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    Using Exocad for SX plan

    Discussion in 'Implants' started by 2thm8kr, Dec 2, 2016.

    1. 2thm8kr
      Devilish

      2thm8kr Beanosavedmysociallife Full Member

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      This patient has had some serious periodontal issues over the years. Almost all of the uppers extracted along with most of the lower posteriors. This will be a bar retained case upper and lower at the patient's option. You can see the sinus grafts in the pan below.

      Lower Flipper.png

      Numbers 27 and 28 are completely blown out. This old telescopic bridge is mobile and ready to give it up.


      Lower Flipper2.png

      3d rendering shows the damage to the buccal cortical plate. Patient was appointed to remove this bridge and extract 21,22,27,28. The bridge and # 27 and 28 came out in the alginate for this dx/sx workup.:eek:

      We had planned to do the upper first, but since the lower bridge is hanging on by #'s 21 & 22 we will need a solution for the patient quickly. Upper already has a flipper that establishes the patient's midline and incisal edge position so I will use that to make a virtual lower flipper so my acrylic lab will have template to make an immediate flipper that functions as best as possible with the upper. VDO is being preserved by the posteriors. They will go away when we are finished with the restorations.

      Preop situ1.png
      Preop situ

      Lower VE.png

      VE with Preop.png

      Lower virtual extractions


      Using the gingiva design feature in exo 6136 a digital dx is done on the extracted arch using the virtual articulator module for functional adjustments.


      Virtual Waxup1.png

      Virtual Waxup2.png

      This waxup was sent out for printing this morning. After the acrylic lab is finished duplicating it I will transform it into a scan appliance by attaching radio opaque markers. I now have to wait for the acrylic lab to finish their part before moving forward with the plan for the lower. The upper flipper was scanned and sent out for printing. It will be used as a scan appliance for the upper sx plan.

      Upper Flipper.png

      Upper flipper scan................
       
      Last edited: Dec 2, 2016
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    2. JMN
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      JMN Christian Member Donator Full Member

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      Wow. Really.
       
    3. 2thm8kr
      Devilish

      2thm8kr Beanosavedmysociallife Full Member

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      Since we have to wait for the acrylic lab. Here is another similar case that is a little further along. Same goals, upper and lower bar retained restorations.

      Borosilicate glass.png

      3d rendering of CBCT scan with appliance in place and opaque markers.

      Scan with Appliance.png

      CT scan with appliance. You can see how the occlusion as lifted the scan appliance off of the ridge on the patient's left.
      Implants will be anterior of the mental foramens, so probably not an issue.

      Scan Appliance Merged.png

      Scan appliance and soft tissue imported and matched to CTCB data ready to plan implants underneath the lower denture.
       
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    4. Car 54
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      Car 54 Well-Known Member Donator Full Member

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      I don't know whether to hit, Like, Informative or Winner, but maybe rather, Incredible. Thank goodness we have techs out there like 2th, who know what they're doing. This type of work is beyond me and my knowledge, for proper case planning, diagnosis and treatment.
       
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    5. 2thm8kr
      Devilish

      2thm8kr Beanosavedmysociallife Full Member

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      Thank you for the kind words, but it really is no different than any other skill you have acquired in this biz or something else. It seems daunting at first, but after you have a few under your belt it gets easier. It also helps to make friends with surgeons and build a rapport with them.
       
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    6. zero_zero
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      zero_zero Well-Known Member Full Member

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      And there you have it folks, the power of Exo and conjunction of open software ;) Kudos to 2th for his innovative work...:Congrats:
       
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    7. TheLabGuy

      TheLabGuy Just a Member Full Member

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      Yeah 2th, way to make us all feel pretty dumb right now....take a bow Sir!!! I have to admit though, the title had me going for a second....the "SX plan"...the things that entered my mind!!!
       
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    8. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Getting back to the first patient. Looking at the scan of the soft tissue it seems we have a ton of width.


      Upper arch ridge width.png

      Here is a 2d cross sectional view of the soft tissue and the flipper over the CT scan of the ridge. The area marked in red is where we will look at the ridge in 2d.

      2d cross section.png

      The bone width is approximately 5.4mm. That doesn't dive us a lot of options in that area. Ever wonder why a surgeon tosses your lab made surgical guide in the trash and places the implants somewhere else? Here is a prime example of why. Without the 3d x-ray information that guide you spent all that time on is merely a suggested implant location.

      2d with implant.png

      Same slice with a 3.8 x 9 implant. We are right at the nasal floor and the implant barely fits between the cortical plates.
      You can also see the radiolucency around the lower right bridge abutments before they came out in the impression.
       
    9. rkm rdt
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      rkm rdt Well-Known Member Donator Full Member

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      I felt really stupid too and just pressed the winner button to make it look like I understood what he just did.
       
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    10. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      A little click bait....
       
    11. TheLabGuy

      TheLabGuy Just a Member Full Member

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      What cone beam software is this?
       
    12. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Zero knows open software solutions are where it's at. :Rock:
       
    13. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Romexis. Planmeca is another company with open philosophy and those Finns are quite innovative.
       
    14. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Not trying to make anyone feel stupid, just trying to open techs eyes to what is possible with what you already know and some 3d images.
       
    15. Car 54
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      Car 54 Well-Known Member Donator Full Member

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      That makes me feel better :)
       
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    16. rkm rdt
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      rkm rdt Well-Known Member Donator Full Member

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      I know and really appreciate what you are sharing and contributing here.You are a pioneer my friend.

      Now if you will excuse me, I have to trim some single dies.:(
       
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    17. TheLabGuy

      TheLabGuy Just a Member Full Member

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      Whats the price on Romexis software?....strictly cone beam, or cat scan can be applied as well using this software?
       
    18. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Any open format dicom image can be imported. Romexis is a software that has many modules similar to exo or 3Shape.
      If you bought a product from Planmeca that uses software, then you get the basic Romexis if you want to add CAD they have
      a branded version of exo, if you want ortho software you can buy that module, etc. I'll shoot you a pm as I am not giving free advertising
      to corporates.
       
    19. RDA
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      RDA Active Member Full Member

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      All I have to say is, WOW! Way to go 2th!

      [​IMG]
       
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    20. 2thm8kr
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      2thm8kr Beanosavedmysociallife Full Member

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      Printed Flipper.png
      Printed flipper for the upper scan appliance just arrived.:Rock:

      Scan appliance.png

      Scan appliance fabricated.
       
      Last edited: Dec 2, 2016
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