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Adhesive residue on the CAD-CAM surgical guide sleeve: A ... · DENTAL TECHNIQUE Adhesive residue...
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DENTAL TECHNIQUE Adhesive residue on the CAD-CAM surgical guide sleeve: A technical report Phillip Roe, DDS, MS, a Kitichai Rungcharassaeng, DDS, MS, b Joseph Y. Kan, DDS, MS, c and Armand Putra, BDS, MSD d For many years, 3-dimensional (3D) data from computed to- mography have provided essen- tial information (bone volume and vital structures), thereby improving treatment planning. 1 Today, computer-guided sur- gery has allowed clinicians to virtually plan implant posi- tions based on the proposed prosthetic design, using computed tomography data along with computer-aided design and computer-aided manufacturing (CAD-CAM) and treatment planning software. 2 Because CAD-CAM surgical guides can pre- cisely control implant placement in 3D, an indirect interim restoration can also be fabricated before implant surgery. 3,4 A key component in the CAD-CAM surgical guide (NobelGuide; Nobel Biocare) armamentarium that facil- itates this process is the guided cylinder with pin (Guided Cylinder with Pin; Nobel Biocare) assembly. This labo- ratory component helps to maintain a geometric rela- tionship between the surgical guided sleeve and the implant analog, which allows the clinician and technician to produce a definitive cast for the fabrication of an in- direct interim restoration. Vertical accuracy of the implant position, however, relies on the complete adaptation of the laboratory components to the guide sleeve. The purpose of this article was to discuss the pros- thetic significance of adhesive residue on the intaglio surface of the surgical guide sleeve. A straightforward technique is introduced for identifying and removing any adhesive residue. TECHNIQUE The following is a technique for identifying and removing any adhesive residue: 1. Verify the fit of the surgical guide to the teeth on the original cast to ensure complete adaptation. 2. Inspect the intaglio surface of the surgical guide sleeve for traces of adhesive residue under magnification (Fig. 1). When adhesive residue is not apparent, attach the laboratory compo- nents to the surgical guide sleeve and evaluate the degree of component adaptation ( Fig. 2). If this interface is not accessible to visual inspec- tion, use a radiograph to confirm adaptation (Fig. 3). a Assistant Professor, Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif, and Private practice, Edmonds, Wash. b Professor, Department of Orthodontics and Dentofacial Orthopedics, Loma Linda University School of Dentistry, Loma Linda, Calif. c Professor, Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif. d Fellow, Advanced Education in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif. ABSTRACT Computer-aided design and computer-aided manufacturing (CAD-CAM) surgical guides can be used by the clinician and dental technician to create a definitive cast before surgery, thereby allowing an indirect interim restoration to be fabricated. However, the accurate transfer of the interim restoration from the laboratory to the surgical site requires a precise interface between components. This article reports the prosthetic significance of adhesive residue on the intaglio surface of the CAD-CAM surgical guide sleeve, which can create errors in the implant analog position of the definitive cast. A technique for identifying the presence of residue and its careful removal are also introduced. (J Prosthet Dent 2019;121:746-8) 746 THE JOURNAL OF PROSTHETIC DENTISTRY Downloaded for Anonymous User (n/a) at Loma Linda University from ClinicalKey.com by Elsevier on May 28, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
Transcript of Adhesive residue on the CAD-CAM surgical guide sleeve: A ... · DENTAL TECHNIQUE Adhesive residue...
DENTAL TECHNIQUE
aAssistant PrbProfessor, DcProfessor, DdFellow, Adva
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Adhesive residue on the CAD-CAM surgical guide sleeve:A technical report
Phillip Roe, DDS, MS,a Kitichai Rungcharassaeng, DDS, MS,b Joseph Y. Kan, DDS, MS,c andArmand Putra, BDS, MSDd
ABSTRACTComputer-aided design and computer-aided manufacturing (CAD-CAM) surgical guides can beused by the clinician and dental technician to create a definitive cast before surgery, therebyallowing an indirect interim restoration to be fabricated. However, the accurate transfer of theinterim restoration from the laboratory to the surgical site requires a precise interface betweencomponents. This article reports the prosthetic significance of adhesive residue on the intagliosurface of the CAD-CAM surgical guide sleeve, which can create errors in the implant analogposition of the definitive cast. A technique for identifying the presence of residue and its carefulremoval are also introduced. (J Prosthet Dent 2019;121:746-8)
For many years, 3-dimensional(3D) data from computed to-mography have provided essen-tial information (bone volumeand vital structures), therebyimproving treatment planning.1
Today, computer-guided sur-gery has allowed clinicians tovirtually plan implant posi-tions based on the proposed
prosthetic design, using computed tomography dataalong with computer-aided design and computer-aidedmanufacturing (CAD-CAM) and treatment planningsoftware.2 Because CAD-CAM surgical guides can pre-cisely control implant placement in 3D, an indirectinterim restoration can also be fabricated before implantsurgery.3,4A key component in the CAD-CAM surgical guide(NobelGuide; Nobel Biocare) armamentarium that facil-itates this process is the guided cylinder with pin (GuidedCylinder with Pin; Nobel Biocare) assembly. This labo-ratory component helps to maintain a geometric rela-tionship between the surgical guided sleeve and theimplant analog, which allows the clinician and technicianto produce a definitive cast for the fabrication of an in-direct interim restoration. Vertical accuracy of the implantposition, however, relies on the complete adaptation ofthe laboratory components to the guide sleeve.
