Fabricating reduction Guide indexed to milled denture

T

tyjthomas

Member
Full Member
Messages
70
Reaction score
1
Does anyone know if there is a way to design a sustructure that will be secured into the bone and act as a bone reduction guide and then having that guide be indexed to a milled denture for easy pick-up after the implants are placed? Preferably, it would be nice to keep this within Exocad/Exoplan, but open to other options if required.
 
2thm8kr

2thm8kr

Beanosavedmysociallife
Full Member
Messages
11,304
Reaction score
2,510
Yes this is possible, but there is not a clear work flow in exoplan. It will take going back and forth between regular CADApp and exoplan, saving stl files and being creative with both softwares and imaginative with your mind. Matera version of exoplan does not have anchor pins and I haven't checked if Plovdiv is officially released in US version yet(?) Maybe resellers here could verify. Beta versions of exoplan have lots of refinements and added features with many more implant libraries, SX kits, and anchor pins from various implant companies.
 
DAL Claxton

DAL Claxton

Active Member
Full Member
Messages
104
Reaction score
0
Heya, Plovdiv is released in the US. If you wanted to do a denture over a reduction guide that you've also created, easiest thing I could think of is the new Plovdiv offset structure over bar. Afterwards use that substructure (the reduction guide) and design a denture over that.

As for the reduction guide, I just ran through a quick case in exoplan, and I'm not seeing any possibility for real design there, most of that has to be exported to the actual CAD software. You can export the Dicom files into STL, so you could export the bone, then reduce it there, create the offset substructure, then do the denture all in CAD though.
 
2thm8kr

2thm8kr

Beanosavedmysociallife
Full Member
Messages
11,304
Reaction score
2,510
Heya, Plovdiv is released in the US. If you wanted to do a denture over a reduction guide that you've also created, easiest thing I could think of is the new Plovdiv offset structure over bar. Afterwards use that substructure (the reduction guide) and design a denture over that.

As for the reduction guide, I just ran through a quick case in exoplan, and I'm not seeing any possibility for real design there, most of that has to be exported to the actual CAD software. You can export the Dicom files into STL, so you could export the bone, then reduce it there, create the offset substructure, then do the denture all in CAD though.
How about a step by step?
 
Affinity

Affinity

Well-Known Member
Donator
Full Member
Messages
6,915
Reaction score
1,062
Ive seen screenshots of this on instagram. Looks like a lot of work..
 
T

tyjthomas

Member
Full Member
Messages
70
Reaction score
1
Heya, Plovdiv is released in the US. If you wanted to do a denture over a reduction guide that you've also created, easiest thing I could think of is the new Plovdiv offset structure over bar. Afterwards use that substructure (the reduction guide) and design a denture over that.

As for the reduction guide, I just ran through a quick case in exoplan, and I'm not seeing any possibility for real design there, most of that has to be exported to the actual CAD software. You can export the Dicom files into STL, so you could export the bone, then reduce it there, create the offset substructure, then do the denture all in CAD though.
Interesting. I saw something similar using blue sky plan and mesh mixer but the way it was done wasn’t quite what I was looking for....

I’d love to be able to make a reduction guide and then attach implant guide into that which could later switch out to the temp hybrid to pick it up for conversion. That temp hybrid/denture could be designed off of the imported facial photos and planning.

If you have any workflow or suggestions, I’d love to hear them!
 
DAL Claxton

DAL Claxton

Active Member
Full Member
Messages
104
Reaction score
0
@2thm8kr were you talking about a full reduction guide stpXstp, or just exporting an STL from Exoplan Dicom?

I believe doing a reduction guide, then a surgical from that result would be more difficult. You would need another Dicom of the now reduced bone. The only way I can imagine to do both simultaneously would be to know how much you can/would reduce, place the implant at the appropriate new level (hoping the doctor follows the guide to a T) then export the STL after surgical guide creation.

