The fabrication of a surgical stent for an implant case usually adds an additional appointment and additional expense to the patient.  The following technique allows surgical stents to be easily fabricated for many implant cases without using a dental laboratory.

Prior to an extraction or sectioning of a failing fixed partial denture, make alginate impressions for diagnostic casts.  If the patient wears a removable partial denture, it should be seated in the mouth when the impressions are made.  If the patient is considered an acceptable implant candidate by the surgeon, and the patient accepts the proposed implant treatment plan, the diagnostic casts are analyzed by the restorative doctor.  In the areas where implants are to be placed, broken down teeth are filled in with wax and missing teeth are replaced with modified denture teeth.  If the existing tooth alignment and occlusion are deemed acceptable, a clear, "suck-down" stent is made over the arch where implants are to be placed.  The diagnostic casts and stent can then be sent to the surgeon where holes are drilled through the occlusal surface of the stent corresponding to the tooth sites where implants are to be placed.  The open, transparent stent allows the surgeon to slightly angle the implant drills, within the confines of the stent, as necessary to penetrate the available alveolar bone.

Surgical stents that do not give the surgeon room to modify the angle of the pilot drill are often of little benefit during the surgical procedure when there is alveolar ridge atrophy.  This type of stent helps avoid such problems.

I want to emphasize that this technique usually works very well for implant retained single crowns or fixed partial dentures where the pre-extraction occlusion is acceptable.  Arches with large, non-restored edentulous spaces may require a laboratory wax-up.   Most importantly, the diagnostic impressions must be made before existing fixed partial dentures are sectioned and necessary extractions are performed.

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Should Patients Stop Taking Aspirin Prior To Dental Extractions?

It has long been recommended by most dentists that their patients cease aspirin use prior to invasive oral surgical procedures. Unfortunately, there has been no clear guideline regarding which patients and surgical procedures require cessation of aspirin use, and for how long before and after the surgery aspirin use should be stopped. For patients taking aspirin to prevent stroke or myocardial infarction, cessation of this drug could subject these patients to unnecessary risk if the proposed surgical procedure could safely be performed without significant bleeding.

A recent prospective study performed at the Carolina Medical Center in Charlotte, NC examined whether or not aspirin use was associated with significant bleeding complication following single tooth extraction. Thirty-six healthy patients were given either 325 mg of aspirin or a placebo for two days prior to and two days after a single tooth extraction.  Bleeding complication was assessed by telephone between 3-7 at 40-55 hours after extraction. There was no statistically significant difference in intra-operative or post-operate bleeding duration between the aspirin and placebo groups. The investigators concluded that there is no indication for the discontinuance of aspirin for patients undergoing single tooth extraction. If a patient requires multiple extractions, impacted tooth removal, or takes multiple anticoagulants aspirin therapy cessation may still need to be considered.

Reference:    Valerin MA, Brennon, Mt, Noll JL. Napenqs JT, Kent ML, Fox PC, Lockhart PB.
Relationship Between Aspirin Use and Postoperative Bleeding From Dental Extractions in a Healthy Population.
Oral Surg Oral Med Oral Path Oral Radiol Endo 2006; 102:326

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