Variety of Surgical Guides and Protocols for Bone Reduction Prior to Implant Placement: A Narrative Review

Abstract

Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician’s choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.

The clinical effect of the digital guide in the early implant restoration of second molars

“…In recent years, some studies have reported that at 4–8 weeks after tooth extraction, a large amount of the alveolar crest has not been absorbed [ 24 , 25 ]. In order to prevent excessive absorption of alveolar bone and obtain a good aesthetic effect later on, early implantation is encouraged [ 26 ].…”

Dental Implant Placement by Using Metal Reinforced Acrylic Stent - An Innovative Technique

“…The flap has a flange that extends onto the slope of the ridge, keeping it away from the osteotomy site and preventing it from falling back onto the surgical site. With this an assistant also visualizes the surgical site without interrupting the surgeon to guide for correct positioning and depth [2]. A small aperture is given on the occlusal side so that the pilot drill could be placed in accurate position from the buccal side rather than the occlusal side in cases when the patient has reduced mouth opening or when the implant has to be placed most posteriorly.…”

“…The transfer of diagnostic and prosthetic planning information to the surgical phase is critical. Ideal Prerequisites-It should be rigid buccolingually, mesio distally and apico coronally in the correct position [1][2][3].…”

“…To accomplish correct implant placement within the bone, the templates regulated depth, trajectory and diameter [2]. • Reduces the number of manual errors associated with implant implantation by hand.…”

Comparing digital and traditional guides in first molar implant surgery: A randomized clinical trial

“…With the improvement of medical technology, implant repair has become the preferred method for clinicians and patients to treat missing teeth [1,2]. The use of an implant guide plate can help achieve u n c o r r e c t e d p r o o f v e r s i o n accurate positioning in the operative process and guarantee the correct position, angle, and depth of the implant [3][4][5].…”