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Ask UsSaving on Surgical Guide Stents
Print This PostDr. Klein asks:
I am trying to conserve my expenses for dental implants in my practice. Dental implantology is just not
turning out to be as profitable as I expected.
Therefore, I would like to start making my own surgical guide stents instead of paying my lab upwards of $250. I
would like to use .020 inch suck-down shells for dental implant cases where I am having a
maxillary central incisor replaced. I would like the long axis of the dental implant to be thru the incisal-edge cingulum area. How do I build this into the stent? Do you think my plan of making my own stents is a good idea? Any other suggestions?
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11 Responses to “ Saving on Surgical Guide Stents ”
If you visit my web site, you will see a simple radiographic stent technique in the “Articles” section…we’re working on a second article (Part II) for construction of an “in-office” surgical guide. However, if you use Cone Beam CT for imaging…and od multiple sites, I’d still use a lab service…hope this will help, Dale
I find that a “suckdown ” guide works fine in many cases & I often prefer it over lab made guides. I let the lab place the tooth in the ideal position (or have the restorative DDS fabricate it). In the anterior single tooth application, i ‘carve out’ the lingual of the tooth to be replaced to just below the incisal edge - this marker, plus observation of the cingulum & palatal CE junction of adjacent teeth gives me all the info I need for bucco-palatal position. The clear aspect of the shell allows me to see where i am placing it on the alveolar ridge and also adjust the position if necessary(if you have any concern about this, you can drill right thru the tooth before you trim the paaltal aspect and mark the cast - then do a suckdown on the dimple in the cast - now you ahve a crestal marker as well!) i find it easy enuf to see where i am going using this stent - easier than the solid lab guides.
also , be sure and mark the the buccal CE junction ( so far, liquid ‘white -out’ works best for me ) now , you now where the platform of the implant goes as well (1.5 mm -3mm below the clinical CEJ, depending on your philosophy).
Long story short , I find that these clear, simple guides are more useful than the ‘rigid’ lab and computer generated guides in most cases.
If you are not finding implant dentistry as profitable as you expected, you should draw a few conclusions. Firstly, you need to perform a thorough and complete diagnosis including a diagnostic waxup and pertinent radiographic tests, whether that is periapical radiographs, a panoramic radiograph or CT scans (of one form or another). You need to determine the surgical and/or prosthetic portions of the treatment, whichever you are performing. Determine the cost of equipment, supplies and chairtime for the portions of the treatment you are performing. You may find that your bottom line AND, more importantly, your patients may be better served if you perform one portion of the therapy and refer the patient to someone who either specializes or has more experience in the other aspect of implant dentistry.
I started using the new thermoplastic surgical guide from Straumann several months ago… Took only a few minutes of lab time to fabricate it. Plus, the cost is only ~$30 each. I used it both as a radiographic(w/ Cone Beam CT) and surgical guide. Hope this information helps!
Vacuum formed guides are fine for small number of implants. As the number of abutments holding the guide decreases, these guides tend to move and warp very easily, making idealized placement more difficult, especially when there is no posterior fixed component. While saving money is fine, you do not want to complicate the surgical process by skimping on an important component.
In partially dentate cases my simple solution is to position 3i Guide Stent Tubes, secure to the cast, block out undercuts and lubricate. Flow Triad gel over adjacent occlusal surfaces and around the tubes. Boxing wax can be used to limit the gel’s movement. Cure and modify as required. It takes me more time to describe it than to do it.
My Concern of “suck-down” stent is that it doesn’t define the facial surface of the restoration well. I think it is one of the most critical aspect of placing an implant in the esthetic zone.
Dr. Young’s method of using a guide tube control this well, as long as you position the tube appropriately.
One of the technical people at 3i suggested a very easy and cheap way of constructing surgical guides. First, place and secure the 3i surgical guide tubes on the mounted cast. I do this by drilling the proposed pilot drill holes into the cast and placing the tubes over the ends of the drills after I insert them into the holes in the cast. At this point, you have the proposed preps drilled and the tubes placed precisly over them. You can see where the abutments will wind up vs. the opposing teeth and get an idea about the need for bone grafting. Second, flow blue mousse all over the tubes and teeth and ridge. There is no need to block out or lubricate the cast. When it sets, remove and trim to allow visual verification of full seating at the time of surgery. You have a semi-rigid surgical stint with stainless steel tubes that match the diameter of the initial pilot drill for implant site prep. I usually have a consult with my surgical partner when we get together and do the final planning for the case. I give him the mounted models and surgical guides then.
Dr. Koons,
It is a great idea. How does your surgeon sterilze or disinfect the guide? Thanks.
i use a surgcial stent made from clear, heat cured acrylic resin. it is very rigid and will be adapted well on the edentulous ridge or remaining natural dentition. it would cost around $30.
A surgical guide with a drillstop allows precise placement —these can be made for less than $2. Visit my website at www.drillstops.com and click on the user manuel.
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