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Evidence on a real case by using Winmed 3 Pro VP and Galileo 2 device (Patent Pending).
In this description we will explain the process used for the rehabilitation of a lower jaw with prosthetic guided method and without engraving any flap during the surgical phase (flapless).
To follow the immediate application of a temporary, acrylic and reinforced, fixed bridge, obtained by simply replicating the shape of the old fixed bridge (about fifteen years old).
You should start by taking of a precise impressions of the patient jaws and also an occlusal registration wax. Your dental technician will prepare the radiological mask (dental and/or mucosa supported) which incorporates radiopaque (or so made) teeth, positioned in the ideal position.
The interested stone model is then placed and fixed to the suitable positioning base of the Galileo 2 device. From this moment on the mask equipped with the radiopaque teeth can be easily removed and repositioned always to the known selected position. In the above image you can see also the Spot Stage containing the radiopaque reference spheres.
Such reference Spot Stage is then positioned on the suitable front base and lowered until it will touch the teeth of the ideal prosthetic mounting and fixed to them by some drops of auto or photo polymerising resin. In this way we have introduced a reference system (which we will then meet again in the TC of the patient) and which will allow to Winmed 3 Software the correlation among the measures done on the virtual 3d model built from the TC data on the computer and the measures on the stone model/ real mask.
Once the Spot Stage is fixed, the front part can be removed so that it will not be cumbersome to the patient. Using the mask the TC will be done inserting then on the computer display either the ideal position of the radiopaque prosthetic teeth and the reference system know represented by the radiopaque spheres inserted in the Spot Stage.
By loading the patient’s TC from the Cd-Rom it will be possible to do a whole series of working out including the alignment and the calibration, the carrying on of scanning at will oriented, the reformat of the trans-axial views and of the panoramic view, the 3D drawing of the bottom alveolar nerves, the 3D visualisation etc..
You should proceed then by choosing and inserting of foreseen dental implants that you can position according to the anatomical structure of the bone and of the radiopaque teeth which represent the ideal prosthetic mounting.
It will then be possible to decide for the visualisation in innovative way and realistic three-dimensional panoramic which will show the real course of the panoramic view and allow you to better appreciate the cutting of the anatomic structure and of the implants just as the transparent modality in the 3D view.
From the geometrical point of view the axis of each implant does intersect the two horizontal Galileo 2 planes in just two points.
Such planes are also reported in 3D by the software Winmed 3 ( the intersection is enlighten for didactic purposes by two yellow spheres along the implant axis).The two virtual planes in Winmed 3 are visible in the picture in green and blue colours).
The software Winmed 3 Pro Vp allows to print, on transparent acetate sheets, some references as for position and inclination for each unique implant as explained in the previous pictures. This print (i.e. the print relevant to the two intersections of each unique implants on the above mentioned planes) will allow to re-find the space co-ordinates of the implant as simulated on the computer (and so the axe of the implant self) on the real stone model. You will so be able to drill the holes on the radiological mask, which will then become our surgical template, to be employed for the surgical step on the patient.
The transparent sheet is cut and the two printing masks obtained are aligned to the references present on the two planes of the Galileo 2 device and fixed with some simple tape.
All is so fixed on the suitable housing of Galileo 2. The reclining base can be oriented and once both the position and the inclination is determined it will be possible to block comfortably the position reached.
It is very easy to gain the alignment: you will just need to sight the two symbols printed on the transparent sheets ( as explained they represent the intersection of each implant on two virtual planes) and apply them on the two real correspondent plexiglass planes of Galileo 2 simply by orienting and moving the reclining base until you gain their alignment. In the picture above you can see the image as appears when we have aligned the implant identified with blue colour and number 1 on the software Winmed 3. In this way we have found the axe of the blue implant, the one previously positioned in the 3d TC by means of the Software Winmed 3, and we have reported it on the real model.
After the alignment you have to replace the sight with the suitable drilling device. You can now proceed by drilling of the mask (the spot stage with the radiopaques sphere is not more necessary and can be removed) and you obtain so a hole big enough to position the surgical guide for the surgical guided drill.
You can proceed then with the drilling of the patient stone model too. It will be possible to insert the axes information of the implants and their inclination. This is essential to better prepare the temporary bridge which you will be using in the immediate load.
By using some small pre-curved pins it will be easier to calculate a common axis for inserting the temporary bridge having also already the possibility to choose the correct inclination of the abutments to be screwed on the implants.
Here are a couple of pictures which give a general outlook of the whole holes made on the model and of the small pre-curved pins inserted in order to estimate the common axis for inserting of the temporary bridge also with reference to the mask just drilled.
As previously explained it will be comfortably to prepare the temporary bridge and test the interferences with the seats of the future implant stumps in order to assist the adaptation (reducing work time) of the temporary bridge self when the surgical phase for inserting the implant fixtures has just ended.
You have to finish the preparation of the surgical mask by replacing the drilling device on Galileo 2 with a suitable positioner that will allow you to insert, in the mask, the surgical guide. In this case we have used a system which, by choice, allows the employ of sequential guides with growing diameters for the different surgical drills.
By completing the inserting of the guide we obtain the template ready for the dutiful and usual cold sterilization operations before the surgical phase.
The system of sequential guides foreseen also a support which simplify the positioning during the surgical phase. In this case we have used just the 2mm diameter guide for the surgical homonymous drill phase ( for more details please check the procedure explained in the previous clinical case ) following the same protocol.
With the employment of temporary implant abutments, made of acethalic resin, which allow an eventual direct and rapid modification straight on the oral cavity, you gain an improvement in execution. This makes the adaptation phase further comfortably before to employ the temporary fixed bridge. In this clinical case we have also done the foreseen extractions of the teeth 4.3 and 4.8.
Above the temporary fixed bridge just applied (obtained, as said, by the replication of the shape of the pre-existent prosthetic rehabilitation) further to the panoramic RX made just after the insertion of the implants and just before the extraction of element 4.3 and 4.8.
The temporary acethalic abutments weren’t screwed yet. The case will be completed in its iconography and description as son as we will proceed with the rehabilitation with the final fixed prosthesis after the healing period necessary for the integration of the implants.
For further information please do not hesitate to contact us.
Click on the following images to enlarge the catalogue’s pictures.
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