[Implant placement on restricted mesiodistal space with simulation software and guiding system: a case report]

A surgical guiding system with simulation software has recently been used for safe implant treatment. We report a clinical case in which we successfully used this system for implant treatment of a congenital tooth missing region with severely restricted mesiodistal space. The patient was a 19-year-old female whose mandibular right deciduous canine was wobbling without a successional permanent tooth and who desired implant treatment. CT images showed that this site was narrow buccal-lingually and only five millimeters in mesiodistal width. The implant position was planned using simulation software (SimPlant : Materialise Dental) based on CT data and a surgical guide template (SurgiGuide : Materialise Dental) was fabricated prior to the implant surgery. During the implant surgery, the deciduous canine was extracted under local anesthesia. The implant bed was prepared with the surgical guide template and an implant was installed. One month after surgery, the position of the implant was examined with a cone-beam CT, which demonstrated that the implant position was exactly the same as planned. At 5 months, a provisional prosthesis was delivered and optimal soft-tissue condition was formed by modifying the provisional prosthesis. Then, the final impression was taken and a ceramo-metal implant-supported crown was delivered. In this case of a congenital tooth missing region with narrow space, implant treatment with simulation software and the surgical guide system provided excellent clinical results.