Guided dental implant surgery

Guided dental implant surgery

Guided dental implant surgery is a method of surgically placing a dental implant in the most ideal position. It utilizes the best technology to create a guide that aids the doctor in implant placement.

What is guided dental implant surgery?

It consists of a surgical guide that fits on the patient in a precise position and therefore allows precise placement of dental implants.

How do we accomplish guided dental implant surgery?

We need a CBCT 3 dimensional x-ray of the jaw, a digital impression or model of the teeth and or gums, software to plan the dental implants, and a 3D printer. Next, we take the data from those things and stitch the digital information together in the software to design the guide. Finally, we print the surgical on a 3D printer and insert metal sleeves later.

There are 2 methods to fabricate a surgical guide for guided dental implant surgery.

We can make a guide from a model, known as model based, or from a CBCT based. There is few reasons to do a model guide in this day and age. Other options for the surgical guide include tooth, bone, or tissue born options.

Model based method 1 2
  1. Stone cast on surveyor and use 2mm drill press to place hole at desired angle 5-10mm deep
  2. Place 2x10mm drill blank (McMaster-Carr Co) into hole
  3. Next, place 2mm bushing over blank
  4. Place appropriate guide sleeve over bushing
  5. Inject any light polymerizing gel (Triad Gel) around guide pins
  6. Need inserts for different sizes
Image of model guided surgery
Cast should be marked as shown
CBCT based 1
  1. Inital cast has teeth set in ideal location and barium sulfate flipper or denture that the patient wears.
  2. CBCT with flipper in place
  3. Implants placed on software

 

How to make a CBCT guide on edentulous patient.

Cory Glen video using BSB.

Guide surgery case example

 

Image of tooth born surgical guide being placed

Another view of surgical guide in the mouth

Image of drilling for a dental implant with surgical guide

Drilling through the surgical guide

Image drilling through surgical guide

Drilling through surgical guide

Image of flapless guided dental implant surgery

Immediately after denatl implants placed. Since this was done flapless there is very little pain after.

Final x-ray of Guided dental implant surgery

 

What are the options and techniques for a 3D printed dental implant surgical guide?

What are the options for surgical guides if don’t print own?

$35 to scan stone model and print surgical guide. 3-5 day turn around Digi 3D

Dominion Milling Center will print a surgical guide for you for $35. Need scan of teeth no model printing.

Top companies for 3D guided dental implant surgery

  1. Nsequence is one of the biggest names because they work with Pikos.
  2. Bonadent is another one that looks slick I saw on dt.

What are the 3D printing in office surgical guide options?

Never absolute precision in CBCT. Most systems have 20-30% barium sulphate acrylic scan prosthesis (not Nobel that uses gp). If partially edentulous may not need at all, use teeth as reference.

Types – with any of these types it helps to have holes in guide or drill holes self to ensure fully seating. Post 35

  1. Tooth born=most accurate
  2. Tissue born
  3. Bone born

Companies

  1. SimPlant – Facilitate (bone guide available)
  2. NobelGuide/NobelClinician
  3. 3D Diagnostix (bone guide available)
  4. Sicat – Sirona
  5. VIP3 – Biohorizons (no pilot)
  6. Blue Sky Plan (bone guide available)
  7. CoDiagnostix
  8. Cybermed – OnDemand (bone guide available)
  9. iGuide by iDent
  10. EasyGuide by Keystone dental (pilot only)
  11. gonyX by Straumann
  12. Guided Surgery Solutions
  13. Anatomage – InVivo5 (bone guide available)
  14. 360 Imaging
  15. Canada Bay
  16. Implant Concierge
  17. Jurim Dental Studio
  18. Nemotec
  19. nSequence Great bone guide system
  20. Ottawa Dental Lab
  21. Swiss Meda/SMOP
  22. GuideSMILE V2R Biomedical Great pin referenced provisional in use Tischler article in dentalcetoday

Indications

  1. 3 or more implants in a row
  2. Proximity to vital structures, adjacent teeth
  3. Questionable bone volume (significant soft or hard tissue defects)
  4. Implant position critical to restorative success
  5. Flapless plan
  6. Multiple unit or complete arch immediate restorations planned

94% patients have some form of nonodontogenic pathology!! List is here

Large volume CBCT has 2.7-25 times radiation pano, kind of useless since we use limited image.
CBCT is about 20% conventional CT in radiation
Thyroid collar can reduce exposure by 40%
CAS (carotid artery stenosis) found in pano is about 2-5%. Duplex ultrasound is gold standard to confirm

Place cotton roll under upper lip before CBCT to prevent shadowing.

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