Three-dimensional guidance system for implant insertion: Part I

A technique is presented, with two sets of newly designed drills, that facilitates three-dimensional guided insertion of implants. A radiographic guide has been fabricated with titanium markers that are transferred into the CT scan reformatted images. The resulting cross-sectional and panoramic reformatted images provide the precise location for each implant. The buccolingual and mesiodistal inclinations of each implant are measured and transferred to a surgical guide that contains steel drill guide tubes. The starting point and three-dimensional orientation of each implant is then transferred to a pilot osteotomy. The widening of an osteotomy, with end-cutting drills of the usual design, can lead to the loss of orientation because a wider drill cannot be effectively guided by a smaller diameter osteotomy. A newly designed set of drills has been developed that maintains tracking of the original orientation as the incremental increase in width proceeds. The three-dimensional guidance system for implant insertion was first accomplished in vitro and then on patients.