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This paper presents a novel guide template technique for implant placement. In esthetic implant dentistry with its restoration-driven implant placement as well as in complete-arch cases with multiple implants, the precise positioning and angulation of dental implants is crucial for achieving the desired prosthetic results. Difficulties in implant positioning may arise especially with grafted jaws resulting from communication problems between surgeon and prosthodontist. This method may alleviate some of the problems common to conventional template techniques, where the drill is usually directly guided by the template. The key idea is to fixate the implant position and angulation by the help of Kirschner wires which are inserted in the alveolar ridge right through the mucosa before elevation of a mucoperiosteal flap. Thanks to this sequence, the template for guiding the wires may be positioned precisely, even on grafted edentulous ridges. After the insertion of the wires, the bone is exposed and the implant cavities prepared with a trephine drill guided over the wires alone or over wires combined with a special guidance cylinder fitting the trephine drill. The method may be combined with different planning and radiological techniques. Since the use of the template is detached from the actual drilling process, the danger of introducing debris of plastic or metal into the preparation site may be avoided. The present technique might be helpful for difficult cases by improving communication between prosthodontist and surgeon and also render additional security to the surgeon with less routine in dental implant insertion.

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Clinical Paper Orthognathic SurgerySkeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up Abstract. 33 patients (27 females; 6 males) were retrospectively analysed for skeletal and dental relapse before distraction osteogenesis (DOG) of the mandibular anterior alveolar process at T1 (17.0 days), after DOG at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Skeletal correction (T3 À T1) was mainly achieved through the distraction of the anterior alveolar segment in a rotational manner where the incisors were more proclined. The horizontal backward relapse (T4 À T3) measured À0.8 mm or 19.0% at point B (p < 0.001) and À1.6 mm or 25.0% at incision inferior (p < 0.001). Age, gender, amount and type (rotational versus translational) of advancement were not correlated with the amount of relapse. High angle patients (NL/ML 0 ; p < 0.01) and patients with large gonial angle (p < 0.05) showed significantly smaller relapse rates at point B. Overcorrection of the overjet achieved by the distraction was seen in a third of the patients and could be a reason for relapse. Considering the amount of skeletal relapse the DOG could be an alternative to bilateral sagittal split osteotomy for mandibular advancement in selected cases.