The case history is designed to collect all patient data in order to allow a correct diagnosis.
The dental visit aims to assess the general state of health of the mouth, preventive care, and the evaluation of operating spaces as a reduced oral opening may prevent the correct execution of the technique.
The impressions in the study can be detected with standard spoons or with those suitable for edentulous patients. From the precision impression the authorised laboratory creates the plaster Master model by eliminating the strong undercuts up to the arches. This model must be duplicated thus obtaining one free of undercuts.
In the event of post extractives the areas of undercuts must be managed considering that the surgical guide will rest on the mucosa.
The radiological template must respond to the construction specifications learned by the technicians during the training course and must meet the specifications of the construction check list.
The cases which fall within the
Verification of correct positioning of the radiological template. If it is with dental support, using the appropriate inspection window, if it is resting on the mucous membranes it must have the widest possible extension.
The template assembly technique consists in solidifying the radiological template and the Universal Stent with registration material which must be radiolucent (e.g. polyether).
In case it is necessary to acquire both arches two distinct radiological templates will be performed which will be assembled at the same time as the Universal Stent*.
It is also possible to remove the buccal portion and connect the arch containing the markers to the radiological template.
For cases falling within the ModelGuide Easy protocol the Universal Stent is positioned with the registration material directly on the arch considered.
*The Universal Stent is to be regarded as disposable
The patient must be sent to the radiology centre equipped with the Universal Stent already fitted with the registration material, all accompanied by an adequate prescription containing instructions for the radiologist (See annex B).
The request for a CT or conebeam exam in the arch/and interest can be prescribed provided that the radio-opaque markers present on the Universal Stent are also obtained
The CT EXAM must be obtained by the design software (Implant 3D and derivatives), so as to develop the case.
Once the virtual design has been completed, the surgical project must be exported onto a CD ROM.
If the study is equipped with optical scanner it will not be necessary to send the material but simply to send the STL file scan related to the plaster model together with the implant project.
The following scans must be performed and sent:
• Plaster model with radiological template and Universal Stent positioned
• Plaster model with radiological template positioned
• Plaster model
For cases falling within the ModelGuide Easy protocol the scan of the plaster model with the Universal Stent and the scan of just the plaster model will suffice.
The order of the surgical guide must be made online through the portal BioOrd (clienti.bio-nova.eu).
If the study is equipped with optical scanner the order is completed by telematic systems.
If the study is not equipped with a scanner, the shipping package must be prepared, which must contain the radiological template assembled with the Universal Stent, the project files on CD ROM, the master model, the duplicate model, the order form and the check list stamped and signed.
After inserting the order it is necessary to wait for the arrival of the express courier who will collect the material for the manufacture of the surgical guide.
Each packaging must be reserved for only one case/patient.
Every single piece inside the shipping package must be individually protected.
It is possible to receive the STL file of the surgical guide for printing in house or to directly receive the finished surgical guide, printed by Bionova with 3Dad ultra high resolution printers.
• It is important to avoid creating anaesthetic boluses that can prevent a proper housing of the guide.
GUM TISSUE REMOVAL
• Performed by means of a suitable Guided Gum Tissue Remover after having housed the guide.
THE SURGICAL OPERCOLUM
• The surgical guide should be removed to facili- tate the removal of the operculum of the mucosa.
• Create the housing crestal plate of the implant head by removing all interference related to the progress of the alveolar crest.
• Starting from the first cutter of length 8 mm, the subsequent longer cutters work guided both by the bushes of the surgical guide and by 8 mm of the pilot cutter.
From the point of view of the sequence of the cut- ters we must consider that these may vary betwe- en the various types of implant and in relation to the quality of the bone in the implant site.
LAYING THE IMPLANT
• Special fitters screwed to the implant are used so as to bring the implant to the height while maintaining the insertion axis in line with the software project.
With these fitters it is also possible to trace the position of the connection system.
• If provided or fitting healing bolts or screws of the first surgical step.
• The choice to perform an immediate loading is at the discretion of the professional performing the operation.
Certainly the ModelGuide technique, thanks to the option of making a temporary prebuilt prosthesis, can facilitate this therapeutic choice where the clinical conditions and literature data make it viable.