A 3D model of the patient before the pontics were resected from the #28-x-x-31 fixed bridge is imported into the software to use for FutureTooth™ position. An outline of the pontics will be visible in the cross-sectional views of the bone scan.
The case was planned using Blue Sky Plan. The implant is placed so the distal of the #29 abutment contacts the mesial of the #30 abutment, setting the correct spacing between the #29 and #30 implants.
In the cross-sectional view, the outline of the pontic of the pre-existing bridge is visible. The implant is positioned so the centerline is aligned with the center of the pontic for both tooth #29 and #30.
The positions of the implant centerlines are viewed as they relate to the gingival crest and adjacent teeth.
The mesial-distal spacing of the #29 and #30 abutments is finalized on the 3D model. The software allows movement of the implants in any direction to fine-tune their positions.
Preoperative view of the teeth #29,30 site
Preoperative view of tube guide in place
Preoperative view of ThinLayer™ guide in place. There is visual and physical access to the implant sites and the guide easily allows for flap reflection. The guide hole in the ThinLayer™ guide replicates the top of the guide tube of the tube guide.
Spear drill placed in insert to establish bleeding points
Bleeding points are used to confirm position of implant entry points.
2 mm drill with drill stop inserted into guide tube and drilled to depth. Custom drill stops were made to fit the entire series of standard Nobel twist drills, which were used until the final osteotomy diameter was achieved.
Guide pins in place showing osteotomy position
Occlusal view of osteotomies
The use of the ThinLayer™ guide for placing the tooth #29 site implant and countersinking the tooth #30 site osteotomy. The countersink and implant driver are centered in the guide hole.
Occlusal view of implant position
Radiograph of implant placement
Teeth #29,30 flapless, with tube and ThinLayer® guides
The surgical plan was developed in Blue Sky Plan, with cross-sectional, axial, panoramic, and 3D views of the bone, gingiva, and teeth.
The surgery was performed with the tube and ThinLayer® guides from Guided Surgery Solutions, who manufacture the guides from the 3D plan and provide custom 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 drill placed through the insert (drill stop) in the tube guide to create bleeding points in the implant positions. An endo file through the insert could also be used, if preferred. Next, a spear or lance 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 unobstructed view of surgical site. The 2 mm drill is placed through guide hole at an angle, which requires no more vertical space than freehand drilling. The drill is uprighted until the tip of the drill is in the pilot hole, then the drill is 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.
