Surgical guides

[gallagerdental]

I have a request by a periodontist to fabricate a surgical guide using horizontal slots on buccal and labial flanges. I assume he wants this to locate the alveolar ridge for placing implants. Can anyone give me any guidelines on positions of these grooves or any other information? Thank you for your help.


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[gallagerdental]

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[2thm8kr]

Hey Gallagher, get the ct scans and design it with fixation screws. After the surgeon flaps it and the pins are positioned that thing 'ain't' goin no wheres.

 

[gallagerdental]

Thanks for the suggestion !


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[lcmlabforum]

I don't have pictures but I used to do that for my surgeons so you can visualize better
and the flange would be kept to retract the flab away while the drilling is performed.
Sometimes, the flab can be tucked into the slots, but your slots are too narrow for that
purpose.
Can you give me name of the periodontist? Is/was he in/from Houston?
LCM

 

[gallagerdental]

Thanks for your input LCM .It helps a lot. I don't know if it's proper to give his name on this forum, but we are both from New Jersey. As far as I know he never lived in Houston area. Again I am greatful for your help.


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[lcmlabforum]

No problem, just wondering if it was someone who worked with a template I made while in the residency in
Houston.
Am sure someone can come up with better designs than mine.
!
LCM

 

[kcdt]

I have a request by a periodontist to fabricate a surgical guide using horizontal slots on buccal and labial flanges. I assume he wants this to locate the alveolar ridge for placing implants. Can anyone give me any guidelines on positions of these grooves or any other information? Thank you for your help.


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Ive seen a surgeon use something like that to aid the ridge reduction as well.

 

[gallagerdental]

Thx. Just wondering if there were any guide lines-size, shape, placement or how many. Maybe I'm over thinking this ?


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[kcdt]

Thx. Just wondering if there were any guide lines-size, shape, placement or how many. Maybe I'm over thinking this ?


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I'd get the surgeon to explain what they're for; otherwise how can you make any judgement on design?
The clinic has some responsibility to not leave you guessing.

 

[gallagerdental]

Just wanted to comment. Case so far has been three part. First we made a temp. Partial( leaving only both cuspids, all other teeth extracted. This will be an all on four or more, I'm told)second part is full lower immediate & stent as you see(currently working on both) which will be sent to periodontist prior to surgery. I spoke to Dr. Again this week, asked for specific dimensions of slots, he couldn't tell me. Apparently, a lab designed this for him before & he's used it since. Best I can get out of him is that he can see ridge of tissue & bone to determine what length of implant & abutments to be placed. Also I'm told I will have to determine length of the abutments, at time of surgery. This will be interesting.


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[2thm8kr]

Now is the time to broach the subject of 3d guided surgery.

 

[kcdt]

Just wanted to comment. Case so far has been three part. First we made a temp. Partial( leaving only both cuspids, all other teeth extracted. This will be an all on four or more, I'm told)second part is full lower immediate & stent as you see(currently working on both) which will be sent to periodontist prior to surgery. I spoke to Dr. Again this week, asked for specific dimensions of slots, he couldn't tell me. Apparently, a lab designed this for him before & he's used it since. Best I can get out of him is that he can see ridge of tissue & bone to determine what length of implant & abutments to be placed. Also I'm told I will have to determine length of the abutments, at time of surgery. This will be interesting.


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Sure seems like you're getting asked to do a lot with no specifics.

Not really keen on the sound of that.

I'd like to think that at this level of procedure, the Drs involved would be more interested in overseeing their responsibilities.

 

[lcmlabforum]

Red flags going up.
I would stop and bail because being told to be responsible for something without
proper information, and that you are responsible for the abutment selection.
The surgeon cannot even tell where the implant will be, how far is bone level/platform
from soft tissue, where the restorative space will be, how angled it would be in order
to avoid sinus or mandibular nerve, so you are supposed to 'prescribe' the implant
trajectory of how many implants to use?
You got to be kidding me, right?
Either you will end up making one that they cannot use, or will not use, or
used and try to pin the problems on you.
That is when Mark Jackson needs to come in to discuss the legal implications
of fabricating a surgical guide without the benefit of a Cone Beam or other advance
imaging.
Let alone trying to convert a partial to a fixed provisional . . .
As the folks on the Titanic were saying. "Abandon ship!"
Just my 2 cents worth.
LCM

 

[JKraver]

Lol, whats the worst that can happen? 10 implants it is!

 

[gallagerdental]

Lets just say there is more to this story then I can print. I have got all the angles covered,I hope,legally & ethically. Everything is well documented & backed by GP, who is standup guy.over the years I have walked away from many a situation without giving it a second thought. Currently I feel I still have control over my situation,if at any point, I feel I don't or won't, I'm out.However,If left to this guys way of doing things, I'd be placing the fixtures too! PS, as far as final transitional & guide he will be signing off on it. Copies will be forewarded to GP. So far I'm hanging in there at GP's request,again I don't stick my neck out.


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[Andrew Priddy]

this is a good read...
http://www.dentistrytoday.com/ce-articles/383

maybe bill it out as a restorative template...
I of course, need to read further

 

[gallagerdental]

Wanted to get back on results of surgery- long day for patient and everyone involved but in the end everything went fairly well.( with a few hiccups) I won't go there. However one thing interesting came up. Specialist had trouble orienting transitional appliance . I'm thinking of making a jig to help, any thoughts?


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[Labwa]

In relation to the opposing dentition?

 

[gallagerdental]

Yes , something to correct tissue flap displacement which tended to throw off occlusion. I was thinking of a gelb type appliance with a vertical opening that would allow tacking the anterior most cylinder which would lock in initial position.


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