DENTAL TECHNIQUE

Computer-guided implant planning using a preexisting

removable partial dental prosthesis
Jong-Eun Kim, DDS, MSDa and June-Sung Shim, DDS, PhDb

Prosthetic restoration with ABSTRACT

dental implants requires
Converting a conventional removable partial dental prosthesis (RPDP) into an implant-assisted
proper implant positioning for removable partial dental prosthesis (IARPDP) may be facilitated by using data from the intaglio
predictability, adequate func- surface of the RPDP for proper implant placement. This procedure can be done by connecting the
tion, esthetics, and mainte- data from the intaglio surface of the RPDP to the residual ridge data of the cone beam computed
nance of periodontal health.1 tomography scan with implant planning software. However, although a misplaced implant under
Implant placement based an RPDP can cause various complications, as yet, no technique has connected the information on a
solely on the remaining avail- patient’s existing RPDP to the implant planning software. This article presents computer-guided
implant planning, using a patient’s existing RPDP. (J Prosthet Dent 2017;117:13-17)
able bone without consider-
ation of other prosthetic
factors makes it difficult to achieve an optimal prosthetic Implantation planning software using CBCT has enabled
restoration.2 The use of cross-sectional radiography, more precise 3-dimensional (3D) implantation planning
such as cone beam computed tomography (CBCT), and the use of a well-designed surgical implantation
provides detailed information about bone volume, bone guide.4 Such software can help determine the proper
mineral density, and anatomic structures of the implant depth and angle of implants by considering the
site.3 CBCT allows more accurate implant positioning remaining bone and the desired definitive shape of the
and more appropriate implant size selection. prosthesis and allowing the virtual determination of the

Figure 1. A, Intraoral view of patient with partial edentulism. B, With removable partial dental prosthesis in place.

a
Clinical Research Assistant Professor, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea.
b
Professor, Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea.

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14 Volume 117 Issue 1

CBCT data. A virtual waxing using computer-aided

design (CAD) software or a scan of a diagnostic
waxing in the shape of the intended prosthesis is
used to determine the location of the implant.7
Because these processes are generally performed in
the fabrication of an implant-supported fixed dental
prosthesis, the clinician could perform implantation-
guided surgery using such data and fabricate an
optimal definitive prosthesis.7
An implant-assisted removable partial dental pros-
thesis (IARPDP) is an alternative prosthesis with a dental
implant placed in the edentulous area to support a
conventional removable partial dental prosthesis
(RPDP), using a healing abutment or a retentive attach-
ment. An IARPDP dramatically enhances the stability of
the RPDP and patient satisfaction, reducing the side ef-
fects of such extreme alveolar bone loss of the edentulous
area or a combination syndrome.8 In patients with an
IARPDP, the implant should be placed within the
framework of the patient’s existing removable dental
prosthesis if the RPDP is well designed and the artificial
teeth are in an ideal position. Thus, if the procedure is
planned from a virtual tooth arrangement or diagnostic
waxing procedure, the location of the implant can be
established independently of the preexisting RPDP. For
IARPDPs, selecting the position of the implant is
important because it may affect the stress distribution of
the prosthesis.9,10 Although efforts have been made to
use conventional RPDPs to position implants under
IARPDPs, ideal positioning cannot be determined
because it is an analog approach that relies solely on a
dental cast analysis without the information from a
CBCT.11
This article introduces an alternative approach to
fabricating implantation surgical guides by recording the
positional relationship between the patient’s remaining
arch and the existing RPDP by using CAD software and
exporting it to implant-guided planning software.

TECHNIQUE

Figure 2. Three types of scan data should be obtained in addition to
CBCT data. A, Partially edentulous dental cast without existing denture.
B, Dental cast with prosthesis in place. C, Existing RPDP. CBCT, cone
beam computed tomography; RPDP, removable partial dental
prosthesis.
proper diameter and length of the implant.5
Implantation-guided surgery is particularly useful
when the bone volume or anatomy is critical and when
appropriate implant positioning is important for es-
thetics or stress distribution.6
Implantation-guided surgery in patients with par-
tial edentulism begins with the superimposition of a
dental cast of the patient’s edentulous state over the
1. Evaluate the quality of the preexisting RPDP of the
patient in terms of fit, esthetics, surrounding tissue,
and tooth location. Fabricate a new RPDP first if
necessary (Fig. 1).
2. Make a CBCT scan of the patient without wearing a
radiographic device, as part of the conventional
planning system for guided surgery in partially
edentulous situations.
3. Prepare 3 types of scan data with a 3D tabletop
scanner (Identica Blue; Medit Co) in addition to
CBCT data: a partially edentulous dental cast
without the existing RPDP, a dental cast with the
RPDP in place, and the patient’s existing RPDP
alone (Fig. 2).

THE JOURNAL OF PROSTHETIC DENTISTRY Kim and Shim

January 2017 15

Figure 3. Recording positional relationship of scanned data. A, Partially edentulous cast without preexisting RPDP and cast with RPDP in place.
B, Patient’s preexisting RPDP and of cast with RPDP in place. RPDP, removable partial dental prosthesis.

