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Project Description

Lower 2nd molar, with flap exposure, including treatment planning with Blue Sky Plan and the ThinLayer® Guide

The surgical plan for this case was developed in Blue Sky Plan, with cross-sectional, axial, panoramic, and 3D views of the bone, gingiva, and teeth. Articulated models are shown in 3D view and outline of opposing teeth visible in cross-sectional view. Whereas traditional “tube” guides often cannot be used with molars due to vertical space constraints, this case features a ThinLayer® Guides from Guided Surgery Solutions, which requires no more vertical space than freehand drilling.

In the panoramic view, the implant is placed with the abutment diameter sized to use as a “virtual tooth” (~10 mm diameter for molars). The mesial-distal position of the implant is approximated by placing the abutment against the distal of the 1st molar.

In the cross-sectional view, the abutment is resized to 1 mm diameter for use as the center line of the implant. The implant is oriented in the bone so that the platform is at the crest and the center line is aligned with the lingual cusp of the opposing tooth. The outline of the gingiva is evident from a scanned stone model, allowing determination of tissue thickness at the implant site.

In the 3D view, the “centered” model is a scanned image of a stone model in which a reference point was made, indicating the ideal entry point for the osteotomy. For a molar implant the entry point would be approximately 6 mm from the distal of the adjacent tooth. It may not always be possible to achieve the ideal entry point, but this view will indicate the planned position relative to the ideal position. The resized “virtual tooth” abutment also shows the relationship between the future tooth and the adjacent tooth. Viewing the scanned articulated model in the 3D view is another way to check the relationship between the implant center line and the opposing tooth.

The surgery was performed with the tube and ThinLayer® Guides from Guided Surgery Solutions, who manufactured the guides from the 3D Blue Sky Plan and provided custom, disposable drill stops for each drill in the sequence. The inner diameter of each drill stop holds it flush to the drill shaft and fluted area. The outer diameter of each stop is flush with the inner diameter of the tube (in the tube guide) and the diameter of the hole in the ThinLayer® Guide.

First the tube guide was placed and a spear or lance drill placed through the insert (drill stop) in the tube to create bleeding points in the implant positions. An endo file through the insert could also be used, if preferred. Next, a spear drill was used through the insert/tube to create pilot hole by placing the tip into the bleeding point and drilling through gingiva to 4-5 mm bone depth.

The tube guide was removed and a flap was reflected before the ThinLayer® Guide was placed. Its guide hole replicates the top of a guide tube. The open buccal “window” allows an unobstructed view of the surgical site and ease of flap reflection. The 2 mm drill is placed through the guide hole at an angle, which requires no more vertical space than freehand drilling. The drill is then uprighted until the tip of the drill is in the pilot hole before being inserted to depth.

This is repeated with drills of increasing diameter, until the final drill is placed through guide hole and used.  The countersink and implant driver were centered in the guide hole. This can be especially helpful in Type 3 or Type 4 bone.

Radiographs of the planned and final implant positions are included.

Please visit our Advantages page for more information for about the ThinLayer® Guide system.

Related Downloads

ThinLayer® Guide case 31, flap exposure, with Blue Sky Plan Download
Treatment Planning Software (partially and fully edentulous) Download

Related Slide Presentation (from Oct 2012 webinar)

Project Details

  • Date January 14, 2013
  • Tags Cases
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