# Digital Planning Technique for Surgical Guides for Prosthetic Implants before Orthodontic Treatment
## 3 Case Reports
### Case No. 1
\begin{table}
\begin{tabular}{c c c c} \hline \hline
**Treatment Plan** & \multicolumn{2}{c}{**Advantages**} & **Disadvantages** \\ \hline \multirow{6}{*}{I} & 1. & 3D setup and accurate planning of final tooth position; & \\  & 2. & Surgical guide for tooth 21 implant planned on teeth & \\  & & in their final position; & \\  & 3. & Distalization of sector 2 to achieve Class I molar & \\  & 4. & relationship using tooth 21 implant; & \\  & 4. & More esthetic treatment; & \\  & 5. & More comfortable for the patient (oral hygiene) [7]. & \\ \hline \multirow{2}{*}{II} & 1. & Less expensive; & 1. & Implant surgery can be performed only \\  & 2. & Good occlusion. & 2. & after orthodontic treatment; \\  & & & 2. & Less comfortable treatment for the \\  & & & patient. \\ \hline \multirow{6}{*}{III} & 1. & & 1. & Not recommended by orthodontist; \\  & 2. & Patient would lose healthy teeth; & \\  & 1. & Less expensive; & 3. & Due to extraction of premolars, upper \\  & 2. & Good occlusion. & & front teeth would be distalized and \\  & & & support for upper lip would be lost, \\  & & & therefore upper lip would look smaller. \\ \hline \multirow{6}{*}{IV} & 1. & & 1. & Angle class would not be corrected; \\  & & & 2. & Patient would experience greater and \\  & & & uneven tooth wear; \\ \cline{1-1}  & 1. & There are no advantages of this treatment method. & 3. & Implant would be placed in the space \\ \cline{1-1}  & & & available now and if the patient decides \\ \cline{1-1}  & & & to perform orthodontic treatment later \\ \cline{1-1}  & & & in life, the possibility for orthodontic \\ \cline{1-1}  & & & treatment would be limited. \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Advantages and disadvantages of the suggested treatment plans. Figure 5: Digital planning: (**a**) ponics of teeth 21 and 35 at the beginning of the orthodontic treatment; (**b**) ponics of teeth 21 and 35 at the end of the orthodontic treatment. After receiving the surgical guide, the surgeon planned the procedure. Tooth 21 was extracted and the implant surgery of tooth 21 was immediately performed using a prepared guide (Figures 6 and 7). Because the procedure was performed in the frontal aesthetic region, a temporary crown of tooth 21 was made using temporary Straumann abutment (Figure 8). It is important to mention that the temporary crown of tooth 21 was excluded from occlusion and all functional moves in order to avoid force on the implant. After the implant surgery, 3 months were given for the implant to integrate with the bone. After these 3 months the patient was asked to repeat the 3-Shape scanning. The second scan was carried out using a scan body to specify the implant's position, in order to make a clinically proper temporary crown of tooth 21 that would withstand occlusal forces (Figure 9). Figure 6: Digital planning of the surgical guide of Case 1. Figure 7: Using the surgical guide for implant surgery. Moreover, the second scan was performed in order to update the existing 3D plan for orthodontic treatment with aligners. It is important to mention that tooth 35 was missing; however, there was not enough space for an implant for this tooth. Therefore, orthodontic treatment was planned as follows:  
* For aligner stages 1 to 16, a mini screw in the area between teeth 34 and 36 was added for the distalization and uprighting of teeth 36 and 37. * A segment of braces was used to distalize teeth 36 and 37, employing the mini screw as skeletal anchorage. The segment of braces consisted of two metal brackets on teeth 36 and 37, a piece of stainless steel archive of size 16 \(\times\) 22, and a heavy-force 9-mm  
Figure 8: Temporary crown after immediate the implant surgery. Figure 9: Scan with the scan body. closed-coil spring. The length of the archive used was measured by adding 2 mm to the distance between the mini screw and tooth 37, leaving space for the teeth to slide distally. * The distalization of teeth 16, 17, 26, and 27 was planned with aligners by adding Class II elastics of 6 Oz and a quarter of an inch.