The purpose of this article was to discuss the pros-thetic significance of adhesive residue on the intaglio
ofessor, Department of Restorative Dentistry, Loma Linda University Schooepartment of Orthodontics and Dentofacial Orthopedics, Loma Linda Univepartment of Restorative Dentistry, Loma Linda University School of Dentinced Education in Implant Dentistry, Loma Linda University School of De
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surface of the surgical guide sleeve. A straightforwardtechnique is introduced for identifying and removing anyadhesive residue.
TECHNIQUE
The following is a technique for identifying and removingany adhesive residue:
1. Verify the fit of the surgical guide to the teeth on theoriginal cast to ensure complete adaptation.
2. Inspect the intaglio surface of the surgical guidesleeve for traces of adhesive residue undermagnification (Fig. 1). When adhesive residueis not apparent, attach the laboratory compo-nents to the surgical guide sleeve and evaluatethe degree of component adaptation (Fig. 2). Ifthis interface is not accessible to visual inspec-tion, use a radiograph to confirm adaptation(Fig. 3).
l of Dentistry, Loma Linda, Calif, and Private practice, Edmonds, Wash.ersity School of Dentistry, Loma Linda, Calif.stry, Loma Linda, Calif.ntistry, Loma Linda, Calif.
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Figure 1. Adhesive residue on intaglio surfaces of surgical guide sleeves. Figure 2. Incomplete adaptation of laboratory components to surgicalguide sleeve.
Figure 3. Radiograph confirming incomplete adaptation. Figure 4. Careful preparation of surgical guide adjacent to surgical guidesleeves.
Figure 5. Adhesive residue removed from guide sleeve with carver. Figure 6. Intaglio surface of surgical guide sleeves after removingadhesive residue.
May 2019 747
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3. Remove residue by preparing the walls of thesurgical guide adjacent to the guide sleeve with aside-cutting, flat, non-cutting, end carbide rotaryinstrument (H364E; Komet USA) at 1000 to 2000
e et al
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rpm to offset the guide wall approximately 0.75 to1.0 mm from the guide sleeve (Fig. 4). This offsetwill ensure that the laboratory components will notbind to the wall of the surgical guide.
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Figure 7. Complete adaptation of laboratory components to surgicalguide sleeve.
Figure 8. Radiograph confirming complete adaptation.
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4. Use a sharp hand instrument (½ Discoid-CleoidCarver; Hu-Friedy) to remove the adhesive residueon the intaglio surface of the guide sleeve (Fig. 5).
5. After selective adjustments have been made to thesurgical guide, the intaglio surface of the surgicalguide sleeve should be clear of adhesive residue(Fig. 6).
6. Verify complete adaptation of the laboratory com-ponents to the intaglio surface of the surgical guidesleeve visually or with a radiograph (Figs. 7, 8).
DISCUSSION
Placement of a dental implant in the correct position isnecessary for both esthetic and functional outcomes ofthe subsequent restoration.5 The advent of the CAD-CAM surgical guide has improved the predictability ofthe surgical placement of implants, significantlyincreasing accuracy compared with conventionalimplant placement.6 These CAD-CAM surgical guidescan also be used by the clinician or technician to create adefinitive cast, thereby allowing an indirect interimrestoration to be fabricated before the surgery.4 Thebenefits of an indirect interim restoration include anoverall increase in material strength and therefore areduction in prosthetic complications during the healingphase. In addition, it serves to minimize the timeinvolved in chairside reline procedures and/or adjust-ments. A precise interface between laboratory compo-nents is essential to the fabrication of the definitive castand the success of the subsequent interim restoration.Adhesive residue on the intaglio surface of the surgicalguide sleeve can create a disparity between the spatialorientation of the implant analog in the definitive castand the implant in the clinical situation. These dispar-
E JOURNAL OF PROSTHETIC DENTISTRY
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ities would result in vertical discrepancy between thelaboratory fabrication and clinical placement of theimmediate interim restoration and should be minimizedor eliminated.
SUMMARY
Adjusting the CAD-CAM surgical guide to ensure com-plete adaptation of the laboratory components to thesurgical sleeve is a straightforward procedure requiringlittle time and a basic armamentarium. The describedselective adjustments will ensure complete removal ofthe adhesive residue, producing an accurate definitivecast from which the indirect interim restoration can befabricated.
REFERENCES
1. Schwarz MS, Rothman SL, Rhodes M, Chafetz N. Computed tomography indental implantation surgery. Dent Clin North Am 1989;33:555-97.
2. Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle CHF,et al. Computer technology applications in surgical implant dentistry: a sys-tematic review. Int J Oral Maxillofac Implants 2009;suppl 24:92-109.
3. Marchack CB, Moy PK. The use of a custom template for immediate loadingwith the definitive prosthesis: a clinical report. J Calif Dent Assoc 2003;31:925-9.
4. Kan JY, Rungcharassaeng K, Oyama K, Chung SH, Lozada JL. Computer-guided immediate provisionalization of anterior multiple adjacent implants:surgical and prosthodontic rationale. Pract Proced Aesthet Dent 2006;18:617-23.
5. Rungcharassaeng K, Caruso JM, Kan JY, Schutyser F, Boumans T. Accuracy ofcomputer-guided surgery: a comparison of operator experience. J ProsthetDent 2015;114:407-13.
6. Noharet R, Pettersson A, Bourgeois D. Accuracy of implant placement in theposterior maxilla as related to 2 types of surgical guides: a pilot study in thehuman cadaver. J Prosthet Dent 2014;112:526-32.
Corresponding author:Dr Phillip Roe21701 76th Avenue W, Suite 204Edmonds, WA 98026Email: [email protected]
Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.https://doi.org/10.1016/j.prosdent.2018.03.010
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