A New Surgical Template with a Handpiece Positioner for Use During Flapless Placement of Four Dental Implants to Retain a Mandibular Overdenture Moustafa Abdou ELsyad, BDS, MSc, PhD Lecturer, Department of Removable Prosthodontics, University of Mansoura, Faculty of Dentistry, Eldakahlia, Egypt Keywords Surgical template; implant placement; edentulous mandible; flapless technique. Correspondence Moustafa Abdou ELsyad, Department of Removable Prosthodontics, Faculty of Dentistry, University of Mansoura, P.O. Box 35516, 68 EL Gomhoria Street, EL Mansoura, EL Dakahlia, Egypt. E-mail: M_syad@mans.edu.eg The author denies any conflicts of interest. Accepted January 3, 2012 doi: 10.1111/j.1532-849X.2012.00870.x Abstract This article describes the fabrication of a new and inexpensive surgical template from a radiographic template for flapless placement of dental implants to retain a mandibular overdenture. A radiographic template with radiopaque metal plate markers is constructed and used as a guide for achieving three-dimensional evaluation of bone using computed tomography (CT). The potential position and angulation of the implants are measured relative to the metal plates using the CT data. The radiographic template is converted into a surgical template by attaching rigid metal rods that guide the handpiece precisely during subsequent drilling procedures. Implant-retained overdentures and implant-supported prosthe- ses are sensitive to the position and angulation of the implants for two reasons: (1) to fabricate an esthetic, hygienic, and func- tional prosthesis, and (2) to position the implants and the reten- tive matrices parallel to each other and to the path of insertion of the prosthesis. 1-3 The precise placement of implants requires the use of appropriate imaging techniques together with the use of a well-constructed surgical template. 4 Surgical templates are often fabricated either manually or stereolithographically 5 according to computer-assisted implant planning. These tem- plates provide adequate precision of implant placement in the mesiodistal and buccolingual directions and simplify immedi- ate loading protocol, particularly for complete dentures due to minimally invasive surgery and possibility of prosthesis con- struction before the surgery. 6-8 However, critical objections to such technology are the costly software or the stereolithograph- ically produced surgical templates. 6 Moreover, most of these templates depend on the use of surgical sleeves or cylinders, which only allow control of the initial drilling, and it is not pos- sible to use the template as the drill diameter increases during the osteotomy preparation. 9 Even with the use of the Nobel- Guide (NobelBiocare, Yorba Linda, CA) sleeve-in-sleeve sys- tem, implant placement accuracy can also be influenced by drill attrition from inevitable contact with the titanium sleeves with consecutive drilling. 10 Transfer of radiographic information to the surgical tem- plate remains a challenge, especially in an edentulous arch, because the reflection of the flap makes a conventionally made surgical template inaccurate and less predictable due to space between the alveolar crest and the template. 11-12 The flapless procedure reduces chairside time, 13 minimizes invasive surgi- cal procedures, and preserves tissue support for the template during surgical manipulation. 1 This article describes a step-by-step technique for the fabri- cation of a sleeveless surgical template for implant placement in the edentulous mandible using a flapless approach. The tem- plate is inexpensive and does not require complex equipment or techniques. Technique Maxillary and mandibular irreversible hydrocolloid impres- sions (Alginate CA 37 Superior Pink, Cavex Holland BV, Amsterdam, The Netherlands) are made and poured with type IV stone (ZETA, Orthodontic Stone; Whip Mix Corp., Louisville, KY). The resultant casts are mounted on a semi- adjustable articulator (Model 8800; Whip Mix Corp.) in cen- tric relation at the correct occlusal vertical dimension (OVD). The diagnostic tooth arrangement that satisfies function and esthetics is completed on trial denture bases. Journal of Prosthodontics 00 (2012) 1–5 c  2012 by the American College of Prosthodontists 1