Surgical Guide Help......

[ChrisR]

Have A request from a doctor for a surgical guide for tooth #19. He wants a vac. form, clear acrilic tooth and a 2mm hole drilled throu. I tried it today by waxing #19, duping model, 1mm biocryl suck down then adding biocryl ice to edentulous area by brush. got it 3/4 of the way filled, dropped it on master model and salt n peppered the tissue area. pressure potted it for about 20 minutes. the pontic / placement area came out great but on the interior of the biocryl it is very cloudy and rough. Is this from the monomer melting the biocryl or maybe the stone breaking down ??? Any suggestions what to do different or a better way ??

[TheLabGuy]

What I do is a suckdown, then cut my hole where needed, take a casting sprue, cut off the resovoir, then superglue that sprue into place where the implant will go. Easy and efficient, and doctors love it, makes it simple for them.

[ChrisR]

So you are not making adding a solid tooth in the edent. area ? Just a plastic sprue to giude the doctor to the area ?? Did I understand that right ??

[TheLabGuy]

Yeah, sorry about that, forgot that most important detail....lol Once you got the suck down of the denture tooth, take the denture tooth out of the suck down, put suck down back on the model, and put a sprue in it, simple as that, gives the dentist a guide and limits their axis of insertion of that drill. Hope that helps.

[ChrisR]

Ok i get it now. sounds way easier that the way i'm goin now. Might have to give 1 a try and see what the doc thinks. thanks

[DMC]

I do the same sort of thing. Depending on what implant is being placed, I'll get some rope wax (same that I cut for sprues) and just push it on the model exactly where I want an implant. I leave it sticking up an inch or more, trying to keep the wax perfectly straight.

I then throw the model in a scanner, and digitize. I hand draw a margin covering a few teeth on either side of edentulous area and covering the ridge and sprue. I then call that one big tooth. Remove undercuts so it will draw on/off with one click of mouse. Make "coping" 2mm thick and send to printer.

I'll post a pic of what we get. I then just cut open the top of the canal, leaving a tube to guide. I think the wall of guide should be hard metal, and I need to make two piece and cast inner wall.

Scott

Inner wall I guess ranges from 2.8mm-5/6mm?? Depends on size/brand of mplnt

(does this make sense?)

[Kreyer]

To prevent contamination of the surgical site implant guide sleeves should be titanium.

Attachments International link for Extension Guide Sleeves http://www.attachments.com/implantca...f/pg264aux.pdf


Another option for guide sleeves and inserts is Deplaque link to their website is..
https://www.deplaque.com/professional/catalog/login.php

Rob

[DMC]

That seems logical. I thought the sleeves should be titanium or gold. (gold too soft? Expensive?)

I was going to make my own sleeves

Attachments international is a great company.

Ask for Darwin, he know what he's talking about.

[TomZ]

Scanoguides are becoming the gold standardfor implant placement. There are guides for full arch, single and multiple tooth restorations.
Heres a link to a laboratory instruction slideshow which will start you thinking about different ways to fabricate them.
Implant Scanoguide technique

[adamjhuathan]

Those are some cool links Kreyer, I just found this forum while browsing and i get some cool ideas on here... thank you guys!

Originally Posted by Kreyer

To prevent contamination of the surgical site implant guide sleeves should be titanium.

Attachments International link for Extension Guide Sleeves http://www.attachments.com/implantca...f/pg264aux.pdf


Another option for guide sleeves and inserts is Deplaque link to their website is..
https://www.deplaque.com/professional/catalog/login.php

Rob

[rmcmanus]

Try this


Terry Charters---Planning for Success

Richard

[Brian]

This isn't rocket science..... And Z is correct; if you want to spoil your client and show some high speed low drag ability the Scancryl is the heat! Good job on that one Thomas..

[billydte]

why would you use Scancryl over radiopaque teeth?


Terry Charters---Planning for Success. .................this is with stranum implants right? I went through a class with stranum on this, but all my docs use zimmer and zimmer don't make those parts. Guess it wouldn't matter as long as there the same size.

We make some Sirona Galileo's guides, I like them a lot. when just doing a regular guide, we place aluminum drill sleeves.

[TomZ]

Billydte-

You can use any tooth manufacturers tooth for the try-in which will eventually be the final prosthetic, and its duplicated in a radiopaque version from the wax up.
flexibility-
You dont have to purchase a radiopaque tooth version for one shot.
lowers the cost-
ScanoCryl is $62.00 for a pound

[kcdt]

Originally Posted by DMC

That seems logical. I thought the sleeves should be titanium or gold. (gold too soft? Expensive?)

I was going to make my own sleeves

Attachments international is a great company.

Ask for Darwin, he know what he's talking about.

Titanium sleeves (I use 3i) run $3/ea. I charge $6. They have lot #s that are traceable and are FDA approved for the use, as i assume are the ones Robert mentioned.
Why would you go to the expense and trouble of trying to make one... bad time management.

[rmcmanus]

Originally Posted by billydte

Terry Charters---Planning for Success. .................this is with stranum implants right? I went through a class with stranum on this, but all my docs use zimmer and zimmer don't make those parts. Guess it wouldn't matter as long as there the same size.

