What To Do While Your Crown Is In The Oven

Darin O'Bryan, D.D.S.

12 years ago

I have been working with Sheldon Lerner at Blue Sky Bio to help make implants with CERECguide and Sicat even easier.  What he has come up with are some stops that fit right over the drills to create a drill stop.  They come in different lengths.  Currently they are used with the astra keys from Sirona, however that is changing.  Soon we will have sleeve inserts that fit right into the CEREC guide hole or Sicat guide that will make the need for keys obsolete.  

Let's walk through this case:  Patient had #30 removed and grafted.  It is now ready for the implant.  The plan is a 5mm X 9mm conus which is the astra clone. 

We have our guide already except for removing the Tak material from underneath the guide. Here is a little trick that Brandt Jones posted the other day.  Brandt thanks for the tip.  It made the removal quick and easy.  No melting plastic and no material to bind the seat of your guide.  You take a tissue punch right over the guide hole.  Use the slow speed dialed down to about 5-10k rpms.  If you leave it set at 20k rpms you may cut into the guide and it will heat the plastic a little.  Not bad but at the lower rpms it won't heat up at all. 

Here I am using the 6mm punch.

It takes out a perfect little plug that flicks out of the punch. 

Now on to our case.   The area of #30 had plenty of keratized gingiva so doing a punch was no problem.

Here is the stop mounted on the drill and in the guide.  Each stop is for different length implant and drill size.  For CERECguide you just measure from the tip of the drill to the stop.  With the 9mm it was 20mm so our D2 was 19.  This case was done with the long drills but soon we will have stops for the short drills as well.  Making guided surgery in the posterior much easier.

And now for the actual surgery and implant placement.  This is a single drill protocol for osteotomy creation.  I have the study if anyone is interested.  The basics of it is a single good sharp drill like this generates just about the same heat going to depth as the pilot drill.  Since the surgery is guided we don't have to worry about checking angulation, depth etc... 

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Okay I am now tired after all that hard work.  It takes longer to get the patient numb and place the guide than it does to do the surgery.  Here is the final position. 

And to compare it with the plan from the Galileos

Notice that the final position is right where we planned.  As more of the products get developed the system will be come keyless and have short drills for tough to reach posterior teeth. In the end the complete system would include the surgical kit which is basically 8 drills, the driver, a wrench, 8 stops for the drills and then sleeves for either the CERECguide or sicat as needed.  If you already had a surgical kit, driver and wrench you would only need the 8 drills corresponding to the 4 implants in both long and short.   

This could very likely be the most simple system out there to work with when it is all said and done.  Also to get started the capital investment will be the lowest around.