I
mproved and more natural implant placements are something that the entire dental community strives for with each passing day. Every new insight into the latest implant design or treatment approach has pushed the limits on how to best serve patients who are living with complete or partial edentulism.
The current gold standard for optimising long-term results is prosthetically-driven implant placement. This looks to determine the progression of treatment through the lens of the final prosthesis, ensuring the position and depth of the implant places the prosthesis in the optimal location, through precise treatment planning.[i] In return, clinicians can expect to deliver an aesthetic result that has considered everything from emergence profiles to cleanability, and facilitating the future management of potential complications such as peri-implantitis.
An understanding of how prosthetically driven implant dentistry can benefit patient outcomes is paramount. Alongside this, clinicians should consider the changes they need to make to their treatment planning to be able to provide such care in a predictable, effective manner.
The approach and its benefits
Implant dentistry has always been focused on restoring function, first and foremost. However, over time clinicians have started to look at how to optimise and maintain aesthetics, moving away from a surgically-driven approach to one led by the final prosthesis.[ii] This is not to say that the functional outcome is neglected in the dental professional’s mind, but rather that aspects such as occlusion may even be improved by first thinking about the final result and working backwards.
In prosthetically-driven implant dentistry, the final restoration guides the positioning of the supporting implant fixtures.ii This requires optimal conditions of the alveolar bone and surrounding tissues – if this is not present, perhaps due to atrophy or prior injury, augmentation of bone or soft tissue is typically required.[iii]
Even in the most complex implant placement cases, prosthetically-driven approaches are optimal. Zygomatic implant placement requires a high level of skill and experience, and anatomical navigation with the support of preoperative surgical plans and guides has seen success.[iv] Prosthetically-driven implantology is feasible in such circumstances, creating optimal results in even the most difficult cases.iv Detailed treatment planning is essential in these cases, and the development of digital solutions has meant that approaches such as prosthetically-driven surgical navigation are options established in the available literature.iv
Two steps ahead
The key to each instance of prosthetically-driven implant placement lies in the treatment planning. Dental surgeons and prosthodontists should work closely together for an ideal outcome.
The use of digital planning approaches has developed with time. 3D imaging, such as that offered by cone beam computed tomography (CBCT) solutions, now provides crucial information.[v] The insights presented improve upon those that are attained through traditional 2D radiography when used in digital planning software. The prosthetic set-up can be rendered digitally, and used alongside a virtually reconstructed anatomy to plan placements to the millimetre. Clinicians may find this supports a predictable outcome by offering a greater awareness of how the procedure should progress before reaching the surgery.
Once the ideal prosthetic has been constructed, digital planning allows clinicians to make unlimited changes to a provisional treatment plan quickly, and, importantly, with the ability to reverse changes, which is not always possible with conventional physical set-ups. The result can then be easily shared amongst clinicians and dental technicians, who will each be able to contribute new ideas if an optimal approach is yet to be decided upon.
Digitally planned implant placement can also be used to create surgical guides. These allow for predictable accuracy at the time of implant placement, decreasing manual errors, promoting minimally invasive approaches, and allowing for precise and aesthetic results.[vi] However, to ensure clinicians can use these to the best of their ability and optimise the results of prosthetically driven implant planning, they must first use imaging solutions that deliver in-depth, accurate information to inform treatment.
A clearer picture
Clinicians looking to deliver high-quality prosthetically driven implant restorations should consider an imaging solution like the CS 9600 CBCT Scanner from Carestream Dental. The 5-in-1 scanner can be used for CBCT imaging, 3D facial and model scanning, and 2D panoramic and cephalometric imaging to meet a wide range of clinical needs, and can be used with the Prosthetic-Driven Implant Planning Module from Carestream Dental. This software makes implant planning simple and predictable, for outstanding treatment possibilities.
Prosthetically-driven implantology has quickly developed to become a well-regarded treatment approach for dental professionals. With an understanding of how digital imaging and virtual planning can improve workflows, clinicians can confidently create aesthetic and functional outcomes that rejuvenate smiles for years to come.
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Author: Nimisha Nariapara is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
[i] Nulty, A. (2024). A literature review on prosthetically designed guided implant placement and the factors influencing dental implant success. British Dental Journal, 236(3), 169-180.
[ii] Sharma, M. S., Pandey, V., Vartak, V., & Bondekar, V. (2016). Prosthetic driven implantology—a review. Int J Res Health Allied Sci, 2(3), 21-25.
[iii] Chiapasco, M., & Casentini, P. (2018). Horizontal bone‐augmentation procedures in implant dentistry: prosthetically guided regeneration. Periodontology 2000, 77(1), 213-240.
[iv] Wang, F., Fan, S., Huang, W., Shen, Y., Li, C., & Wu, Y. (2022). Dynamic navigation for prosthetically driven zygomatic implant placement in extensive maxillary defects: Results of a prospective case series. Clinical Implant Dentistry and Related Research, 24(4), 435-443.
[v] Ene, V., Rotaru, I., Tabirta, C., & Plesca, D. (2020). Prosthetically driven implant planning. In MedEspera (Vol. 8, pp. 342-343).
[vi] Umapathy, T., Jayam, C., Anila, B. S., & Ashwini, C. P. (2015). Overview of surgical guides for implant therapy. Journal of Dental Implants, 5(1), 48-52.
