GUIDED SURGERY TECHNIQUE

GUIDED SURGERY TECHNIQUE

INDEX WORKFLOW...4 OUR SOLUTIONS...5 PLANNING PROTOCOL - PARTIAL EDENTULISM...6 - TOTAL EDENTULISM...9 SOFTWARE FEATURES...12 SURGICAL COMPONENTS FOR GUIDED IMPLANTOLOGY...14 SURGICAL PROTOCOL...16 The satisfaction of an increasingly demanding number of patients is B&B Dental most ambitious goal. That is why, for getting this, we guarantee professional guided surgery solutions in the field of implant dentistry with a highly efficient customization of the complete project: both surgical and prosthetic steps. B&B Dental aims to offer to doctors and engineers a wide range of software, products and services. Research and development of new technologies are for B&B Dental added values that they can encourage updated and appropriate responses to professionals demands. 3

WORKFLOW SURGERY DIAGNOSIS MANUFACTURE OF SURGICAL TEMPLATE IMPRESSION AND WAX BITE REGISTRATION PLANNING RADIOGRAPHIC TEMPLATE SCANNING CT IMAGING DICOM DIR FILE SENT 4

OUR SOLUTIONS Guided surgery is based on the use of three-dimensional reconstruction of all or part of the dental arch. All decisions are made before surgery, providing more predictable aesthetic and functional results. Prior digital planning based on evaluation and prosthetic criteria speeds up the process and allows the most suitable solution for each individual case to be developed. The comprehensive visualisation made possible by the software means that the advantages of treatment decisions can be explained clearly to the patient. This improves communication between practitioner and patient and reinforces patient confidence. Provided the quantity and quality of the bone and gums are adequate, this innovative solution enables flapless surgery, a minimally invasive procedure which is quicker than traditional open-flap surgery and which is associated with reduced healing time. The prosthetic components can be selected in advance so that the temporary prosthes is can be made and immediately loaded. SOFTWARE Diagnosis 3D implant planning Prosthetic pre-planning SERVICES A specialist laboratory is available to assist the client at every stage of the process, from diagnosis to preparation of the surgical template. PRODUCTS Surgical guides Bushing and specific accessories for guided surgery Customised abutments Surgical kits Temporary prostheses 3D PRINTER 5

PLANNING PROTOCOL Planning protocols are different according to the patient edentulism. Therefore, we substantially distinguish a protocol for partial edentulism and a protocol for total edentulism. PARTIAL EDENTULISM Precision impression (silicone) for partial edentulism. Plaster model. Radiopaque spherical markers. Spherical markers glued on printed individual guide. Radiological individual guide realized. Radiological guide precision verified by the insertion in patient mouth. 6

CAT exam made on patient. Warning: ONLY send the axial images (DICOM DIR files) ALTERNATIVE OPTION EXTERNAL LABORATORY Model with radiological guide shipped (by courier) to our center. Or: the external laboratory scans the model with and without the radiological guide. 7

PLANNING PROTOCOL PARTIAL EDENTULISM Send to B&B Dental (commerciale@bebdental.it) the obtained images (possibly, x-ray and optical scan) together with doctor requests form. Images are overlapped by B&B Dental center. Overlapped images are sent from B&B Dental to the clinic. Case planning. Send back the project to B&B Dental center (commerciale@bebdental.it). The surgical guide is manufactured by our center (with the model if needed). 8

TOTAL EDENTULISM Precision impression (silicone) for total edentulism. Plaster model. Resin base realized. Radiopaque spherical markers. Radiological guide with spherical markers glued on it. Radiological guide precision verified by the insertion in patient mouth. 9

PLANNING PROTOCOL TOTAL EDENTULISM CAT exam made on patient. Warning: ONLY send the axial images (DICOM DIR files) got from the CAT exam made on patient. ALTERNATIVE OPTION RADIOLOGICAL CENTER CAT exam also made on the radiological guide. Detail of the CAT exam made on the radiological guide. ALTERNATIVE OPTION EXTERNAL LABORATORY Model with radiological guide shipped by courier, or model scans with and without the radiological guide. 10

