3D Digital Dentistry
SurgiGuide drill guides and Osteotomes (Dr. Rasmy Shahnavaz)
Successful use of an osteotome through a SurgiGuide
A straight osteotome can be used directly through the SurgiGuide resulting in a better guidance and control. This technique has been used successfully several times since the case described below.
Use of an osteotome for less resorption of the buccal and lingual bone
The osteotome technique may result in expanding the ridge while keeping the periost intact. Using an osteome leads to less resorption of the buccal and lingual bone.
Good knowledge of bone quality
Using Kavos surgical drill unit utilized the opportunity to measure the momentum of the implant while being placed in the bone. This leads to a good understanding of bone quality around the implant.
First diagnosis: Partially edentulous in the maxilla
The patient is a 75-year-old male opera singer. He enjoys good physical health and does not smoke. In the maxilla, he is partially edentulous. The patient has a removable partial denture. Due to inconvenience with the denture the patient would like to have a fixed bridge.
Osteomy needed because of narrow ridge on some implant positions
Like mentioned above, the intra oral examination reveals a partial edentulous maxilla with a fixed bridge 24-26. To be able to examine the patient’s anatomy more precisely, a CT scan of the patient is taken. Next, the CT- data are converted using the SimPlant software. Analyzing the data, the 3D images show a significant bone loss bucco-lingually. In SimPlant software, we plan the following implants for this patient: Straumann ITI Standard Plus 3,3x10mm SLA implants in tooth positions 15, 13, 11, 21 and 23 (US: 4, 6, 8, 9, and 11)
Because of the narrow ridge, on some of the implant positions an osteomy will be needed for this surgery. To enhance the accurate placing of the implants a SurgiGuide drill guide is ordered at Materialise. As we use two different drills (drills 2.2 and 2.8), we need two SurgiGuide drill guides. This makes that SurgiGuide drill guides will be combined with an osteome to perform the surgery.
Combination of SurgiGuide drill guide with osteotome
The SurgiGuide is placed in position (fig. 1) and punch markings are made through the guide with a round burr.
After removing the SurgiGuide punching is performed and the mucosa stents are removed. After replacing the SurgiGuide depth and direction control is initiated with the 2.2 mm drill. A pin is inserted in 11 (US: 8) after drilling a first hole in order to stabilize the SurgiGuide.
The 2nd SurgiGuide is placed and drilling is initiated with a 2.8 burr on position 11 (US: 8) and 21 (US: 9). (fig. 3)
Then the SurgiGuide is removed and a 2.3 mm osteotome is used to expand the ridge in position 15 (US: 4), 13 (US: 6) and 23 (US: 11). (fig. 4)
Note: After this case, several surgeries with osteotome and SurgiGuide have been done without removing the SurgiGuide drill guide. The osteotomy was successfully completed through the SurgiGuide drill guide.
Osteotomy is successfully performed up to 2.8 mm diameter as planned before in SimPlant software. Then the Straumann implants have been placed through the mucosa to the exact depth and healing caps positioned. Finally, the patient’s partial denture has been re-aligned. (fig. 5)
Dr. Rasmy Shahnavaz
Degree in Dental Surgery DDS from Karolinska Institutet ,Stockholm, Sweden 1989 and National Dental Board (USA)1990. Since 1992 private practitioner specialising in aesthetics and implantology. Co-founder and director of SDD AB, main business introducing computer guided surgery in Scandinavia. Lecturer throughout Scandinavia on computer guided surgery and prosthetic solutions. Above all father of 3 lovely girls.