clinically successful over 20 years. This study compared the clinical outcomes of metal-based fixed partial
dentures luted conventionally with zinc phosphate and self-adhesive resin cement.
Methods: Forty-nine patients (mean age 54 13 years) received 49 metal-based fixed partial dentures randomly luted
using zinc phosphate (Richter & Hoffmann, Berlin, Germany) or self-adhesive resin cement (RelyX Unicem Aplicap,
3M ESPE, Germany) at the University Medical Center Regensburg. The core build-up material was highly viscous glass
ionomer; the finishing line was in dentin. The study included 42 posterior, 5 anterior crowns and two onlays. Forty-
seven restorations were made of precious alloys, 2 of non-precious alloys. The restorations were clinically examined
every year. The clinical performance was checked for plaque (0-5; PI, Quigley-Hein), bleeding (0-4; PBI; Mhlemann)
and attachment scores. The examination included pulp vitality and percussion tests.
Statistics: Means of scores, standard deviation, cumulative survival and complication rates were calculated using life
tables.
Results: The mean observation time was 3.16 0.6 years (min: 2.0; max: 4.5 years). During that time no restoration
was lost, no recementation became necessary. One endodontic treatment was performed in the self-adhesive compos-
ite group after 2.9 years. At study end bleeding (1.44 RelyX Unicem vs. 1.25 zinc phosphate) and plaque (1.64 RelyX
Unicem vs. 1.0 zinc phosphate) scores showed no statistically significant difference.
Significance: The self-adhesive resin cement performed clinically as well and can be used as easily as zinc phosphate
cement to retain metal-based restorations over a 38-month observation period.