Send files to B&B Dental (commerciale@bebdental.it) together with doctor requests form. Images are overlapped by B&B Dental center. Overlapped images are sent from B&B Dental to the clinic. Case planning. Send back the project to B&B Dental (commerciale@bebdental.it). The surgical guide is manufactured by our center (with the model if needed, with or without analogs inserted for the prosthetic construction). 11

SOFTWARE FEATURES USER FRIENDLY SOFTWARE FOR SURGERY PLANNING AND ADVANCED DIAGNOSTICS The clinic receives the files from B&B Dental laboratory. Download and uncompress files to open the software. Click START to open the aligned project. (MAC OS: Double click on the software icon) Initial image after opening the software. Once the software is open, double-click the patient s name in the lower left box. Initial project includes CAT and 3D object aligned. At first installation, import the B&B Dental database on the pc by clicking on TOOLS. Enter STL Library, Import DB and select ZIP file stldb_b&b. Measuring the bone dimension to get the correct positioning of the implant. Insert the implants by clicking on implants. A window Add implant gets opened. Select the tooth number and then click OK. 12

Select implant and abutment, choosing diameter and lenght, according to the available residual tissues. Implant insertion and possible correction of the position. Project report creation: click on Implants report settings and fill in before saving the project. Project saving: click on icon SAVE and name the project. Export the project by clicking on icon ZIP/UPLOAD the treatment plan. The clinic sends the project to B&B Dental center (commerciale@bebdental.it). 13

SURGICAL COMPONENTS FOR GUIDED IMPLANTOLOGY GUIDED LANCE DRILL (cod. GD-LANCIA) Sharp and cutting precision drill, used for preparing the site for crestal screws and cortical incision. GUIDED TISSUE PUNCH (cod. GD263) Drill used for soft tissues removal; Ø 5.5 sleeves need an additional converter. GUIDED FLATTENER (cod.gd-264) Drill used for crest flattening. GUIDED COUNTERSINK DRILLS (from cod.gd-sv-30 to cod.gd-sv-50) Drill for top of the implant preparation. Usually used for widening the cortical side in presence of hard bone in order to easily inserting the implant. Drills are available for every implant diameter (Ø 3-3.5-4-4.5-5). GUIDED DRILLS (from cod. GD-30-08 to cod. GD-50-14) Dedicated for a precise preparation of the implant site and an easier insertion of the implant. A continuous and homogeneous cut movement is granted together with a better stability of the instrument during the surgical steps. A drill is available for every diameter and length for 3P, EV and SLIM implant lines. GUIDED COMPACTORS (from cod.gd-761/2 to cod. GD-761/6A) Ideal devices in presence of spongy bone for replacing drills or with a combined use with them. Compactors expand gradually thin crests and compact the implant site, increasing the primary stability of the implant. They are characterized by depth laser markings ( L.6,5-8 - 10-12 ). GUIDED BONE MILL (GD-BM) Drill used for adapting the bone crest in presence of angulated MUA. CONVERTER (cod. GD-708) Adaptor designed for converting drills, compactors and small dimensions drivers ( Ø 4.2); it allows the compatibility in larger sleeves (Ø 5.5). GUIDED MOUNTER DRIVER (cod. GD-769) Driver used with mounter for implants insertion. GUIDED IMPLANTS DRIVER - SLIM implants (cod.gd-00578) Driver used for direct guided insertion of SLIM implants without using the mounter (YELLOW code for SLIM implants line). 14

