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Instructions for use illustrated step by step instructions |
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A
BLPB
The buccal wing (1st of 2 components making up the 'wing assembly'). Features, characteristics, and functions:C
The lingual wing (2ND of 2 components making up the 'wing assembly'). Features, characteristics, and functions:D
Rotation-blocks01
The 3D click guide can be used in an already edentulous site, but also if teeth planned for extraction are still present.02
Expose PA radiograph of the treatment site.03
Full-arch putty-wash impression (3-step)04
Bone Sounding measurements05
Record data from Bone Sounding measurements06
Cone beam computer tomography (cbct) as an alternative to bone sounding measurements. VPS material is radio opaque. Take the CBCT while the patient is (still) wearing the impression. Otherwise a local impression can be made on the cast and transferred to the mouth when the patient is having the CBCT taken. The soft tissue is now easily related to the bone and critical structures. If desired an overlay can be drawn and superimposed, or direct measurements can be transferred to the cast model.07
Cast fabrication and tooth wax–up08
Index fabricationCreate local impression of wax-up / denture tooth using silicone putty material.09
Cut indexCut local impression at the axis of the proposed implant. It will allow precise determination of desired BL implant axis.10
Create dual layer vacuform carrier11
Cut the cast and transfer soft tissue12
Place BLP13
Wing assembly positioning14
Wing assembly positioningAdjust assembly so buccal and lingual wings are parallel to the ridge. This will allow correct clinical radiographic evaluation15
Wing assembly positioningIf the buccal and Lingual RIR's are not parallel to the ridge, then the two RIR's will not overlap in a correctly exposed radiograph which is shot perpendicular to the ridge.16
Mesio-distal positioningTranslate wing assembly into the correct MD relation with neighboring teeth. Since the clinician can see the teeth, exact determination of the MD position is readily achievable.17
Mesio-distal positioningIncorrect MD position will have a negative effect on the prosthetic outcome and implant position.If erroneously positioned, then a small clinical correction is possible (section 35,36).18
Mesio-distal implant axis estimation19
Mesio-distal implant axis estimationDo not excessively over rotate the axis as it will bring the system outside of the maximum 7º degree adjustability.20
Reversible fixation of wing assemblyHot glue top of BLP to crossbar, or Lingual and Buccal RIR's to the vacuform carrier. This will allow reversible evaluation of correctness of position.21
Permanent fixation of wing assembly22
Cut cross bar23
Remove surgical guide from castRemove guide from cast, polish as needed.24
Intra-oral radiographic evaluation25
Intra-oral radiographic evaluationIf the radiograph is exposed incorrectly, non-perpendicular to the ridge, then the images of two RIR's will not overlap and appear as two. This immediately indicates a non-diagnostic image. The radiograph should be retaken. The circles on the buccal wing will allow the application of the "buccal rule", to position the x-ray generator head correctly.26
Evaluate need for rotational corrrection (non needed)27
Evaluate need for rotational corrrection (7º degrees required)28
Guided surgery29
Initial osteotomy30
Implant length determinationThe final length of the implant can then be determined and the osteotomy can be prepared to length.31
Complete osteotomy32
Implant placementThe implant can now be placed with guidance and depth control. (Depending on the availability of dedicated instrumentation from the implant manufacturer.)33
Implant placementImplant placed with full guidance.Addendum
E
7º degree radiographic implant replica34
7º degree radiographic implant replica7º degree RIR, showing the effect of a 7º degree rotation block towards the mesial.35
7º degree radiographic implant replica7º degree RIR, showing the effect of a 7º degree rotation block towards the distal.36
Mesio-distal translation correction37
Mesio-distal translation correctionOnce translated this position can be locked in place with adhesive, or the drill guide can pull the rotation block against the wall of the retention rails.