3-D Virtual Planning Concepts

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Fig. 3a: A radiopaque scanning appliance fabricated from a duplicate of a patient’s existing well-fitting denture (a) allows inspection of tooth position in relation to the underlying bone (b).

Fig. 2: The volumetric rendering aids in the inspection of the bone but does not the desired restorative position.

Fig. 1: The axial view provides insight into the global topography of the maxilla.

Fig. 3b: A radiopaque scanning appliance fabricated from a duplicate of a patient’s existing well-fitting denture (a) allows inspection of tooth position in relation to the underlying bone (b).

Fig. 4a: Cross-sectional slice reveals tooth position in relationship to the bone (a) and the extension of the labial vestibule (red arrow) (b).

Fig. 4b: Cross-sectional slice reveals tooth position in relationship to the bone (a) and the extension of the labial vestibule (red arrow) (b).

Fig. 4c: The relationship to the maxillary sinus is essential for planning in the posterior region, where thin cortical plate can be clearly visualized (arrow) (c).

Fig. 5a: Evaluating a potential receptor site within the cross-sectional view (Slice 63) (a). The positioning of the implant(s) need to fall within the envelope of the teeth (b).

Fig. 5b: Evaluating a potential receptor site within the cross-sectional view (Slice 63) (a). The positioning of the implant(s) need to fall within the envelope of the teeth (b).

Fig. 6a: The cross-sectional image reveals a potential receptor site (a); the realistic implant and abutment simulation (b).

Fig. 6b: The cross-sectional image reveals a potential receptor site (a); the realistic implant and abutment simulation (b).

Fig. 6c: The author’s preference places the implant within a defined zone of available bone defined as the “Triangle of Bone” (TOB) that also acts to relate implant position to the restorative outcome.

Fig. 7a: The occlusal view of the volumetric rendering aids in the implant-to-implant positioning within the bone.

Fig. 7b: Superimposing a translucent scannographic template over the maxilla provides the information to position implants within the restorative envelope.

Fig. 8a: Use of “selective transparency” with abutment extensions above the occlusal plane (a). Ball abutments positioned at the proper tissue cuff height (b).

Fig. 8b: Use of “selective transparency” with abutment extensions above the occlusal plane (a). Ball abutments positioned at the proper tissue cuff height (b).

Fig. 9a: Rotating the views help position implants where they will best support the removable prosthesis.

Fig. 9b: Rotating the views help position implants where they will best support the removable prosthesis.

Fig. 10a: Selective transparency allows the realistic implants and ball abutments to be seen through the prosthesis and the maxillary bone.

Fig. 10b: Selective transparency allows the realistic implants and ball abutments to be seen through the prosthesis and the maxillary bone.

Fig. 11: The distance between the two anterior implants and the maxillary incisor teeth (red arrows) represents a cantilever that could result in tipping of the denture.

Fig. 12a: The use of realistic attachments allows for implant-to-implant positioning around the arch necessary to gain maximum retention and resistance of the prosthesis to dislodgement during mastication.

Fig. 12b: The use of realistic attachments allows for implantto- implant positioning around the arch necessary to gain maximum retention and resistance of the prosthesis to dislodgement during mastication.

Fig. 13: Utilization of virtual abutments aids in determining the correct tissue cuff heights of the abutments above the bone, and through the soft tissue.

Fig. 14a:The vertical distance can be evaluated within the prosthetic design (a), crown-to-root ratios, and the trajectory of the implant-abutment complex can be visualized within the virtual plan.

Fig. 14b:The vertical distance can be evaluated within the prosthetic design (a), crownto- root ratios, and the trajectory of the implant-abutment complex can be visualized within the virtual plan.

Fig. 15a :The top of the implant (red line) serves as the foundation for the abutment at a specific tissue cuff height (green line) (a); the metal housing represented in gold also has a vertical component (yellow line) (b).

Fig. 15b: The top of the implant (red line) serves as the foundation for the abutment at a specific tissue cuff height (green line) (a); the metal housing represented in gold also has a vertical component (yellow line) (b).

Fig. 16: Once the implant position has been confirmed, the software will generate the virtual design of the template.

Fig. 17a: Eight implants positioned to support a fixed restoration (a) to fit within the framework of the desired tooth position (b); using “selective transparency” the underlying bone can be visualized (c).

Fig. 17b: Eight implants positioned to support a fixed restoration (a) to fit within the framework of the desired tooth position (b); using “selective transparency” the underlying bone can be visualized (c).

Fig. 17c: Eight implants positioned to support a fixed restoration (a) to fit within the framework of the desired tooth position (b); using “selective transparency” the underlying bone can be visualized (c).

Fig. 18a: Frontal view of the scanning template with yellow abutment projections seen above the occlusal plane (a); semi-transparent scanning template (b).

Fig. 18b: Frontal view of the scanning template with yellow abutment projections seen above the occlusal plane (a); semi-transparent scanning template (b).

Fig. 18c: And all three objects translucent to visualize the position of the implants within the bone.

Fig. 19a: Another 3-D view showing the emergence of the abutment projections through the scanning template.

Fig. 19b: Another 3-D view showing the emergence of the abutment projections through the scanning template.

Fig. 20a: The template design revealing the guide tubes (a); three blue fixation pins (b); and the entire complex on the 3-D reconstructed volume (c).

Fig. 20b: The template design revealing the guide tubes (a); three blue fixation pins (b); and the entire complex on the 3-D reconstructed volume (c).

Fig. 20c: The template design revealing the guide tubes (a); three blue fixation pins (b); and the entire complex on the 3-D reconstructed volume (c).