GUIDED IMPLANTS DRIVER - EV, 3P implants (cod.gd-701) Driver used for direct guided insertion of EV and 3P implants without using the mounter. PROSTHETIC SCREWDRIVER (SHORT) (cod.inn-61000) Driver used with prosthetic screws and healing screws. ANGLED MUA HOLDER (cod 023-MUA) Holder used for straight and angled MUA positioning in mouth. STRAIGHT MUA DRIVER (cod INN-00637) Driver used manually or with torque ratchet for straight MUA tightening. TORQUE RATCHET (cod.00376din) Used for implants and prosthesis insertion drivers, controlling the tightening torque from 0 to 50 ncm. GUIDED MOUNTERS (cod.gd-768/3 - GD-768/1 - G-768/2) Implant mounter available in 3 different diameters (Ø 3 and Ø 3.5 4 for small sleeve and Ø 4.5 5 for large sleeve). The surgical guide is blocked through the implant insertion. BLOCKING CRESTAL SCREWS (cod.gd-pin/57, GD-PIN/510, GD-PIN/67, GD-PIN/610) Devices which crestally block the surgical guide. Available in two different diameters (Ø 4.2 and 5.5) and two lenghts (L. 7 and L.10). LANCE DRILL FOR FRONTAL PIN (GD-FOG) Special drill for lateral pin site preparation; the passage through the sleeve must be made to end of stroke for optimum pin sealing. NOT INCLUDED IN THE KIT TITANIUM/PEEK SLEEVES (Ø 4.2: cod.gd-706, GD-764P/ Ø 5.5: cod.gd-707,gd-765p) Guided sleeves for drills and compactors. They are manufactured in 2 different materials: TITANIUM and PEEK available in two different diameters: 4.2 (for implants Ø 3-3.4-3.5-4) and 5.5 (for impiants Ø 4.5-5). In case of a limited mouth opening, peek half-opened sleeves (cod. GD-703P e GD-704P ) are definitely suggested. Upper hexagon of peek sleeves is in phase with the implant hexagon for a correct MUA and angled abutments positioning. FRONTAL PINS (GD-PING) Used for fixing the surgical guide, pushed to end of stroke. RADIOPAQUE MARKERS (Cod.GD-SFERE) Radiopaque markers used for radiological guide creation. They have to be glued in a minimum 5 units quantity for optimal overlapping of CAT and model stl file. They are sold in 5 units boxes. 15

SURGICAL PROTOCOL STEP 1 Surgical guide positioning. Implant area mucotomy with removable guide with 4.2 diameter sleeves. CONVERTER mounted on the mucotome in case of 5.5 diameter sleeves. Implant areas mucotomy with removable guide with 5.5 diameter sleeves. Soft tissue removal. Implant site preparation with LANCE DRILL for blocking crestal screw insertion. 16

STEP 2 Blocking crestal screw insertion for surgical guide stabilization. Use of FLATTENER (only in presence of not regular crests). Implant site preparation: LANCE DRILL (4.2 diameter for small sleeve, together with a converter for 5.5 diameter sleeve). Implant collar preparation: COUNTERSINK DRILL in presence of hard bone (drill diameter compliant to the implant to be inserted). Implant site preparation: GUIDED DRILLS in progressive sequence (lenght and diameter). Implant insertion can be done with GUIDED IMPLANT DRIVER. Implant insertion. As alternative: use of the MOUNTER for inserting the implant and blocking the surgical guide. 17

STEP 3 Implant insertion with MOUNTER (using the mounter improve the surgical guide stabilization). Blocking crestal screw removal. Implant site preparation. Implant insertion. MOUNTER removal. Surgical guide removal. Cover screw insertion. As alternative: peek trasmucosal screw direct insertion. 18

Via San Benedetto, 1837-40018 San Pietro in Casale (BO) Italy Tel. +39 (0) 51.81.13.75 - Fax +39 (0) 51.666.94.00 info@bebdental.it - www.bebdental.it EN ISO 13485 Sistema Qualità Certificato Certified UNI quality EN ISO system 13485 UNI EN ISO 13485