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CT GUIDANCE FOR IMPLANT SURGERY. Treatment Advancement? Marketing Ploy?. WHY USE CT GUIDANCE?. Precise surgery Time savings Avoidance of critical structures Avoidance of grafting/prior knowledge of graft necessity Tooth site placement Implant parallelism Immediate provisionalization. - PowerPoint PPT Presentation
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CT GUIDANCE FOR IMPLANT SURGERY
Treatment Advancement?Marketing Ploy?
WHY USE CT GUIDANCE?• Precise surgery• Time savings• Avoidance of critical structures• Avoidance of grafting/prior knowledge of
graft necessity• Tooth site placement• Implant parallelism • Immediate provisionalization
Why Not?
• NOT for every case• NOT a substitute for surgical training and
experience• NOT a way to avoid treatment planning
decisions• NOT an automated decision maker
Treatment ProtocolDisclaimer: Neither Dr. Rotter nor Dr. Blackwell have any monetary interest in the corporations identified in this presentation.
Photo courtesy iDent
Photo courtesy iDent
CT Guide
• Mandatory FIRST step in planning CT guided implant procedures
• Simple to construct• Must be made EXACTLY according to
protocol in order to accurately produce the surgical guide
CT Guide
• Good quality alginate impressions
• Must capture sulcus areas buccally and lingually
• Full palate is needed when implants placed in maxilla
Photo courtesy iDent
CT Guide
• Teeth are set up on the model in the edentulous areas in the ideal position for prosthetic restoration
Photo courtesy iDent
CT Guide
• Fully Edentulous:– Shape of complete
denture– Extends to sulcus
areas– Complete palatal
coveragePhoto courtesy iDent
CT Guide
• Partially Edentulous:– Extends into sulcus
area– Covers occlusal/incisal
surfaces of remaining teeth
– Covers buccal/labial surfaces approx. 3mm
Photo courtesy iDent
CT Guide
• The shape of the CT guide is made in wax and a mold is made from putty impression material
Photo courtesy iDent
CT Guide
• Wax is removed with hot water
• Acrylic injected into mold
Photo courtesy iDent
CT Guide
• Made from clear acrylic, approximately 3mm in thickness
• MUST BE RIGID• NO VACUFORM• No Barium is used• Metal pin placed in
the center of each missing tooth
Photo courtesy iDent
CT Guide
• Pin location is used to predict surgical locations
• Software can automatically place implant in the location of each pin
Photo courtesy iDent
CT Guide• 1mm round drill used
to drill 6 holes approx. equally spaced in the lingual or palatal side of the CT guide.
• Holes should be far from the teeth
• Gutta Percha compressed into holes, and covered with acrylic
Photo courtesy iDent
It is essential that there are EXACTLY6 markers, no larger than 1mm in diameter. This is necessary to allow the software to combine the 2 scans of the CT guide
CT Guide
• Try in prior to CT scan– Intimate fit with no
rocking
Photo courtesy iDent
CT Guide/Surgical GuideHandmade CT Guide – TO-- Digitally manufactured
surgical guide
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy iDent
Surgical Guide
• If possible, leave at least 1-2 teeth to help stabilize surgical guide, even if these teeth will be extracted after implant placement.
Photo courtesy iDent
Photo courtesy iDent
Photo courtesy 3i
Photo courtesy 3i
If you have an interest in obtaining a copy of the interactive used in this presentation, please email Dr. Rotter at [email protected]
Photo courtesy 3i
Surgical Procedure and Temporization
If you have an interest in obtaining a copy of the video used in this presentation, please email Dr. Rotter at [email protected]
Summary
TOOL E
START SMALL R
GAIN EXPERIENCE E
PLANNED PROCEDURES WORK BEST
THANK YOU!
