Digital Surgical Guide

TheLabGuy

TheLabGuy

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#1
I wanted to do a surgical guide completely digital, from start to finish. I must premise this by I have never used any of this software.
Step 1. Doctor wants a surgical guide made, sent me an impression...poured impression
Step 2. Scanned the models using the Medit i500
Step 3. Took that digital file and uploaded to BlueSkyBioPlan
Step 4. Inputted the information BlueSkyBio asked for, moved the implant where it should be close (sure, would of been great with .dicom file...ctscan or conebeam but didn't get that).
Step 5. Sent the last pic below (which is the 3d file blueskybio produces) to the Roland
Step 6. Mill (took about two hours) the guide using the 50 clear puck from Axsys.
That BlueSkyBio is pretty slick, I like it. This took me about 15mins to do to get to Step 6. I used the free (you get two) BlueSkyBio to do this, I get one more free then you are charged $20 per 3d file you create/export. Total cost, stone, time, puck, and even if you add the $20 creation fee would be around $40. I don't know if their is a better software, simpler way, or even more cost effective digitally, feel free to share. And hey, this was my first one, don't hesitate to call it crap or give your criticism, it's all good.








 
Brett Hansen CDT

Brett Hansen CDT

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#2
That is awesome! I am set up to use Denstply's planning software, but I can't get any docs to use a cone beam scan. :(
 
B

BNB

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#4
Hello, I am wondering about a few things!

Did the poured impression tell you where exactly to position the guide?
Curious because I have tried using Blue Sky before and wasn't sure how to place the implant myself.
Was it more of a educated estimation of where exactly the guide is to be placed?

Was thinking of sending screenshots to the doctor and communicate with them about it.
Wouldn't want to create a guide by myself thats off a few mm's and off a few degrees.
Doesn't help that is completely new to me as well.
 
TheLabGuy

TheLabGuy

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Very nice.
Is there a metal sleeve?
I didn't put one, but that's a great question. Anybody know if BlueSkyBio has metal sleeves for this???

That is awesome! I am set up to use Denstply's planning software, but I can't get any docs to use a cone beam scan. :(
Yeah, I run into same problem, but I wanted to do it digitally, that when I do get a cone beam it will be no big deal.
 
2thm8kr

2thm8kr

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#6
I didn't put one, but that's a great question. Anybody know if BlueSkyBio has metal sleeves for this???


Yeah, I run into same problem, but I wanted to do it digitally, that when I do get a cone beam it will be no big deal.
I think BSB has sleeves in their online store.
Some implant companies sell them as well. Inuse them for most cases unless the patients anatomy interferes with the fit interdentally. Then sleeveless. I have surgical keys to double check the fit of sleeveless guides before sending them out.

Funny story about trying to get some from 3i....they told me to find some aftermarket non-genuine since they quit selling them months ago.
 
TheLabGuy

TheLabGuy

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#7
Hello, I am wondering about a few things!

Did the poured impression tell you where exactly to position the guide?
Curious because I have tried using Blue Sky before and wasn't sure how to place the implant myself.
Was it more of a educated estimation of where exactly the guide is to be placed?

Was thinking of sending screenshots to the doctor and communicate with them about it.
Wouldn't want to create a guide by myself thats off a few mm's and off a few degrees.
Doesn't help that is completely new to me as well.
No, there was no exact implant position...and to be honest, without a .dicom file to import with (which you can with BSB) its a total educated guess at best. I've spoken with a few Surgeons who place implants with surgical templates/guides and they tell me, unless it's a bone anchor type of surgical guide, then we just use the guide for pilot hole placement. As digital becomes more mainstream, I think we will start seeing those .dicom files come in with requests for surgical guides...or maybe the Docs will start printing them in-office. Either way, it was kinda cool to do.
 
TheLabGuy

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I think BSB has sleeves in their online store.
Some implant companies sell them as well. Inuse them for most cases unless the patients anatomy interferes with the fit interdentally. Then sleeveless. I have surgical keys to double check the fit of sleeveless guides before sending them out.

Funny story about trying to get some from 3i....they told me to find some aftermarket non-genuine since they quit selling them months ago.
Good info, I remember you doing something like this not too long ago @2thm8kr . I can't remember how you did it though, what software (if any) did you use on yours?
 
PRO ARTS DL

PRO ARTS DL

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#9
I've fiddled a bit with BSB but haven't really planned any cases for doctors. It seems really easy to use and very straightforward. I feel that I just don't know enough about placement of implants and I have high concern of liability with implant planning. Even if it is a straightforward single unit case.

Did you get to pick any implant just to use as a dummy guide?

BSB does sell the metal sleeves. Usually at the end of the planning it will give you a list of the parts to be ordered from their website. I am not sure if they sell for every implant company they support or only for their system.
 
2thm8kr

2thm8kr

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Good info, I remember you doing something like this not too long ago @2thm8kr . I can't remember how you did it though, what software (if any) did you use on yours?
At the time I made that post I was using Planmeca planning software.

Right now I'm using GuideMia (hi Frank).
Most powerful planning software I have used so far. Probably pass on exoplan when it comes out Stateside if ever.
 
TheLabGuy

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I've fiddled a bit with BSB but haven't really planned any cases for doctors. It seems really easy to use and very straightforward. I feel that I just don't know enough about placement of implants and I have high concern of liability with implant planning. Even if it is a straightforward single unit case.

Did you get to pick any implant just to use as a dummy guide?

BSB does sell the metal sleeves. Usually at the end of the planning it will give you a list of the parts to be ordered from their website. I am not sure if they sell for every implant company they support or only for their system.
More great info...yeah, I just picked an implant, I know this surgeon uses Straumann mostly, so I picked a Straumann implant. As for placement of implants, I agree, this should be done with Doc,tech, and surgeon because their is some rules you should know...i.e. type of bone, depth of implant, nerves or sinus concerns, how much palatal or buccal bone width. Tons of things to be concerned with, and if i do start getting .dicom files, I would confer with surgeon/gd at that stage of designing.
 
TheLabGuy

TheLabGuy

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At the time I made that post I was using Planmeca planning software.

Right now I'm using GuideMia (hi Frank).
Most powerful planning software I have used so far. Probably pass on exoplan when it comes out Stateside if ever.
Tell us more about GuideMia please...never heard of it.
 
Andrew Priddy

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#16
3Shape is fairly intuitive, but not worth the 6k when we do them infrequently..
How much was the BSB?

It must have most major systems is it allowed for Straumann.
 
TheLabGuy

TheLabGuy

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3Shape is fairly intuitive, but not worth the 6k when we do them infrequently..
How much was the BSB?

It must have most major systems is it allowed for Straumann.
BSB is free for the first two...it's a little tricky to do without a .dicom (cbct or cat scan) but you can do it. After the first two, it's $20. I'd use it again, want to do it with the dicom file with the surgeon and gd input. Also, yes it has Straumann, all the platforms, including all major manufacturers along with blueskybio implants as well.
 
2thm8kr

2thm8kr

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#18
Without dicom, sx guide is merely a suggested location. I know that lots of surgeons and/or GPs want them, but it is the 21st century and this technology has been around for a decade at the very least.

Not trying to crap on anyone's parade here, but this is something you should push for. There are still plenty of horrible placements that are guided because "that's where the bone is", but you will know up front and be able to give the patient options to make an informed decision on treatment.
Analog DX digitized or straight digital and dicom. It is not the standard of care yet, but it should be. If for some reason the case ends up in court every one involved in the treatment and restorative will wish they had one.

$.02
 
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