Integration-Step By Step
I feel the integration of cone beam CT and the CEREC technology is one of the most amazing things available in dentistry...there is very little that enhances the patient experience more than getting to see the level of detail we go to in order to ensure that they receive the best possible treatment. I had the pleasure of presenting at Patterson's Technology Summit in December to demonstrate the integration and workflow we go through when planning implants, so their TA's could have a better understanding of the process when helping out the dental offices they support. I have noticed lately that several people have asked for a reference about the process, so I thought I would share it here in the hope it answers some basic questions for our community.
So, what do we need? Well, a BlueCam or OmniCam, the Galileos, XG3D, or SL 3D, the Galaxis software, and an SSI export license. If you are planning to mill your own guides, you need to ensure that you have the most current versions of the software.
We begin with the CEREC...we will designate the edentulous area as a crown(the material is irrelevant):
We will then want to take a nice scan to the contralateral canine(note that we do not need an opposing or a bite):
We will then design an ideal crown-contact strength is not important, and obviously we have no opposing so we aren't concerned with occlusion. Simply design the crown where you would like it and ensure it is appropriate in the arch form:
We will then advance to the mill screen, where we will export the file onto a usb drive:
These are my USB drives of choice:
The key to this is that we are exporting the SSI file, NOT the RST-this is only possible if you have the SSI license:
Next we, will open up our cone beam scan and start working through the software:
Once we have identified our nerves, we will click on the CAD/CAM tab and import the SSI file into the software:
We verify that we have the proper file and then go about the process of stitching it to our scan:
Now, it is time to plan our implant:
And here is our final plan, with the implant planned safely away from the nerve and centered under our desired final restorative outcome:
And at this point, we are ready to order(or mill) our guide:
This process allows us to place the implant easily and predictably, which also helps make the restorative phase very smooth:
Hopefully this helps some users out there as they are working through the integration process...time to gear up for the Super Bowl tomorrow!
love the face that you were able to give such a great presentation and still make me laugh at your thumb drives. only you ponz!
Great presentation. Being on the fence about placing implants as I am, this helps motivate me to start the process. Thank you.
Thanks guys...@Matthew, that was the purpose of the post...I know a lot of people have been hesitant to get started, so I hope that by showing the simplicity of the process it encourages them to jump in. Go for it, and certainly don't hesitate to reach out if you need any help or have any questions!
Really well put together and easy to follow Ponzio! My only concern is your taste in usb drives.
nice presentation but I echo Buttermans comments. Next time I see you I have some nice simple plain usb drives Ill give you. :)
I've had a case lately that isn't stitching. Anything come to mind that I can check or change?
Also, another question. Although I've planned a few cases now. I preparing to complete my first case in the office with guided surgery through Sirona. What is your go-to guide? Obviously, I understand that there are different preferences for different cases but what is your favorite when all things are ideal? Do you do SICAT guides, mill your own or send to an alternate lab?
Thanks in advance.
Shana is there a lot of metal scatter in the ct due to existing metal restorations? A mouthful of pfms will be difficult or impossible to to stitch to a digital model
can you post a screenshot of the CT?
I don't think I'll even need to screen shot that for you. There is PFM everywhere. So, what's the solution in a case where this is the issue?
Sicat classic guide with or without scanning appliance as needed
https://www.sicat.com/media/wysiwyg/pdfSicat/2015_06_02_EN.pdf
@Shana-Sorry for the delay...been crazy at the office, and with baseball season upon us any free time has been spent coaching my kids' teams! While CG2 is great, I have preferred designing the guide and having it printed at a lab and sent back...I generally don't need a guide the same day so I don't mind paying a little extra and waiting a few days rather than having to do the work(and deal with the mess) in office. Just my workflow, but all the options we have available to us are awesome...also, if you have a lot of metal scatter, you need to do as John mentions-take the scan with a scan plate so the guide can be fabricated. Hope that helps...please feel free to reach out with any other questions!
@Kris-Thanks-and I love your design post-way to simplify it for everyone!
Hi Anthony,tx for the best thread you gave me; being a newbee could you explain how to put the sleeve in the planning as I haven't the 4 implant brands that come with guided sirona implant surgery.are sirona keys a turnaround to use CG2 with whatever implant? Greetings from Italy
Ciao Paulo-
If you aren't using one of those four brands, you will likely have to use an Optiguide or Digiguide from Sicat so they can place the appropriate sleeve. Does that make sense? Please let me know if you need anything! Vengo a Italia quest' estate con la mia famiglia!
Ciao Anthony,I was wondering if I can print the guide and put the sirona keys(s,m,l) inside the" holes" to fit the drills? Does it make sense?but is there a way to locate the drill guide always in the same position obviously making the same flapless or fla surgery.describe me your trip in Italy and I could give you some advice.By your surname I think you speak a little italian isn'it.ciao
