Implant Studio, Immediate Load Temp...

[kcdt]

i only mean that the team should comprise of at least one highly experienced assistant/denturist who is familiar with surgical techniques, to help as you learn what is good and what is not, in the aspects of designing something like this; there are certain things you should know before placing implants digitally, such as how to analyze bone quality in a scan, how to avoid bad bone, how to see and avoid whatever is left of the PDL after your bone reduction. its a complicated thing juggling this digitally.

Every AO4 I've had go off the rails was when surgeon goes off on their own and uses a digital guide.

 

[CoolHandLuke]

ive never had that experience. all the surgeons ive done guides for have never wanted to do them themselves.

none of them cared enough about their ct data to want to. but they were able to tell me and my team that the placement in such and such an area would not be good for reasons.

but i guess that's more or less how its supposed to work really; you get to fix dr screwup's screw ups.

 

[2thm8kr]

I don't know where you guys are finding these surgeons?? The ones I work with are very interested in my digital guides and planning. They go over the placement sites and tell me where to tweak the implant in the plan. I have them lining up to work with me.

Digital DX and digital planning. The only way to go!

 

[TheLabGuy]

No Way!!!
No Way I would touch this case without a ct scan or conebeam to work from digitally. It's THAT, or the analog way, a immediate denture fabricated then the Doc can immediate load off that denture and use it as a surgical guide template as well. That's the only two ways to really do a immediate load case like this in my opinion. Anything else you try to do is setting up yourself up for major (possible lawsuit) failure...good luck!!!

 

[Sarah Downs]

We do have a CT scan! Thankfully. We're not going into this totally blind.

And for the record, the surgeon is going to be looking over the implant positioning in person before approving the design. It's more the workflow for taking the implant positioning from Implant Studio to 3Shape and designing a temp for immediate loading that I'm worried about. I'm not sure how to copy that information over accurately without a scan of the temp abutments already in place.

Would the surgical guide be accurate enough to place cylinder holes in the restoration, you think? I suppose it better be pretty accurate. It's being used for surgery, after all.

 

[2thm8kr]

All guided surgeries for implant placement have the potential for inaccuracies up to .5mm in any direction.

A small deviance at the platform translates to a larger deviance at the screw channel end of the temp cylinder or abutment.

Look into scan appliances.

 

[Affinity]

You’re assuming the surgeon will actually use the guide for all of the implants. If it’s acrylic, the dr can open the channels to fit passively then cement it.

 

[TheLabGuy]

We do have a CT scan! Thankfully. We're not going into this totally blind.

And for the record, the surgeon is going to be looking over the implant positioning in person before approving the design. It's more the workflow for taking the implant positioning from Implant Studio to 3Shape and designing a temp for immediate loading that I'm worried about. I'm not sure how to copy that information over accurately without a scan of the temp abutments already in place.

Would the surgical guide be accurate enough to place cylinder holes in the restoration, you think? I suppose it better be pretty accurate. It's being used for surgery, after all.

A case like this should have flaps during surgery...and they will flap the entire ridge (some times they sew it to the cheek to hold it out of the way, pretty neat if you haven't seen it). Then, alveolarplasty and graph where needed. The surgical stent should have bone anchors with surgical guide holes in these type of cases. If surgery isn't done like that then the surgical stent is used mostly as a verification for the pilot holes and the surgeon goes free nilly at it per say. If a cat scan was done like you said, was any radiographical markers placed during CT scan?...or a radiopaque denture made?

 

[Sarah Downs]

Thanks for your ideas, everyone. After speaking with the surgeon this afternoon, we got things mostly sorted out.

The most complicated parts of the surgical guide were planned with the surgeon standing right there. The only thing I need to figure out how to do from there is how to get a couple of anchor pins put into the guide. I'm having trouble figuring out how to do that in Implant Studio.

As for the immediate load temp, we're using a half-analog method of basically pouring up a second model of the preparation arch, mocking up implant positions using the surgical guide, and using it as a basis to design a temp. We'll be able to get the implants in almost exactly the right spot this way, since we have a few teeth to make sure the guide is secure on the stone model.