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    Implant Surgical Guide

    Discussion in 'Case Presentations' started by patmo141, Oct 20, 2011.

    1. patmo141

      patmo141 Active Member Full Member

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      Hey Guys,

      I wanted to post a little bit about my most recent project which has spun off of my Blender project before. For this one, my initial work has been with some great collaborators in France. I coded an-add on for Blender to plan implant placement with the final restoration in mind. The surgical guide can be 3d printed, milled, SLA'ed or whatever CAM technique suites you. The guide can be planned entirely on the CT scan data assuming minimal metal restorations and adequate space between the teeth (not in MIP). Otherwise, you will need a 2ndary scan (eg, CT, White light or laser scan of stone model). Here are the resutls of some preliminary tests with a <3000Euro 3d printer....a little rough still but, first try fit the stone model being designed directly from CT scan.

      I would imagine in the future, a metal sleeve which matches any drill system could be secured into the plastic holes. For this first test, the guide is just for initial guidance and no physical guidance. Measurements were made in software for depth references but there would be no physical depth or angulation limitation (plastic guide vs metal drill = contaminated placement site)

      This is all preliminary work so comments, criticisms, ideas are all welcome.

      I'll start:
      -bulky
      -not transparent/translucent
      guide_with_holes.png 3d_printed_guide2.jpg splint side view.jpg splint_tooth_side.jpg
       
      Last edited: Oct 20, 2011
      • Winner Winner x 1
    2. patmo141

      patmo141 Active Member Full Member

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      Early Integration with Fixed Module

      Here are two videos showing my early attempts at integrating the implant and fixed modules together. These were tutorials for some of my initial testers so they are a little long. If 10 minutes is too long, simply view the screen shots :) This does show the current work flows.

      [YOUTUBE]4h4XqLlhvB0[/YOUTUBE]
      [YOUTUBE]7qIEA1vALco[/YOUTUBE]
      preliminary fixed planning.jpg implant_placement_teeth.jpg cross_section_view.jpg
       
      • Informative Informative x 1
    3. NicelyMKV
      Spaced

      NicelyMKV Well-Known Member Full Member

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      Very cool! I would like to know where you are going with all this hard work? Competing against Exocad? Looking good so far.
       
    4. k2 Ceramic Studio
      Artistic

      k2 Ceramic Studio Well-Known Member Full Member

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      Exocad watch your back

      I am with you on this one Nicely, what you know and are able to do blows most techs/dentists out of the water. BIG RESPECT, I mean it, what you have done looks fantastic. I love playing with this stuff but when it comes to designing it from scratch then thats a different ball game. Would be happy to give a donation for a diagnostic software tool like this.:)
       
    5. paulg100

      paulg100 Well-Known Member Full Member

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      i have no idea where you find the time to do all this, but great stuff :typing:
       
    6. Mark Jackson

      Mark Jackson New Member

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      How do you prevent perforating the sinus? Hitting the nerve or blood vessels? I would be very, very careful of making surgical guides without the supporting CT Scan and 3D imaging, and adding metal guide tubes only further increases liability by implying you have a level of precision you clearly don't have. I know you're just doing this for fun, but be careful....

      ai3.photobucket.com_albums_y79_Ngagi_PlanningStation.jpg
      ai3.photobucket.com_albums_y79_Ngagi_PlanningStation.jpg
       
    7. patmo141

      patmo141 Active Member Full Member

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      Thanks for the comments Mark. You always force me to think more deeply int things. Answers in blue.

      ai3.photobucket.com_albums_y79_Ngagi_PlanningStation.jpg
       
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    8. patmo141

      patmo141 Active Member Full Member

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      Thanks Nicely and K2. While I have worked hard and am proud of my work, I don't think I'm in those leagues yet. I think Exocad (and the other CAD packages) are wonderful products and they do a good job taking care of all the details needed to have something work day in and day out without too much room for the user to get in a bind. I picture my little project working in the academic and less "critical" market.

      My father has a saying..."You only turn down money once... when you didn't understand the question"

      https://sites.google.com/site/blenderdental/donate

      I've had this link up but haven't been putting it out there really. If I got enough support, I would really like to try and build a white light scanner. Otherwise, I will just do the things listed on that page.

      @paul

      I dunno. I have only been occasionally tweaking the Fixed module here and there, working on little bits, not really putting as much time into it as before. It's more in the refinement stage. For the implant module, I banged out the initial work in just a few days as it was mostly copy/paste and mild alterations to code blocks I had already written. It was less than two weeks from when I started writing code for it to when the first guide was 3d printed!
       
