Diagnostic cast, Radio graphical and

Surgical stint

Dr. Abdullah Alkeraidis

BDS, Prostho (cert), Msc, Dental Implant (Cert), FICOI
Consultant in prosthodontics, RDC

Introduction
Acceptably predictable restoration of lost dental
,gingival, and alveolar structures can be
accomplished with dental implant and appropriate
prosthetic restorations.
The surgeon must keep in mind that the basis for
and all-implant goal is the success of the final
dental restoration.

The restorative dentist and his or her patient will

judge the success of the case based on the
placement, function, and esthetic excellence of
the final dental restoration

Diagnosis & Treatment Plan

Mounted Diagnostic Cast
Diagnostic Wax-set up
Surgical Template (Stent)
Radiographic stent

Mounted diagnostic casts

Maxilla and mandible relationship
Interarch space
Edentulous space
Ridge width & conformation
Occlusal plane

Diagnostic wax-up
Accurately reflects the final prosthesis
Tooth position
Denture base

Aids in determining the position of the

implants (Cingulum, Central Fossa)
Aids in determining the length of the
abutment heads
Interarch space
Opposing Occlusion

Can be used to optimize aesthetic results

Tooth position
Soft tissue support

Diagnostic wax-up
Used in Fabrication of indices
Buccal-Labial
Lingual

Used in the fabrication of radiographic

template
Measure horizontal dimensions
Measure vertical dimensions

Used in the fabrication of the surgical

template
Partially edentulous patients
Edentulous patients

Radiographic Analysis
radiographs - aid to determine amount of
space& bone available
radiographs - panoramic and periapical

(CT

scan or tomography - as indicated)

CT (computed tomography) scan - gives more
accurate & reliable assessment of bone (quality,
quantity & width) & locate of anatomic structures

Radiographic Template
Radiographic stent - (can be used as surgical
stent)
Acrylic stent with lead beads or ball -bearings
(5mm) placed in proposed fixture locations
Allows more accurate radiographic
interpretation

Radiographic Templates
Metal objects (bearing balls and wires)
Gutta-percha embedded into resin
Lead foil embedded into resin
Barium impregnated into resin
Porcelain teeth
Mixture of ortho resin and amalgam

Surgical Templates
surgical guide stent: one of the most
critical factors for obtaining an ideal
surgical & esthetic result
used during fixture installation as
guide for optimal B/L and M/D
position

Surgical Templates (Stents)

Used as implant site locator
Assure proper angulations

Surgical Templates (Stents)

Assure that the abutments will be
emerging from the most optimal areas,
such as cingula of incisors and central
fossae of molars.
Used to point out the site of each implant
at the time of uncovering (Stage II).

Surgical Template for single tooth

replacement
Mark on the cast the ideal locations of implants
Fix denture teeth using sticky wax
Make an Omnivac shell using 0.02 inch clear
material
Trim to include 2 teeth on either side of
operative area
Make access holes in cingula of anteriors and in
central fossae of posteriors
The template should be cold sterilized

Problem list & treatment considerations

Teeth
Periodontium
Radiographic analysis
Surgical analysis
Esthetic analysis

Problem list & treatment considerations

Occlusal analysis
Advs/disadvs of proposed treatment
Referrals/specialty consults
Appointment sequencing
Treatment alternatives

Problem list & treatment considerations

periodontium - bone support
Lekholm & Zarb classification
quality - best - thick compact cortical bone
w/core of dense trabecular cancellous bone
best region - mandibular symphysis; poorest
in posterior regions

periodontium - bone support

quantity - required for implant - 6mm buccallingual width w/sufficient tissue volume
8mm interradicular bone width
10mm alveolar bone above IAN canal or
below maxillary sinus

periodontium - bone support

quantity - required for implant - if inadequate
bone support may need ridge or site
augmentation
ramus or chin graft (autograft)
DFDBA (allograft)
Bio-Oss(xenograft)

Problem list & treatment considerations

periodontium - bone support
place implants minimum of 2mm from IAN
canal or below maxillary sinus
crown/root ratio
mobility
furcations
probing depths

Problem list & treatment considerations

periodontium
mucogingival problems
need sufficient tissue volume to recreate
gingival papilla
need some attached gingiva to maintain periimplant sulcus
1st year post-op bone resorption ~ 1mm
*crest of bone optimal 2- 3mm below CEJ