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Integrating SurgiGuide with the SAFE drills and Nobel Replace Tapered drills for the implant treatment of a partially edentulous maxilla
A. Parashis DDS, Dr.Odont., P. Andritsakis DDS, MSc, P. Diamantopoulos PhD.
The patient was a 65 years old healthy female. She was wearing a fixed prosthesis (teeth #16,11,21,25,26) as abutments for the last 13 years. She had recurrent caries (teeth #16,11,21) and tooth 16 was not restorable because of extensive decay (fig. 1).
The images were converted to a SimPlant file and five Nobel Replace Tapered implants were planned:
4.3 x 10mm position #16
4.3 x 16mm position #14
3.5 x 16mm position #13
3.5 x 16mm position #22
4.3 x 13mm position #24
Preparation of the patient for the ConeBeam CT Scan
The old prosthesis was removed, tooth #16 was extracted and a new fixed, acrylic reinforced with metal, prosthesis was constructed (fig.2).
Four months later, a duplicate acrylic prosthesis was fabricated; access holes were drilled and filled with guttapercha at the places where the correct prosthetic position for implants was estimated. Dry foil was wrapped around the teeth to identify their perimeter. Care was taken not to cover the abutment teeth since it was important that they were visible on the CT images, for reference and the construction of the SurgiGuides. A CBCT scan was taken with this prosthesis in place.
SurgiGuide drill guides
Three tooth supported SurgiGuides were constructed with tube diameters of 3.2, 4.2 and 5.0mm (Fig. 3A, 3B, 3C). A distance of 9 mm from top of planned implants to top of guiding tubes was retained in all guides, according to the Nobel protocol.
SAFE trephine/drills (Fig. 4A) and Nobelguide tapered drills (Fig. 4B) were utilized with the following sequence:
2. SAFE pilot drills of depth 15, 18, 20 mm were used with the SurgiGuide containing the 3.2mm diameter tubes (Fig.6)
3. Nobelguide tapered drills were used with the SurgiGuide containing the 4.2 diameter tubes (Fig.7) (tapered drill with 8mm length was first used in all positions and then 10, 13 and 16mm drills depending on the length of the implant)
4. Nobelguide tapered drills were used with the SurgiGuide containing the 5.0mm diameter tubes (Fig.8) (10, 13 and 16mm drill length for positions 16, 24 and 14). A flapless approach was followed since the amount of keratinized mucosa was adequate.
The post-operative panoramic X-Ray confirmed the correct position and angulation of all implants as planned (Fig.10) (the abutment on implant in position #13 was tightened).
The prosthesis was reinserted and adjusted at the end of surgery. Postoperative course was uneventful with minimal discomfort and no swelling and the clinical picture was excellent one week after surgery (Fig. 11).
The advantage of using multiple tooth supported SurgiGuides with different guiding tube diameters provides the possibility of integrating the two systems drills (SAFE and Nobelguide drills). Furthermore, since fixation screws are not necessary, the surgeon can repeatedly verify the correct position, depth and angulation of the prepared sites during surgery and raise a flap in case is necessary.