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MI on CD-ROM, 1986 Jan (47-49 ): Use of Splint Material in the Placement of Implants Ri Copyrights 1997 Quintess

through the splint along the axis of the tooth. In this manner, parallelism, proper positionplacement, and angulation needed for the implant can be achieved.

Once the guide pin hole is made through the splint, the guide pin inserted, and thesplint over the guide pin replaced, the surgeon can observe the parallelism and path of insertion and position. The guide pin should fit the exact center of the selected tooth.Without the splint, the implant will often be positioned lingually and may interfere withthe opposing occlusion. 5 With the splint and guide pin in place, the surgeon can easilyobserve lingual clearance and move the implant buccally when needed. The properposition assures that the coronal restoration will be uniformly shaped, and that cleansableembrasure form can be established ( Fig. 3 ).

Recovery of the submerged implant may be a problem. If a surgeon has troublelocating a submerged implant, it may be necessary to increase exposure and useradiographs to assist with recovery. By utilizing the same preoperative splint to pinpointthe location, it can easily be recovered regardless of the amount of bone and soft tissue thathas covered the implant ( Fig. 4 ).

DiscussionTo achieve a desirable result, it is necessary for the restorative dentist to know theobjective. Though present at the surgeon's office during placement of the implant, therestorative dentist can only estimate a placement position. A diagnostic wax-up and splintfabrication will eliminate most of the guess work involved. Delineating parameters of implant size, type, place, position, parallelism, angulation, and occlusion, the splint alsodemonstrates the anticipated tooth form, tooth size, and tooth position for the surgeon.With the guide pin in the implant and the splint material over the implant, it is quiteobvious that the finished restoration will be acceptable. When accompanying the patientand used as a preoperative management tool, the splint obviates the need for the restorativedentist to be a direct participant in the surgery.

ConclusionThe assurance of success in properly placing the implant support for fixed restorations canbe determined preoperatively. The surgical placement of an implant may be technicallyeasy to accomplish. However, to eliminate fabrication problems, the restorative dentistmust know the answers to questions involving placement, size, type, angulation, position,occlusion, parallelism, and esthetics. The use of a clear splint fabricated from a diagnostic

wax-up can provide such information. With this technique the end result is not left tochance, but is preoperatively planned.


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1. Beyron, H. Occlusion: Point of significance in planning restorative procedures. J ProsthetDent 30:641, 1973.

2. Adell, R., Rockler, R., and Brnemark, P-I. A 15 year study of osseointegrated implantsin the treatment of edentulous jaw. Int J Oral Surg 6:387, 1981.

3. Preston, J.D. A systematic approach to the control of esthetic form. J Prosthet Dent35:393-402, 1976.

4. Watt, O.M. Morphological changes in the denture-bearing area following extraction of teeth. Thesis. Seatlane: University of Edinburgh, 1961.

5. Zarb, C.A. The edentulous milieu. J Prosthet Dent 49:825, 1983.


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Figs. 1a to 1d Study cast showing edentulous area (top) and with diagnostic wax-up (top center), Preston's clear splint (bottom center). Splint shown in patient's mouth indicating where implant should be (bottom).


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Figs. 2a and 2b Template used to access vertical bone height and implant length (top). Reversed image with implants in predetermined position (bottom).


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Fig. 3 Splint form used to guide implant placement at surgery.

Fig. 4 Preoperative splint used to locate submerged implants.

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