We will send you Dr. Amr’s 1 hour Lecture if you…

&

This Post

The Prosthetic driven implant placement concept

Surgically Driven

Implant Placement M

id 1990s

Implants should be placed in the position that serve the best prosthetic outcome.

Prosthetic Driven Implant Placement

Correlation between the ideal prosthetic position

and the bone architecture

Implant surgical guides

• The ideal surgical guide allows for:1. Determination of the point of entry2. Control the direction of drilling3. Control the depth of drilling4. Control the parallelism between implants5. Fabrication of a temporary restoration for

immediate loading6. Locate the implant position in the second

stage surgery

Computer based guides (Why?)

• Safety• Accuracy• Simpler surgical intervention

with shorter chair-side time• Expanding the practice• Levelling up the practice to the

world’s state of the art

It has been there for 20 years….Its nice and easy……

Why isn’t it so popular???What are the obstacles in

doing this??

COST

Complexity

Drawback of the conventional Guided systems

Does cooling affect the success rate when using CAI guides???

136 implants, 68 in the maxilla and 68 in the mandible placedwith Dentis Guide

11 implants total failure 92% success rate.

4 implant only failed in the maxilla 94% success rate.

7 implants failed in the mandible 90% success rate

Implant failure in the mandile is higher?????

• Yong L & Moy P 2008. They placed 78 implants with Nobel guide

• 7 failures (9%), 5 out of 7 were longer than 10mm

• They correlated this to overheating

Guides definitely blocks the passage of irrigation causing more heat generation

The simplified universal kit

8 x 2.3 mm starter drill

2.2 pilot drill (10, 12, 14) with modified shaft design)

8x2.8 intermediate drillWe need only 11 instead of 40 tools

Cortical

AccesibilityDifficult or impossible to use in the posterior region in partially dentate

subjects

Difficult to manipulate both the drill guide and handpiece in many cases

(VERY AWKWARD)

Long waiting time

• Average of 10-14 days forplanning, fabrication andshipping the guide fromknown manufacturers

• You can not perform speedyprocedure

How will this work???The open sleeves will allow side approach instead of occlusal approach

3 mm

Cutting flutes

Guiding Shaft

Submerged broken tooth no 9:

Problem list:

1. Very thin labial cortex

2. Thin soft tissue biotype

3. The root inclination

LIP

Possible drilling directions

The surgical guide

Sleeves with facial opening. Accessible in all regions & easy flow of the irrigation

How is the new system different?

Training and education

A 4-day comprehensive training including:1. Patient selection and preparation2. Scanning protocols for different cases3. Biomechanical and technical guidelines for virtual planning4. How to use the 3D printer5. Preparing the guide for surgery and fabricating temporaries6. Surgical room procedure “tips and tricks”7. How to minimize errors and complications

Take home message• CBCT is far beyond being an x-ray. To optimize the outcome prepare

your patient properly before making it• Guided surgery is not a fancy dream anymore. Everyone can do it

simply precisely and economically• Guided surgery is not about blind drilling. It requires education and

training to optimize the outcomes and minimize the errors

Thanks!