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g h
i j
Chapter 5 Surgery Phase Planning 111
Figures 5.33g–j. Guided bone regeneration was performed utilizing tenting screws (g), bovine anorganic bone (h),
and collagen membrane (not shown). Preoperative clinical photograph demonstrating horizontal atrophy of the posterior
maxilla (i). Final metal ceramic restoration illustrating the restoration of posterior maxilla arch form (j).
Limitations of Image-Based
Implant Therapy
Despite advancements there are a number of
limitations for image-based implant surgery.
Three-dimensional imaging necessitates radiographic
modalities that require increased
radiation dosage. The advent of CBCT has
provided a 3-D modality with signifi cantly
reduced radiation dosage. Another limitation
of current imaging technologies is the lack
of an ability to image soft tissue volumes.
Metal scatter artifacts also remain a problem
(Sukovic 2003).
Stereolithographic guides have the limitation
that they lack prosthetic landmarks. It is
therefore critical to utilize a scanning prosthesis
in order to acquire prosthetic landmarks.
These landmarks will then be considered in
constructing the virtual plan. However, the
surgeon cannot modify the osteotomy during
surgery.
There is limited documentation of the safety
and effi cacy of implant surgery performed
with stereolithographic guides. Stereolithographic
guides for applications using rigid
support (tooth and bone-supported) have
been well investigated. Mucosa-supported
guides have a more limited documentation.