SimPlant - Taking the guesswork out of implant dentistry
Dr Frank Lee, Registrar, Prosthodontics Unit, Dept of Restorative Dentistry, National Dental Centre Singapore
 Implants have certainly revolutionised the practice of Dentistry today. Their applications range from single tooth replacements to total dental arch replacement, and even maxillofacial prosthodontics. Within just a few short years, the number of clinics offering dental implants, as well as the number of implant companies have increased exponentially. No one would have thought that in the late 1960s, a certain orthopaedic surgeon, named Prof Per-Ingvar Branemark, would serendipitously discover that titanium actual "osseointegrates" with bone and extrapolate it to dental usage.
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Back then, the overriding consideration in implant planning was to place them in areas where bone was most abundant. This surgically oriented approach soon proved to be disadvantageous due to the resulting prosthesis being unaesthetic and more importantly, biomechanically unstable. This was because the implants were often placed in a haphazard manner, with many of them being non-axially loaded.
These failures in aesthetics and biomechanics prompted a paradigm shift in implant planning. Implant surgeons realised that the prosthetic replacement must be considered prior to planning the position of the implants.
Thus came the restoratively-driven age. Restorative dentists would first conceptualise the prosthetic options and coordinate with the surgeons for the ideal position for implant replacement in relation to the prosthetic outcome. However, often during surgery, the ideal location cannot be achieved as the bone may be insufficient, and thus a compromised position is adopted. Results were therefore not as good as originally planned, due to this failure to visualise the contours of the underlying bone accurately in 3-dimensions.
Now, in this computer-age, CADCAM (Computer-Aided Design-Computer-Aided Manufacturing) will take implant dentistry one step further by allowing 3-dimensional visualisation of both the prosthetic replacement and the underlying bony contours. This allows more precise measurement of bone to ideally place implants for predictable aesthetic and functional outcomes - in essence, removing much of the guesswork.
Materialise Dental's SimPlant (Figure 1) is one such software which integrates the accuracy of 3D CT (Computer Tomography) scans, preoperatively, to the precise planning of the placement of implants, translating the plan to customised CADCAM surgical guides (SurgiGuides) for exact positioning of the implants (Figures 3 and 4). The SAFE System (Secure, Accurate, Flexible, Ergonomic) takes SurgiGuides to the next level, enhancing the predictability and accuracy of implant dentistry. The system combines drilling guidance with depth control.
At the National Dental Centre, the patient undergoing Simplant treatment planning will first have a radiographic stent (Figure 2) fabricated by the prosthodontist. Subsequently, a CT scan of the patient's dental arch with the stent in position is taken. This CT image would then be formatted to integrate with the SimPlant software. Both, the prosthodontist and surgeon, working as a team, will thus be able to manipulate the image on the computer 3-dimensionally, to plan for the ideal position of the dental implants. This allows better treatment coordination, as the prosthodontist can advise the surgeon on the position of implants that can optimise the aesthetic and functional result, and the surgeon, likewise, can advise on the position where bone is sufficient. Once the treatment plan is confirmed by both, the information is sent to Materialise Dental, who will fabricate the SurgiGuides using CADCAM technology. The SurgiGuides will be sent back for use during the surgery 10 working days. This highly accurate system opens the door to immediate loaded cases. Materilise Dental's immediate loading concept, known as The Immediate Smile enables the implant clinician to have the prosthesis pre-manufactured for surgery and makes the implant surgery and provisional restoration possible in one appointment.