Rehabilitation of a partially edentulous, Class IV patient is a difficult and complex procedure. This type of condition is characterized by severely compromised dentition and edentulous areas, with changes in occlusion occurring in relation to the vertical dimension and TMJ dysfunction. Within these complex situations, the use of a provisional fixed prosthesis is paramount to provide sufficient guidance, improve laboratory communication, and optimize the definitive result.
In general, implants should be placed using a surgical template that can be created using stone models, a diagnostic waxup, and a simple, vacuum-formed matrix or a laboratory-processed acrylic prosthesis. Some variations may occur with the introduction of metal tubes, sleeves, or guided pins (eg, Thermoplastic Drill Template, Straumann, Andover, MA) to assist with the drilling process. Recent advancements in the fabrication of these surgical templates have resulted in improved diagnostic imaging through the use of cone beam CT scans. A computerized surgical guide, developed through a CT scan of a template with gutta percha placed in the surgical holes allows correct implant positioning based on the amount of bone available and any future oral rehabilitation anticipated. One of the major challenges in offering a provisional prosthesis immediately following implant placement is, however, the evaluation and establishment of correct intermaxillary relations. The purpose of this article was to describe the use of a triple guide template to serve as a radiographic, surgical, and intermaxillary relations assessment tool. In the authors’ opinion, the triple guide technique reduces the risk of inaccuracies and optimizes the provisional prosthesis construction during final rehabilitation.
Publication details:Practical Procedures & Aesthetic Dentistry 2009; 21(1): 55-59.