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Accuracy of Clinical Implant Position with Cad/Cam Assisted Surgical Guide through a Modified Bone Expansion Technique in an Atrophic Premaxilla: A Case Report

Ramakrishna Harigopal, SK Poovani, NS Mamatha, G Shetty & Srilakshmi J

Aim: To evaluate the accuracy of CAD/CAM surgical guide through a modified bone expansion technique in an atrophic premaxilla.

Background: Achieving the virtual plan of the implant position is a challenging clinical situation especially in an atrophic bone which requires extensive grafting procedures increasing the cost and time of treatment.

Case description: An 18 year old male patient reported with history of partial edentulism in relation to 11, 12 and 21 for past two years. An acrylic stent was fabricated with radiographic markers for virtual planning of implant treatment with pre-operative CBCT. A modified bone expansion technique with a palatal approach which involved the pilot drill preparation slightly 1 mm off the mid crest as compared to the conventional midcrestal approach was carried out in the atrophic pre-maxillary region. A CAD/CAM surgical guide was used for the surgical procedure. Postoperative CBCT with radiographic markers was used for evaluating clinical outcome.

Conclusion: The modified bone expansion technique was able to achieve the planned implant position within the recommended limits of deviation at the same time maintain the integrity of the thin cortical plates.

Clinical significance: A simple modification of the conventional approach of bone expansion can help attain the goal of prosthetic driven treatment plan and also conserve the bone at the osteotomy site.

Keywords: Surgical guide; Dental implant; Bone expansion; Palatal approach; CAD/CAM

Abbreviations: CBCT: Cone Beam Computed Tomography; CAD/CAM: Computer Aided Design/ Computer Aided Milling; VAS: Visual Analog Scale