    9. rkm rdt
      Artistic

      rkm rdt Well-Known Member Donator Full Member

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      I know a great patent lawyer in your area.
       
    10. trianglej

      trianglej Member Full Member

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      Anyone have any info on the Galileos/InLab Surgical Guide Project?
       
    11. dmonwaxa

      dmonwaxa Moderator Staff Member Full Member

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      Great looking stuff Pat, looking at the roots I'm sure it was an extrapolation of the CT scan. Great work my friend keep it up.
       
    12. k2 Ceramic Studio
      Artistic

      k2 Ceramic Studio Well-Known Member Full Member

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      Love the bit about "Taking over the world", Donation done - Keep on Blending.;)
       
    13. patmo141

      patmo141 Active Member Full Member

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      I'm ready to tackle in the implant bar project. Shoot me some files and I'll take a stab at it this weekend. Also, this link is for anyone that wants to drop some STL files that they would like to see designed on in Blender.

      https://dropbox.yousendit.com/Dental-CAD-FIles

      Cheers,
      -Patrick
       
    14. k2 Ceramic Studio
      Artistic

      k2 Ceramic Studio Well-Known Member Full Member

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      Fantastic, going to jump on the comp now and send some!!!!!!!
       
    15. AshleyMarkDMD

      AshleyMarkDMD New Member

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      Folks,
      I just completed my first CT guided implant case with nobel guide. I did all the preclinical workup - including fabricating a radiographic stent, radiographic index, treatment planning online and placement. I haven't had time to develop a final video, but here are a few videos of the preclinical workup. Please ask as many questions as you'd like.
      Tooth #9, Nobel Replace Select 4.3 x 13mm, CEREC composite provisional crown at time of placement.

      Cheers

      Ashley

      CBCT Implant Surgical Stent - Preclinical Workup - Part 1 - YouTube
      Radiographic Stent Fabrication - YouTube
      Computer Aided Implant Surgery + CEREC Crown - "It was the night before...." - YouTube
      Computer Aided Implant Surgery - Placing the Implant - finally - YouTube
       
      Last edited: Oct 30, 2011
    16. patmo141

      patmo141 Active Member Full Member

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      Ashley,

      Thanks so much for posting and congratulations on your first case of this kind. I like some of differences in your protocol compared to what we have been shown here at BU. I especially like the suckdown as opposed to waxing up the guide.

      1. Do you end up purchasing two lab analogues? One for pre-op planning and one for your final impression/master cast later?

      2. I'm curious how you place the lab analog into the pre-op cast. Is the flow like this

      CT scan -> planned ideal implant location -> guide sleeve in stent with CAD/CAM -> analogue in cast is rigidly guided

      or

      CT Scan -> planned ideal implant location -> attempt to place it in cast in that location using the stent as reference-> fixation of guide sleeve into stent using pieces of hardware connected to the lab analogue.


      See what I mean? I'm trying to visualize the flow of 3d information from CT scan to implant placement to final restoration fabrication. Which steps are "rigidly guided" eg with a sleeve of metal vs which steps are "loosely guided" eg trying to angulate your pilot drill based on visual references in the stent.

      Cheers,
      Patrick
       
    17. JohnWilson

      JohnWilson Moderator Staff Member Full Member

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      The nobel guide that is fabricated has a guide ring for the oseotomi and also acts as a drill stop. The table of the fixture will be very very close when this is used appropriately. The dimples on the torque wrench driver allow you line up the tri-lope to face direct buccle. The guide has a part that allows you to affix the lab analog to the guide and then seat it back into the preop cast allowing you to make your provisional.

      Once you affix the analog to the guide, inject soft tissue material,seat the guide back on the cast and do an altered cast with stone to hold the analog you have all the info you need to make a very very close provisional that will be ready the day of surgery.

      It really is pretty simple, sadly the cost to plan properly dictates that many experienced surgeons would rather do with out. While the guide is very very good for GP's just getting into implant dentistry, many surgeons feel it is taking their skill set and relegating it to putting a round peg in a round hole.
       
    18. wveras

      wveras New Member

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      Hi Patrick , did you have another way to send the files ? This way does not work more.Thanks
       
    19. loveablesmile

      loveablesmile New Member Full Member

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