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A stent for presurgical evaluation of implant placement

Fumitaka Takeshita, DDS, PhD, a Tsutomu Tokoshima, DDS, ~ and Tsuneo


Suetsugu, DDS, PhD c
Faculty of Dentistry, Kyushu University, Fukuoka, Japan

This article describes a method of fabricating a stent with barium sulfate and stainless steel tubes
for the accurate radiographic evaluation of the relationships of the predesigned superstructure, the
scheduled implant placement, and the anatomic structure. The barium sulfate in the stent depicts
the outline of the predesigned superstructure, and the stainless steel tubes indicate the intended
location and inclination of the implants o n the computed tomographic scans. In addition, this stent
can be used as a surgical stent to guide the pilot drill to the desired site. (J Prosthet Dent
1997;77:36-8.)

To evaluate the relationship between anatomic


structures and the stent, investigators have reported ra-
diographic presurgical evaluations with gutta-percha, 1-
4 metal spheres, s the baseline, 6 color chalk powder, 7 and
barium sulfate 8 as radiopaque materials. Gutta-percha
has an advantage because of its thermoplastici~ The
advantages of metal spheres are its round shape, easy
fabrication procedure, and ease of measurement of im-
age magnification. Color chalk powder and barium
sulfate materials are useful for observing the outline of
the predesigned superstructure because of their
radiopacity. Three-dimensional imaging with computed
tomography (CT) or tomography is cxtremely helpful
to evaluate the predesigned surgical plan. Several types
ofradiopaque materials have been used to examine their Fig. 1. Clear acrylic resin stent duplicated from patient-ap-
proved trial mandibular denture.
difference in appearance on radiographic images.
Thc purpose of this article is to introduce procedures
for making and using a stent with two types of
radiopaque materials for the evaluation of implant place-
ment.
PROCEDURE
1. Form wax sprues at the distal most teeth bilaterally
of the approved trial wax denture and make a sili-
cone (Exafine putty, GC Corp., Tokyo, Japan) im-
pression. The stent is made of clear autopolymerized
methyl methacrylate resin pour material (Palapress
Valio, Kulzer, Germany).
2. After the clear stent is recovered from the impres-
sion, remove all the teeth. Reposition the clear stent
base in the impression (Fig 1). Mix powder that con-
sists of a 4: I ratio of resin polymer and barium sul- Fig. 2. Radiopacity of various mixture ratios. From left to right,
fate with monomer. Pour the mixture into the tooth Upper, 6(polymer):1 (monomer), 5:!, and 4:1 ; lower, 1:1, 2:1,
forms of the impression. (The degree of radiopacity and 3:1.
of various mixture ratios is illustrated in Fig. 2.)
3. Cure the finished stent at 40 ° C tbr 20 minutes in the
%ssistant Professor, Prosthetic Dentistry [i. processor (Palamat, Kulzer, Germany), then recover
L'Resident, Prosthetic Dentistry II. and polish (Fig. 3).
~Professor and Chairman, Prosthetic Dentistry II. 4. Make the access holes to guide the first surgical drill

36 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 77 NUMBER 1


TAKESHITA, TOKOSHIMA, AND SUETSUGU THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 5. Panoramic tomograph of stent with five stainless steel


Fig. 3. Compietely cured radiopaque teeth. tubes in mandible of patient.

Fig. 4. Occlusa[ view of fabricated stent shows five stainless Fig. 6. Reconstructed image of CT scan indicates relationship
steel tubes in lingual plate. between anterior tooth and predesigned implant placement.