The problem : is that you would have to export the Dicom into CAD, reduce the jaw, then bring the result into Exoplan to set the implant in place. Use that to create the surgical guide (once again hoping the doc reduces exactly) Otherwise the implant wouldn't be perfectly lined up.

If you used a non-engaging to create the temp hybrid it could be less of a problem if it's not torqued 100%, the height difference if extreme could cause an easier break on the hybrid because of jaw forces, but for a pickup that might work.

My recommendation would be to export the jaw from Dicom, create the reduction guide, and have the doc do another CT after reduction. There's just too many things that could go wrong hoping the doc will reduce exactly. Otherwise You could do the reduction and surgical guide at the same time, and have them take an impression of the *actual* resulting implant position.

- Josh
 
2thm8kr

2thm8kr

Beanosavedmysociallife
Full Member
Messages
11,304
Reaction score
2,510
@DAL Claxton

Doing a stackable bone reduction guide, SX guide for the implants, and the temp prosthetic that the patient leaves with after the SX all in one plan. Done it a few times in other software, but there is not an official workflow in exoplan at this time.

Unlikely that you will have a surgeon do a bone reduction procedure and then have the implants placed at a later date. What is t he patient going to do about teeth in the interim? Even with a bone reduction guide the reduction is never exact.
If you will need angle corrected abutments for the temp prosthetic then you will need the screw retained/MUA abutments to engage the chassis geometry.
 
T

tyjthomas

Member
Full Member
Messages
70
Reaction score
1
@DAL Claxton

Doing a stackable bone reduction guide, SX guide for the implants, and the temp prosthetic that the patient leaves with after the SX all in one plan. Done it a few times in other software, but there is not an official workflow in exoplan at this time.

Unlikely that you will have a surgeon do a bone reduction procedure and then have the implants placed at a later date. What is t he patient going to do about teeth in the interim? Even with a bone reduction guide the reduction is never exact.
If you will need angle corrected abutments for the temp prosthetic then you will need the screw retained/MUA abutments to engage the chassis geometry.
What software are you using to do that? I’ve seen something using meshmixer, blue sky, and exo.

Even if it was not a fully guided case but a reduction guide and then a way to better pick up the conversion prosthesis that’d be good. The conversion prosthesis could even be used as the make shift surgical guide.

Regarding angulation, once the abutment is in place, I think it’d be less of an issue as the abutment would correct angulation and then just pick up the non-engaging temp copings.

I know it’s being done. straumann is doing their teeth in a box along with others.
 
2thm8kr

2thm8kr

Beanosavedmysociallife
Full Member
Messages
11,304
Reaction score
2,510
I used GuideMia for bone reduction guide and SX guide. I did the digital DX in exocad and the temp design was attached to the top of the bone reduction guide the same way the SX guide was, stackable. It was not just a straight forward workflow. IMO it could be done easier in exocad/exoplan with some changes, but with FDA approval necessary it will certainly take some time.
 
DAL Claxton

DAL Claxton

Active Member
Full Member
Messages
104
Reaction score
0
Hey, if somebody has a CT scan of an edentulous patient (sans patient info preferably) I could have a go at this. Only one I have access to so far is the Exocad test data, which has almost no bone info in the one area missing a tooth. (little difficult to complete a guide on an area with no bone)
 
T

tyjthomas

Member
Full Member
Messages
70
Reaction score
1
Hey, if somebody has a CT scan of an edentulous patient (sans patient info preferably) I could have a go at this. Only one I have access to so far is the Exocad test data, which has almost no bone info in the one area missing a tooth. (little difficult to complete a guide on an area with no bone)
I will PM you...might have something that will work
 
Affinity

Affinity

Well-Known Member
Donator
Full Member
Messages
6,915
Reaction score
1,062
Im wondering what they made the 'gasket' part out of.. something flexible?
 

Similar threads

D
Replies
7
Views
456
bigj1972
bigj1972
E
Replies
8
Views
1K
Denturetech9918
D
S
Replies
5
Views
923
smileguy49
S
Top Bottom