We make some Sirona Galileo's guides, I like them a lot. when just doing a regular guide, we place aluminum drill sleeves.

--------------
Yes, The Terry Charters technique is for the Straumann system. What I have adapted for other systems is similar to the straumann technique. I find out the diameter of the pilot implant drill the surgeon will use. Then I locate the same sized twist drill- I have only had luck with this by searching the internet to locate distributors of metric diameter twist drills-.

Drill the hole in the model 5-6 mm deep at the implant site using a twist drill sized to the diameter of the pilot drill the surgeon will use. Using another twist drill of the same diameter cut off the end of the twist drill leaving only the smooth end you place in the drill bit. Lubricate this smooth end and place it in the hole in the model. Block out undercuts on the teeth adjacent to the implant zone gingivally with block out material. Place dura lay resin on the smooth end of the twist drill until the dura lay is a even thickness all around. You are going to do a suck down on this twist drill - dura lay "jig" so leave the duralay rough enough for retenton to the suck down material. Place rubber sep on the adjacent teeth you plan to use as support teeth for the guide.

Do the suckdown on top of the model and jig; let it cool , remove the twist drill and finish.

With a supply of the correct diameter twist drills this technique would work for any implant system. It's limitations is that you only provide the guide for the pilot drill but most surgeons find this OK. With some creatitivity and the correct sized drill sleaves I bet the technique could be adapted to do more.

[CPLZ]

.

[kcdt]

Originally Posted by rmcmanus

--------------
Yes, The Terry Charters technique is for the Straumann system. What I have adapted for other systems is similar to the straumann technique. I find out the diameter of the pilot implant drill the surgeon will use. Then I locate the same sized twist drill- I have only had luck with this by searching the internet to locate distributors of metric diameter twist drills-.

Drill the hole in the model 5-6 mm deep at the implant site using a twist drill sized to the diameter of the pilot drill the surgeon will use. Using another twist drill of the same diameter cut off the end of the twist drill leaving only the smooth end you place in the drill bit. Lubricate this smooth end and place it in the hole in the model. Block out undercuts on the teeth adjacent to the implant zone gingivally with block out material. Place dura lay resin on the smooth end of the twist drill until the dura lay is a even thickness all around. You are going to do a suck down on this twist drill - dura lay "jig" so leave the duralay rough enough for retenton to the suck down material. Place rubber sep on the adjacent teeth you plan to use as support teeth for the guide.

Do the suckdown on top of the model and jig; let it cool , remove the twist drill and finish.

With a supply of the correct diameter twist drills this technique would work for any implant system. It's limitations is that you only provide the guide for the pilot drill but most surgeons find this OK. With some creatitivity and the correct sized drill sleaves I bet the technique could be adapted to do more.

I know you posted this sometime back, but i wonder, do you get any feedback from the surgeons? It seems to me that if the pilot drill wobbled or chattered at the initial osteotomy, the resin could be ground away and you'd lose the precision needed for control. Other than cost, is there another reason you don't use a titanium sleeve? I think the whole purpose is to bulletproof the thing in the surgeon's hands, so they don't go off and screw the pooch.

[CShof]

Where does everybody buy their sleeves? Maybe post some links? I saw the Deplaque and Attachments International links above, but do others buy them elsewhere? I tried searching Zahn's website, do they sell them? Prices?

Sorry about all the questions, just looking to do some comparison shopping to find the best price. I assume a sleeve is a sleeve and other than its material the quality will be the same regardless of manufacturer...correct?

[rmcmanus]

Originally Posted by kcdt

I know you posted this sometime back, but i wonder, do you get any feedback from the surgeons? It seems to me that if the pilot drill wobbled or chattered at the initial osteotomy, the resin could be ground away and you'd lose the precision needed for control. Other than cost, is there another reason you don't use a titanium sleeve? I think the whole purpose is to bulletproof the thing in the surgeon's hands, so they don't go off and screw the pooch.

Yes, constant input - every case! Terry has metal sleeves that fit nicely and are replaceable for the various size surgical drills. I do not believe that they are Titanium but honestly I don't understand why they need to be Titanium. They are metal and VERY stable. Most instability is due to the SUCK DOWN NOT BEING HELD FIRMLY BY THR ADJACENT TEETH not because of the type of metal used for the sleeve. You make a plastic "suck down" but the metal sleeve fit inside the "suck down" and the surgical drills are guided by the metal sleeve. The only time the surgeon would use the suckdown as a guide is with the final drill for the Wide neck implant when the oseteotomy is already well defined. I have the guides returned to me and use them as an indicator when the final impressons are done - this way I can see if the surgeon used the guide or not. I can then report if the implants were put where I indicated. If not, I have no responsibility for the implant placements and the surgeon is flying on his own. You have to take responsibility but only if your guide is used and if not you need to know why so that you can grow in knowledge so the next guide is improved. We are not perfect but should always strive for improvement. These guides are for the Straumann System. Call Terry!
Richard McManus

I've looked for the 3i sleeves and cannot find them can you help me with a link?
Thanks
Richard