Guided Implant Surgery
Guided implant surgery involves the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies to plan and execute dental implant placement with a high level of precision. This process typically includes the following steps:
Digital Imaging and Planning
• Cone Beam Computed Tomography (CBCT) scans or other advanced imaging techniques are used to create 3D models of the patient's oral structures.
• Specialized software helps in planning the optimal implant positions based on the available bone structure.
Surgical Guide Design
• A surgical guide, often a 3D-printed device, is designed based on the digital treatment plan.
• This guide assists the dentist or oral surgeon in precisely placing the implants according to the pre-determined positions.
Surgical Procedure
The surgical guide is used during the actual implant placement surgery, ensuring that the implants are positioned accurately
The term “stackable” refers to a concept where multiple guided surgical procedures are performed in sequence or concurrently. This could involve planning and placing multiple implants in a single session or planning a series of implant surgeries that build upon each other, as well as the immediate post surgery insertion of a prosthesis that has been preplanned and is one of the components of the stackable protocol. The advantages of stackable fully guided implant surgeries could include:
Efficiency
Performing multiple procedures in one session may reduce overall treatment time.
Precision
Utilizing guided surgery ensures accurate placement of each implant.
Patient Comfort
Minimizing the number of surgical and restorative sessions may enhance the patient's experience.
It’s essential to note that developments in dental and medical technology occur, and new techniques or terminology may emerge after my last update. If “stackable fully guided implant surgeries” is a term or concept that has gained prominence since then, I recommend consulting the latest literature, attending conferences, or contacting dental professionals who stay current with the latest advancements in the field for the most up-to-date information.
Planning a Guided Implant case.
Planning and designing successful implant guides can be relatively simple if certain steps are followed. Using guides for placing implants can make the difference between a successful case or a failure. It can also make a huge difference in whether or not the laboratory will be able to achieve an aesthetically pleasing result or not.
Communication is Key.
• Photos, Photos, Photos…Please take photos, these not only help in planning and visualization but they are a great way of keeping records as well as way to educate other patients.
• If it is a Cosmetic case and involves 1 or more teeth in the Esthetic zone, a Digital Smile Simulation, is fantastic way to show the patient what their new teeth or smile will look like.
What the Lab Needs To Plan A Case
Accurate Upper and Lower Scans, Impressions or Models of the Patient
CBCT of the patients Jaw. Medium or Large field Scans are preferred and patients should be scanned in an open bite. (Biting on cotton rolls)
Photographs of the Patient.
CBCT of the patients Jaw. Medium or Large field Scans are preferred and patients should be scanned in an open bite. (Biting on cotton rolls)
Step By Step Protocol
The Process
Once the Lab( DLA) has received all the required Data and Information we then:
Scan and Digitize the Patients Models (if analog). Upload the Intra Oral Scans of the Patient (if digital)
Upload and Clean the CBCT scan
Merge the CBCT with the Digital STL files of the patient’s models
Digitally remove any teeth that are being extracted at the time of surgery.
Design a Digital Set up of the teeth to be restored if required.
Using implant planning software, plan the implant placement as ideally as possible, from both a restorative aspect as well as from a clinical aspect. (Available bone)
Once Pre-Planned we then arrange a short online Zoom meeting at your convenience to review the plan and make any changes. As the surgeon you have final say as the plan and design.
Once the plan is approved and signed off by the doctor we design, Fabricate and ship the Guide.
With the guide we include a printed copy of all the implant positions taken in various views as well as a detailed Sequenced Drill plan.
Overview
A dual scan protocol is a 2-step scanning process of fully edentulous patients using CT or CBCT scanners for the purposes of treatment planning. It’s required for the design and fabrication of the following surgical templates:
You Will Need
1. CBCT scan of the denture only with markers.
2. CBCT scan of the patient wearing the same denture with markers
Checklist
The following items are needed for a successful scan:
- Patient’s existing denture, duplicate denture or clear acrylic scanning appliance.
- No metal components (e.g. wire mesh/plate, metallic crown or wire clasps).
- SureMark CT Scan Markers: 6-8 radiopaque (non-metallic) glass beaded-stickers.
- FutarBite Registration: radiolucent bite index.
Preparation for Dual Scan
- Start with a clear acrylic scanning appliance or well-fitted denture with low radiopacity to avoid scatter.
- Check stability and fit (i.e. full palatal coverage, sulcus full depth is reached).
- Do a hard reline if necessary (recommended).
- Dry appliance before sticking the markers so that they don’t move.
- Mark appliance with 6-8 markers for partial or full-arch appliance.
- Cut the markers if necessary so that they can fit.
- Place markers randomly but make sure there are none on the soft tissue surface.
Prosthesis Scan
- Position the appliance as just as it sits in the patient’s mouth on a foam or Styrofoam block.
- Scan the appliance at 80KVP and 2ma if you’re using a Carestream unit. On any other unit, continue to use patient morphology.
- Confirm that all markers are clearly visible in the scan.
Patient Scan
- Prepare a bite registration with full-arch appliance to ensure proper seating.
- Use normal implant planning protocols and the largest field of view.
- Ask the patient to bite firmly on the bite registration to blanch the gums.
- Confirm that all markers are clearly visible and the appliance is seated properly.
Dual Scan Tips & Tricks
Remember that the tissue-supported guide will fit on the patient’s mucosa exactly how your denture fits in the mouth at the time of scanning. (better fitting denture = accurately seated surgical guide)
CBCT scan of the patient wearing the same denture with markers.
Hard Reline your denture as needed before scanning
Your denture must be completely radiolucent to prevent scatter and artifacts in the scan. The only visible indicator will be the radiographic markers
When taking the denture–only scan, we recommend that you use a foam block to rest the denture on during the scan (create a distance between the bite place and the denture).
We always recommend using radiologically compatible CT markers.
If the patient is wearing a denture in one arch and dentate at the opposing arch, scan the patient with the arches separated by couple of millimeters
Transitioning from the surgical temporary to the Final
Clinical Steps For The Doctor
1) Take a bite registration.
2) Take an opposing impression (if needed).
3) Take a full series of photographs including Profile smiling and at rest.
4) Remove the prosthesis.(if u have an IOS, scan the entire prosthesis-occlusal and intaglio.
5) Using the Duplicate prosthesis clean and paint some tray adhesive on the intaglio surface.
6) Screw back into the mouth.
7) Inject light body impression material (Reline) under the prosthetic to capture the healed tissue position.
8) Remove from the patient, and send to the lab.
Lab Steps done Chairside by Larry
9) Attach analogs to the prosthesis.
10) Create a soft tissue model and then pour an implant model with the prosthesis.
11) Using the bite mount on an articulator and lock the occlusion.
12) Take a putty Matrix of the prosthesis on the new model.
13) Clean and return the prosthesis to the patient.
Steps at the Lab
14) Scan the new records into the lab software.
15) Design a new prosthesis using the new records and make the necessary changes.
16) Print a prototype for try in and evaluation. (in office only).
17) Once approved either mill a PMMA Trial Prosthetic or the Final Zirconia