3D Click Guide | Model based guided implant placement training

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- 01
  Do I have to use a vacuform carrier?
  Absolutely not, you can use a variety of materials. In general we like materials that can go over the height of contour of the teeth, so the guide will snap in place. Thermoplastics and even just simple VPS bite registration materials work very well, are fast and inexpensive . See the presentation for samples of each.
- 02
  Can I use CBCT with the 3D Click Guide system?
  Yes, and sometimes you even have to. If you cannot gather sufficient information for safe and reliable implant placement then cross sectional imaging is a must; having said that, in more than 95 % of the 1-2 implant cases we have treated, we do not find the need for CBCT imaging. One should balance the additional cost, time and ionizing radiation versus the need to know. There is a difference between need and want; we should serve the patients best interest. In addition, science is making an ever stronger argument for shorter and smaller implants; the actual information needed is less. For example if you want to place a 13 mm implant close to the mandibular canal, then you better have cross sectional images, on the other hand if you place a 8.5 mm in the same situation, then you need to know 4.5 mm less. Since VPS impression material is radio opaque, it can very easily be incorporated if one desires to combine CBCT with model based guided surgery. The presentation does show the techniques.
- 03
  Is it possible to use multiple implants next to each other?
  Absolutely, it's even easy. You'll have to clip the wings off, so the crossbars from the buccal wings fit together. Then you will end up with the ideal spacing between the implants.
- 04
  Which drills work with the Flexistops?
  The drills with a build-in metal stop work best. You can get those at varying lengths from mayor manufacturers e.g. Astra Tech, Dentply-Friadent & Straumann. The Flexistops will then allow you to modify that length by 1.5 mm increments. Please pay attention to actual drill length, as some manufactures do not count the tip, which can be almost 1 mm. See presentation for some samples.
- 05
  The patient can only open so wide, I have difficulty getting access.
  Guided surgery adds some additional length compared to non-guided surgery, as one has to get the drill guide and drill into the drill sleeve. The 3D Click Guide is a modular system, so you can assemble the "stack", rotation block / drill guide / drill outside of the mouth. Then rotate into the edentulous site, straighten the drill, snap the rotation block in place and drill the osteotomy. Extra short drills are available from some manufacturers, although this stack and rotate concept allows most cases to be completed with the standard drill lengths. See the presentation for the stack and rotate concept.
06
Are the Universal drill-guides really universal?
It depends as the attorneys would say; so no and yes. The objective for them is that one can use the straight drills from the manufacturer the dentist is used to working with. We looked at many different manufactures and selected drill-guide diameters that would satisfy most drilling protocols. Granted you need to be willing to be somewhat flexible. An example is that say Nobel Biocare start with a 2.0 mm twist drill, while Straumann starts with a 2.2 mm twist drill. We selected thus the 2.2 drill guide, as the starting drill guide; thinking that the extra 0.2 mm would not harm the end result. You can of course use any drill-guide from compatible manufacturers, or mix and match with our low cost Universal Drill Guides.

07
I want to use tapered implants, how can I make that work with the 3D Click Guide.
No problem. Most tapered implants start with a straight drill and a drill-guide, and then go to some type of tapered or stepped back drill. If you want to use a tapered drill, then you will have to use drills from compatible manufacturers, as the drills have to fit precisely in the guide-sleeve of the rotation-block. ( e.g Nobel Biocare). Some tapered implant systems are using step back drills. You can use the drills from the manufacturer, or just place an additional 3 mm Flexistop on the last drill and you have a perfect step-back preparation, all without the need to have dedicated step-back drills. For example; drill with 2.0 mm twist drill to length, follow by 2.8 mm to length, now place additional 3 mm ( red) flexistops on the last drill ( 3.3), and you a similar osteotomy preparation as you would with a 2.8/3.2 step-back drill. It's that easy; fewer drills, maximum flexibility.
- 08
  Can I use alginate for the impression or should I use VPS?
  While alginate will take a dimensionally adequate impression, it does now allow as much overextension of the impression as VPS does, when used properly. If you rely on bone sounding which is most often the case, then a VPS impression just captures more of the ridge. If you use CBCT and a local VPS impression, then an alginate impression will do. See the presentation how to over extend a VPS impression.
- 09
  What is the function of the Multi gauge?
  As the word indicates you can measure many different things that we like to know the size off in implant dentistry. You will likely find more uses then the ones we show in the presentation.
10
Can I reuse the system?
To assure its high level of precision, the system is disposable.

11
Is the 3D Click Guide compatible with all implants?
It is compatible with most root-form implants. The system allows you to prepare an osteotomy for any straight or tapered implant that replaces root structures, so it will not work for ortho implants, zygoma implants and subperiostals.
- 12
  What are some of the subtleties of the BLP?
  The BLP allows the operator to fix on the cast surface the Bucco-lingual position, based on bone volume and screw access hole design, as well as location of the top of the implant platform. This analog measures 4 mm wide and 12 mm from the cross pin to the apex.
  The presentation demonstrates some of the neat things you can control with this instrument.
- 13
  Do I have to do flapless surgery?
  No, you can elect to flap if needed or go flapless if possible. Guided surgery is just that, exact placement of a dental implant. Quite often a small flap will help to preserve attached gingiva, place bone graft material or connective tissue. Use aluminum foil to create space under the vacuform carrier if the buccal flap is larger and you will need some space to reposition it. The presentation shows how to easily do that.
- 14
  Are there alternatives to the Accutrac System?
  The objective is to get a cast that can be cut , after which these parts can be repositioned in the correct relationship to each other. We have found the Accutrac system from Coltene-Whaledent to be well suited. Alternatively one can use a simple rubber base former or the well-known Pindex system, also from Coltene-Whaledent.

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