1. Férula radiológica
2. CT Scan
Protocolo Rx y Qx
Este documento explica el protocolo para la solicitud de implantes y la técnica quirúrgica empleada en la colocación de los implantes personalizados Implantize Hybrid.
Ver PDF protocolo quirúrgicoProtocol for digital workflow
1. Scan both archs.
2. Occlusal registration, with smile line, incisal line, midline, mesial canine line and occlusal plane (optional)
3. Scan the teeth trial (cast model)
4. Make teeth trial with radiological markers (Gutta Percha, composite…,)
5. Make the tomography with the trial teeth with the radiological markers, with mouth closed.
6. On the Boneeasy ordering platform, upload CT scan and the digital models of mouth and prosthesis (if applicable).
CT scan protocol
7.Prosthesis trials should be made to obtain final teeth position
8.Radiopaque devices should be bonded on to the vestibular teeth surfaces
9.The patient shall make the CT scan with the guides placed in mouth, and close to ensure teeth position (total occlusion)
Imaging Requirements
10. Usually CT and CBCT’s devices are suitable, but CT has always better fatures of the images
11. The FOV, should be 12cm large, in alternative it can be smaller FOV but the follow structures should be present:
- Maxilla orbita floor, Pterygoide apophisis, and zygoma bone
- Mandible body and ramus till spix spine
12. Recommended slice thickness 0.5mm to 2mm
13. Gantry angle 0º
14. Please ensure that image high-contrast is achieved
15. If natural teeth are present open bite scan should be preform to allow teeth supported surgical guides
16. Obtained dicom files should be compressed in a ZIP folder, in order to upload it into Boneeasy platform during order submission process.
17. Send only DICOM files
CT /CBCT errors – Non suitable for use
Correct CT/CBCT files:
- Complete Zygoma (upper cases) and mandible ramus /angle (lower cases)
- For upper cases, as superior s limit we need the dicoms to show at least until orbit base
- Carefull with metals in mouth, sometimes it can be very difficult to be able to isolate real bone from fake elements on dicom files, and that will lead to a hard fitting of the implant.
Implant design
1. CT scan has to be submitted through Dentlabsoft platform (ZIP folder), through the invitation made previously by BoneEasy team.
2. BoneEasy team will design the implant and send to the doctor (5 work days), who required the implant, to get approval or make some adjustments to the design. This step will be repeated as many times as necessary.
3. Implant will be produced (15 work days).
4. The implant will be delivered with osteossynthesis screws for implantfixation, resin surgical guide, sterilized by Ethylene Oxide, ready for use.
5. Implantize Hybrid order includes:
- Fixation screws
- Resin 3D bone model with osteoromy already done
- The implant
- Resin surgical guide**
- Implant technical file
**A titanium guide can be ordered, it as an extra cost.
Surgical technique
1. A full thickness flap should be made exposing all the fixation are
2.Surgical Guide:
Fix the surgical guide, using the reusable guide fixation pins existing on the surgical kit. To insert th pins it is needed to drill the bone, through surgical guide fixation holes, with th 2.0mm drill available as well. This allows the guide to be totally fixed so the bone preparations could properly done, with the guarantee of its correct positions.
3. Bone Preparations (with guide in place):
- Using the slots of the surgical guide, do the bone osteotomy with the round bone bur.
- Preform osteotomy with Vestibular/Lingual or Vestibular/Palatal movements until achieve the bone level preparation indicated by the surgical guide
4.Implant fitting test:
- Remove the surgical guide.
- Test the implant fitting over the bone preparations previously done.
- If necessary, do some little ajustments to the initial osteotomy
- It needs to fit completely on the vestibular and lingual/palatal areas of bone contact, wit no tension points.
5. Implant fixation:
- For upper cases: With the implant in place, without moving, is necessary to choose one of the Zygoma holes (distal hole), prepare the hole with screw drill of the surgical kit, and then place the screw without total insertion (torque). This step should be repeated for the distal Zygoma hole, in the opposite quadrant.
- For lower implants: start implant fixation also for one distal location of each side, without moving the implant.
- Start with screw bone preparations, place the screw without total insertion and then repeat those two steps for the remaining screws.
- After all screws insertion, it is needed to finalize its insertion with proper
torque - Drilling speed: 1000rpm
- Screws torque: 15 to 20 N
- Multiunit torque: 35N
** Please note that some of the screws are self drilling, and need no hole preparation. Confirm this information in the implant Technical File, sent with each order.
If some parts are not completely adjusted, it could be grafted with some autologous or other bone substitute. But is not mandatory, it only requires clinician analysis case by case, and depends on doctor opinion.
Close the wound properly. The area in contact with the exterior (connections areas) are the most critical. It is necessary to ensure that suture is well done in order to avoid infection and exposure points.
Insert the multiunit abutment and place the prosthesis as previously planned:
- For total arch implants immediate loading is allowed
- For partial implants, immediate loading is not possible. Provisional teeth can be used, but with no occlusion.
- For partial implants, loading is advised to be done 3 months after placing surgery.
Drug therapy protocol
There is no specific protocol for the Implantize surgery.
It should be done the same protocol as for endosseous or zygomatic implants surgery.