according to information obtained from the final cast the reconstructed image of the CT scan can be clearly
and the provisional restoration. observed (Fig. 6). The clear image of the stainless steel
5. Cut stainless steel tube sprues (Murakami Institute, tube demonstrates the predesigned inclination of im-
Fukuoka, Japan) to a uniform height, place into the plant placement, whereas the image of the barium sul-
access hole, and retain with wax (Fig. 4). fate shows the position of the anterior teeth on CT
6. Obtain a panoramic tomograph (Fig. 5) and a CT scans. The location and inclination of predesigned im-
scan (Fig. 6) with the stent in place. plant placement in the stent can then be corrected as
7. After the radiographs are obtained, remove the tube necessary before surgery according to the radiographic
sprues. information. Other advantages of using this procedure
8. Sterilize the stent so it (the access holes) can be used with barium sulfate and stainless steel tubes are its ease
to guide the surgical drill to the desired site for im- of use, economy (inexpensive), and simple design of
plant placement. the materials.
DISCUSSION REFERENCES
The barium sulfate in the stent depicts the outline of 1. Verde MA, Morgano SM. A duabpurpose stent for the implant-supported
prosthesis. J Prosthet Dent 1993;69:276-80.
the predesigned superstructures, and the stainless robes 2. Sonik M, Abrahams J, FaieHaRA. A comparison of the accuracy of periapical,
represent the location and inclination of the intended panoramic, and computerized tomographic radiographs in locating the man-
implant placement. The powder barium sulfate and resin dibular canal. Int j Oral Maxil]ofac Implants 1994;9:455-60.
3. Pesun IJ, Gardner FM. Fabrication of a guide for radiographic evaluation
polymer mixture exhibit good radiopacity without ra- and surgical placement of implants, j Prosthet Dent "[995;73:548-52.
diologic artifact and the panoramic radiographs revealed 4. Stellino G, Morgano SM, Imbe[Ioni A. A dual-purpose, implan~ stent made
the markers and the inclination. from a provisional fixed partial denture. J Prosthet Dent 1995;74:212-4.
5. Lain EW, Ruprecht A, "fang J. Comparison of two-dimensional orthoradially
The most important advantage is found in its use reformatted computed tomography and panoramic radiography for dental
with a CT scan. The radiopaque markers located on implant treatment planning. J Prosthet Dent 1995;74:42-6.

~ANUARY 1997 37
THE JOURNAL OF PROSTHETIC DENTISTRY TAKESHITA,TOKOSHIMA, AND SUETSUGU

6. Sethi A. Precise site location for implants using CT scans: a technical note. Reprint requests to:
Int I Oral Maxillofac Implants 1993;8:433-8. DR. FUMITAKATAKESHiTA
7. Espinosa Marino J, Alvarez Arena[ A, Pardo Cebal[os A, Fernandez Vazquez PROSTHETICDENTISTRY[[
J, Ibaseta Diaz G. Fabrication of an implant radiologic-surgical stent for par- KYUSHUU NIVERSITY
tially edentulous patient. Quintessence Int 1995;26:111-4. 3-1-1 MAIDASHI, H[GASHIKU
8. Basten CH. The use of radiopaque templates for predictable implant place- FUKUOKA812-82
ment. Quintessence Int 1995;26:609-12. JAPAN

Copyright © 1997 by The Editorial Council of The Journal of Prosthetic


Dentistry.
0022-3913/97/$5.00 + 0. 10/1/78437

Hypermineralization of dentinal lesions adjacent to glass


ionomer cement restorations.
ten Cate JM, van Duinen RNB. J Dent Res 1995;74:1266-71.

Purpose. The purpose of this in vivo investigation was to compare the effects of glass ionomer
cement (GIC), amalgam, and composite restorations on bordering dentinal carious lesions.
Material and Methods. Bovine dentin specimens, 6 mm in diameter, were prepared 1 week
before the in vivo investigation. By use of demineralization procedures, caries-like lesions were
created in the dentin specimens. Cylindric preparations (2 mm diameter x 4 mm deep) were
completed in each specimen close to the lesion. The preparations were filled with amalgam or
composite (controls) or with one of two types of glass ionomer cements (test materials). In
experiment I eight individuals participated; each person had one specimen that contained amal-
gam and one specimen that contained GIC attached to the removable partial denture (on con-
tralateral sides) with methyl methacrylate resin. A piece of retentive gauze was placed over each
specimen to promote plaque formation. In experiment II, 12 individuals participated. Two speci-
mens, one that contained composite and one that contained GIC material, were attached to their
removable partial dentures as in experiment I. Gauze was not placed over these specimens. Par-
ticipants in both experiments were asked to brush their teeth and removable partial dentures two
times daily with a supplied combination fluoride toothpaste for the entire 12-week experimental
period. They were instructed not to brush the attached specimens. All participants in this inves-
tigation wore the removable partial dentures 24 hours per day. The specimens were retrieved,
sectioned, and analyzed by microradiography. Student t tests were used for data analysis.
Results. ExperimentI All sections from the amalgam group exhibited furthcr demineralization.
The GIC group specimens, however, all exhibited hypermineralization of depths up to 150 ~m.
Statistical analysis revealed a significant difference in mineral content between the two groups
over the depth of the affected tissue (p < 0.01). Experiment H - - G I C specimens exhibited
remineralization or hypermineralization of the dentin. The composite specimens showed a large
spread in the amounts of demineralization observed. Two of these specimens exhibited
remineralization. In both experiments significantly higher mineral content was observed near the
surface of the GIC specimens than either the amalgam or composite groups. No significant
differences were noted between the two GIC materials.
Conclusions. This study demonstrated that a significant potential for remineralization exists
when GIC restorative materials are used intraorally. 29 R@rcnces.--DL Dixon

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