Sequence of steps in prosthetic guided distraction and

SEQUENCE OF STEPS IN PROSTHETIC GUIDED DISTRACTION AND IMPLANT PLACEMENT Luc Vrielinck, MD, DDS Dpt. Of Oral Maxillofacial Surgery Ziekenhuis Oost Limburg Genk, Belgium Luc@vrielinck.be

Distraction Phase • • • • •

Impression of the upper and lower jaw, registration of the occlusion Mounting the plaster casts in an articulator Perform a prosthetic set-up CBCT or CT scans of the jaw Import the Dicom data in an implant planning software allowing you distraction simulation – – –

• • • • • •

Materialise: Proplan CMF planning software (http://cranio-maxillofacial.materialise.com/proplan-cmfplanning-software) Nobelbiocare: Maxilim – distraction (http://www.medicim.com/en/products/distraction) Maybe other companies provide this as well, I am not aware of these.

Import the optical scan of the prosthetic set-up in the distraction software Plan the distraction vector in such a direction that future implant planning will match the prosthetic set-up Order a cutting guide that will assist you where to place you osteotomy cut for the distraction Order a tooth supported guide that will assist you with positioning of the distraction factor Perform the surgery and place the distractor using the vector guide. Concerning the surgery, many publications can be found (e.g. On PUBMED: http://www.ncbi.nlm.nih.gov/pubmed/?term=distraction+osteogenesis+dental+implant) Clinically perform the distraction during a few weeks and allow for consolidation of the displaced fragment. (At least 3 months)

Dental Implant Phase • Make a new CBCT (less preferably use the old CBCT) to plan the implant position according to the new position of the displaced bone fragment • Order a teeth supported drill guide for placement of the implants • Perform the surgery of implant placement (2 stage) • Perform the second stage surgery • Perform prosthetic treatment