1. CT GUIDANCE FOR IMPLANT SURGERY

2. Treatment Advancement? Marketing Ploy?

3. WHY USE CT GUIDANCE? Precise surgery Time savings Avoidance of critical structures Avoidance of grafting/prior knowledge of graft necessity Tooth site placement Implant parallelism Immediate provisionalization

4. Why Not? NOT for every case NOT a substitute for surgical training and experience NOT a way to avoid treatment planning decisions NOT an automated decision maker

5. Treatment Protocol Disclaimer: Neither Dr. Rotter nor Dr. Blackwell have any monetary interest in the corporations identified in this presentation. Photo courtesy iDent

7. CT Guide Mandatory FIRST step in planning CT guided implant procedures Simple to construct Must be made EXACTLY according to protocol in order to accurately produce the surgical guide

8. CT Guide Good quality alginate impressions Must capture sulcus areas buccally and lingually Full palate is needed when implants placed in maxilla Photo courtesy iDent

9. CT Guide Teeth are set up on the model in the edentulous areas in the ideal position for prosthetic restoration Photo courtesy iDent

10. CT Guide Fully Edentulous: –Shape of complete denture –Extends to sulcus areas –Complete palatal coverage Photo courtesy iDent

11. CT Guide Partially Edentulous: –Extends into sulcus area –Covers occlusal/incisal surfaces of remaining teeth –Covers buccal/labial surfaces approx. 3mm Photo courtesy iDent

12. CT Guide The shape of the CT guide is made in wax and a mold is made from putty impression material Photo courtesy iDent

13. CT Guide Wax is removed with hot water Acrylic injected into mold Photo courtesy iDent

14. CT Guide Made from clear acrylic, approximately 3mm in thickness MUST BE RIGID NO VACUFORM No Barium is used Metal pin placed in the center of each missing tooth Photo courtesy iDent

15. CT Guide Pin location is used to predict surgical locations Software can automatically place implant in the location of each pin Photo courtesy iDent

16. CT Guide 1mm round drill used to drill 6 holes approx. equally spaced in the lingual or palatal side of the CT guide. Holes should be far from the teeth Gutta Percha compressed into holes, and covered with acrylic Photo courtesy iDent

17. It is essential that there are EXACTLY 6 markers, no larger than 1mm in diameter. This is necessary to allow the software to combine the 2 scans of the CT guide

18. CT Guide Try in prior to CT scan –Intimate fit with no rocking Photo courtesy iDent

19. CT Guide/Surgical Guide Handmade CT Guide – TO-- Digitally manufactured surgical guide Photo courtesy iDent

27. Surgical Guide If possible, leave at least 1-2 teeth to help stabilize surgical guide, even if these teeth will be extracted after implant placement. Photo courtesy iDent

29. Photo courtesy 3i

31. If you have an interest in obtaining a copy of the interactive used in this presentation, please email Dr. Rotter at brotter@siue.edu brotter@siue.edu

32. Photo courtesy 3i

33. Surgical Procedure and Temporization If you have an interest in obtaining a copy of the video used in this presentation, please email Dr. Rotter at brotter@siue.edu brotter@siue.edu

34. Summary TOOL E START SMALL R GAIN EXPERIENCE E PLANNED PROCEDURES WORK BEST

35. THANK YOU!