Implant Surgical Guide

P

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
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:
P

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
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
 
NicelyMKV

NicelyMKV

Well-Known Member
Full Member
Messages
3,557
Reaction score
262
Very cool! I would like to know where you are going with all this hard work? Competing against Exocad? Looking good so far.
 
k2 Ceramic Studio

k2 Ceramic Studio

Well-Known Member
Full Member
Messages
1,084
Reaction score
39
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.:)
 
P

paulg100

Well-Known Member
Full Member
Messages
2,163
Reaction score
42
i have no idea where you find the time to do all this, but great stuff :typing:
 
Mark Jackson

Mark Jackson

New Member
Messages
1,908
Reaction score
13
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
 
P

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
Thanks for the comments Mark. You always force me to think more deeply int things. Answers in blue.

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,

I apologize if those images are misleading. The models you are looking at are segmented from CT scan data. The 3d printed model was designed only from CT scan data and yet it fits the physical stone model.


and adding metal guide tubes only further increases liability

Liability is definitely one of my concerns, all my software is distributed with a licesnse which explicitely states it is "not fit for any purpose" among other things (GNU General Public License version 2). Any advice you have on this topic I would love to hear. More importantly than being liable for someone getting hurt, I just don't want anyone to get hurt period.

by implying you have a level of precision you clearly don't have.

The precision is a function of the CT scanner and whatever segmentation techniques used to extract the iso surfaces (thresholding, marching cubes, dilation contraction etc). I agree that viewing of the originial volume data would be a useful adjunct in planning. But, I haven't implied anything. If you can find the volume of bone, soft tissue etc to +/- .5mm (random example),then that's the precision of our planning. Knowing the exact geometry of the surgical instruments used will allow for precise placement...to the precision level of scanner + segmentation methods + manufacturing methods. The planning precision is precise to 0.1micro meter and can be another 4powers of 10 smaller which is far more accurate than the CT methods used on live people. CT scan segmentation accuracy is on the order of 1mm typically (I'm not 100% up to date on that) and the particular 3d printer has precision to ~.2mm. Long story, the accuracy and precision is most affected by the scan and the manufacturing, my software can plan to a level which is far more precise than either of those.

ai3.photobucket.com_albums_y79_Ngagi_PlanningStation.jpg
that station is awesome.
ai3.photobucket.com_albums_y79_Ngagi_PlanningStation.jpg
 
P

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
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.

Would be happy to give a donation for a diagnostic software tool like this.:)

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!
 
rkm rdt

rkm rdt

Well-Known Member
Full Member
Messages
21,409
Reaction score
3,288
I know a great patent lawyer in your area.
 
trianglej

trianglej

Member
Full Member
Messages
85
Reaction score
0
Anyone have any info on the Galileos/InLab Surgical Guide Project?
 
dmonwaxa

dmonwaxa

Well-Known Member
Full Member
Messages
2,740
Reaction score
233
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.
 
k2 Ceramic Studio

k2 Ceramic Studio

Well-Known Member
Full Member
Messages
1,084
Reaction score
39
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.

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

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
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
 
A

AshleyMarkDMD

New Member
Messages
13
Reaction score
0
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:
P

patmo141

Active Member
Sponsors
Full Member
Messages
436
Reaction score
56
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
 
JohnWilson

JohnWilson

Well-Known Member
Full Member
Messages
5,487
Reaction score
1,575
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.
 
W

wveras

New Member
Messages
2
Reaction score
0
Hi Patrick , did you have another way to send the files ? This way does not work more.Thanks
 

Similar threads

Brett Hansen CDT
Replies
6
Views
608
TheLabGuy
TheLabGuy
E
Replies
8
Views
1K
Denturetech9918
D
Brett Hansen CDT
Replies
3
Views
585
tehnik
tehnik
Top Bottom