Figure 4. A, Importing three STL data files allowed positional relationship to be determined on CAD software. B, Data from cast with RPDP in place
excluded. CAD, computer-aided design; RPDP, removable partial dental prosthesis.

4. Make impressions with and without the RPDP and
scan these casts and the patient’s RPDP with the
tabletop scanner. When RPDPs are difficult to scan
because of their glossy surface, use scan powder to
reduce reflection.
5. Once the scanning process is complete, superim-
pose the scan data for the partially edentulous cast
and denture-wearing cast (Fig. 3A) and the data for
the existing denture and denture-wearing cast
(Fig. 3B) by using the scan registration option in the
CAD software (Exocad; Exocad GmbH).
6. After superimposition, remove the denture-wearing
cast data and save individual stereolithography
(STL) files. In this way, the 3 data sets can be
converted into STL data that include positional
relationship information based on the denture-
wearing cast. Confirm that the positional relation-
ship is accurate by importing the STL data into the
Exocad software (Fig. 4A). The relationship between
the existing denture data and the partially edentu-
lous cast data can be determined even when
excluding the denture wearing cast data (Fig. 4B).
7. In planning the implant placement for a patient
with partial edentulism, superimpose the STL data
of the partially edentulous cast and the dental CBCT
data in the implant planning software (In2Guide;
CyberMed Co) and determine the relationship be-
tween the patient’s RPDP and the dental CBCT after
importing the STL data for the existing denture; this
describes its positional relationship to the STL data
for the existing teeth (Fig. 5).
8. Determine the desired implant location by using the
STL data for the existing RPDP and fabricate an
implant surgical template based on the STL data
obtained from the partially edentulous cast (Fig. 6).
DISCUSSION
The location of an implant is important for the appro-
priate fabrication of a durable, functional, and esthetic
prosthesis. Among the different types of prosthesis, the
distal extension IARPDP is unique in that the soft tissue
of the residual ridge and the implant supporting the
denture have different supportive capabilities. Thus,
studies have focused on the optimal implant site for the
proper distribution of stress.9,10 An IARPDP may be used
with a healing cap on the implant to support the denture
or can be connected with an attachment to achieve
additional retention. An implant’s placement affects the
retention of the IARPDP, the location of the artificial

Kim and Shim THE JOURNAL OF PROSTHETIC DENTISTRY

16 Volume 117 Issue 1

Figure 5. STL data of partially edentulous state and preexisting RPDP imported in implant planning software. STL data of patient’s preexisting
RPDP indicated by yellow outline. RPDP, removable partial dental prosthesis; STL, stereolithography.

Figure 6. A, Surgical template designed in implant planning software. B, Surgical template positioned intraorally.

teeth, and the denture’s contour.12 If the implant is
placed in an inappropriate location under the removable
dental prosthesis, the IARPDP may fracture due to the
inadequate thickness of the acrylic resin or the resin may
have excessive contours.13,14 An overcontoured denture
base can affect esthetics, phonetics, and function.15
Determining the relationship of an adequately
designed preexisting RPDP and the partially edentulous
state with 3D implant planning software, as described in
this article, can replace the virtual waxing process and
help determine the adequate implant location through an
approach based on the position of the existing RPDP.
Before changing the position of the patient’s preex-
isting RPDP in the implant planning software, the state
of the preexisting RPDP must be evaluated. If the denture
is of good general quality with adequate tooth position

THE JOURNAL OF PROSTHETIC DENTISTRY Kim and Shim

January 2017
but does not fit properly, the intaglio surface of the RPDP
should first be modified through a reline procedure.
However, if the RPDP is not suitable for use because of
its ill fit, lack of esthetics, or inadequate occlusion, a new
RPDP should be fabricated and a surgical guide for
implant placement should be generated using the new
RPDP as a reference.16
The importation of complete removable dental pros-
thesis information into implantation planning software is
generally performed for patients with complete edentu-
lism because there are no existing natural teeth that can
be superimposed as reference parameters. However, a
guide can be generated for patients with partial
edentulism to determine the implant position using the
process reported in this article if the patient’s existing
denture has appropriate tooth arrangement. In particular,
in patients with an IARPDP, proper implant positioning
may be obtained using denture framework data by con-
necting the RPDP to the residual ridge of the CBCT in the
planning software.
This planning method is useful in patients with an
IARPDP converted from a conventional RPDP or newly
fabricated IARPDP with simultaneous implant place-
ment. This technique can be used in patients planned for
an implant-supported FDP with a conventional RPDP if
the position of the conventional RPDP is an acceptable
reference for the implant’s position.
SUMMARY
For computer-guided implantation planning using a
preexisting removable partial dental prosthesis, super-
imposition process is required based on a denture-
wearing cast to record the positional relationship
between the patient’s remaining arch and the existing
RPDP, using CAD software and transferring it to
implant-guided planning software. This process allows
optimal implant positioning, making positional relation-
ship of the removable partial denture prosthesis to the
residual ridge of the CBCT in the planning software.
Kim and Shim
17
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Corresponding author:
Dr June-Sung Shim
Department of Prosthodontics
College of Dentistry
Yonsei University
50-1 Yonsei-ro, Seodaemun-Gu
Seoul, 03722
SOUTH KOREA
Email: jfshim@yuhs.ac
Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.
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