Precision Surgical Guide

PRECISION SURGICAL GUIDES
Surgical Guides are valuable

Prosthetically driven implant prosthesis assures good aesthetics, function and more importantly hygiene maintenance enabling long time success. Accuracy in treatment planning and implementation of planned treatment is vital for this success. Following advancements that have occurred in treatment planning (virtual software) for implant prosthesis; an equal rise is to be expected in transferring the planned therapy to surgical fruition. In this regard, surgical templates have enabled clinicians to deliver predictable surgical & prosthetic rehabilitation. Surgical guides have not only decreased the chances of iatrogenic damage of critical anatomic structures; they also increase the esthetic and functional advantages of prosthodontic-driven implants. Within the constraints of this article, the authors describe an overview of use of surgical guides in clinical situations. If a clinician is considered a pilot, then the surgical guide is his navigator.

Advantages of surgical guide

  1. Decreases manual errors associated with free hand implant placement
  2. Minimally invasive procedure‑since surgical guides allow minimal intervention, postoperative surgical problems are minimized providing psychological benefit to both patient and clinician
  3. Precision – Implants are prosthetically driven components; any deviation can lead to abrupt results in functioning. With surgical guides, implant placement has become more accurate
  4. Safety – Safety is the biggest factor when placing implants in critical areas of the mouth. Even the slightest error can lead to severe complications. With guides, such deviations can be prevented. Vital structure damage is easily prevented.
  5. Predictability – Alertness throughout the whole procedure cannot be maintained. Even experienced hands are associated with decreased quality in comparison to guided implantation technique•
  6. Aesthetics – It is seen that use of surgical guides to transfer software planning to the actual placement has shown good cosmetic results•
  7. Hygiene – Maintenance of proper oral health is ensured because of correct implant placement• For best survival, implant supported prosthesis should be placed in preplanned positions. Guides can help such quality placements of implants• Reduction of implant surgery time.
  8. Ease in fabrication: Most implants have built‑in software, which enables online shopping and ordering with a single button.
  9. Special surgical guide types, such as bone reduction guides are available that can enable graft harvesting.
  10. Guide itself can act as a temporary prosthesis for fully edentulous cases.
  11. Increased visibility of the surgical site and easy access for flap exposure.
  12. Accurate results for beginners.
  13. Foresee the costs
  14. Reduce own costs because less implant surgery time is necessary and the absence of failures.

Disadvantages

  1. Once if guides are fabricated, they do not allow any change or modification from predetermined position if required at the time of surgery.
  2. Any tissue changes (e.g. Swelling, loss of abutment teeth) between time of ordering and implant installation can alter fit of the prosthesis, ultimately functioning of implant prosthesis.
  3. Guide dislocation can occur during surgery if the guide is not stabilized.
  4. Drill lodgement in stents
  5. Guide dislocation also occurs when drilling is intended to penetrate hard bone, producing torsional forces on the sleeves, thus lifting off the guide.
  6. Start‑up cost associated with software purchasing•
  7. Greater learning curves.

Flow chart for surgical guide use

  • Step 1: Diagnosis and treatment planning.
  • Step 2: Virtual implant and prosthesis planning with software.
  • Step 3: Selection of particular implant system and components.
  • Step 4: Planning for the surgical guide compatible with a particular implant system.
    • Step 4a: If more than 3 teeth‑tooth borne, if less than 3 teeth‑mucosa or bone borne surgical guide.
    • Step 4b: Selection of anchors (depending on the site, implant number, angulation, anatomical limitation)
  • Step 5: Surgical guide fabrication (online ordering is possible with most soft wares)
  • Step 6: Disinfection of received surgical guides followed by evaluation of guides.
    • Step 6a: For teeth supported‑evaluate on cast and patients mouth.
    • Step 6b: For mucosa supported‑evaluate on cast and patient’s mouth, for a mucosa‑supported guide, it is recommended to make a surgical index to stabilize the guide during fixation.
    • Step 6c: For bone supported‑evaluate on digital bone model.
  • Step 7: Verification of specific surgical drills and drill keys.
  • Step 8: Stabilization of guides in patient’s mouth using anchor pins followed by verification of the guide stability.
  • Step 9: Drill sequence.
  • Step 10: Fixture installation (possible with safe guides).

SURGICAL GUIDE PROTOCOL FOR SPECIAL SITUATIONS

  • 1.  SURGICAL GUIDE PROTOCOL FOR HEAVILY RESTORED OR UNRESTORED DENTITION– Read More

 

 

  • 2. PROTOCOL FOR EDENTULOUS CASES
    • a. Prepare denture to establish functional and esthetic requirements of the case.
    • b. Duplicate the denture in PMMA
    • c. Create base on the denture undersurface, keep base height minimum 10 mm
    • d. Put 6 composite bulbs on denture at different location and 8 composite bulbs along the edges of the poured cast
    • e. Optical scan the denture with cast poured on it
    • f. Remove the denture from the poured caste
    • g. Optical scan of the poured cast. check all composite bulbs are scanned properly.
    • h. CBCT of the jaw with denture on and CBCT of the denture alone.
  • 3. TOOTH SUPPORTED GUIDE    a. CBCT of the site with three teeth minimum on either side if possible (open mouth as teeth in occlusion create difficulty in superimposition and segmentation).
    • b. Optical scan of the jaw/dental model

Types of Surgical Guides

Depending on your patient’s needs and individualized treatment plan, we provides three different types of surgical guides to provide the most personalized and accurate results for implant restoration surgeries. These three options include a SAFE Guide, Universal Guide, and Pilot Guide.

SAFE Guide

The SAFE Guide is used when clinicians need the most accurate implant placement. This Guide provides full drill and implant guidance including a physical stop, ensuring that you will never drill too deep. The SAFE Guide is compatible with the brand specific surgical kit of your choice including: Straumann, BioHorizons, Bicon, Dentsply Sirona Implants, Zimmer Dental, Biomet 3i and Nobel Biocare.

Universal Guide

Just like its name implies, the Universal Guide is compatible with all dental implant brands. By inserting different Universal Drill Keys, you only have to use one guide while still maintaining accuracy during all steps of the procedure. This Guide is used when you seek accurate guidance of all drill steps.

Pilot Guide

When clinicians want an accurate entry point, a Pilot Guide provides guidance for the first drilling step. The pilot guide increases the predictability of implant surgery and can be used to treat both partially edentulous and edentulous patients. Any standard surgery kit can be used with the Pilot Guide.