Tips And Techniques

Planning:

• Be sure the CT scanning appliance fits and is seated completely in the mouth before scan is performed. Failure to confirm a stable fit of the scanning appliance may result in a poorly fitting surgical guide affecting the outcome of the procedure.
• Refer to the surgical guide manufacturer for specific instructions on how to mask anatomical structures and plan for fixation of the surgical guide.
• Download the most recent version of planning software including implant libraries.
• Implants currently compatible with the Navigator System Include:
• Certain® Parallel-Walled MicroMiniplant™ 4 & 5mm Implants
• OSSEOTITE XP® 4/5mm Implants
• PREVAIL® 3/4/3, 4/5/4 and straight PREVAIL 4/3 and 5/4mm Implants.
• Height of the master cylinder above the implant platform is variable (7.5, 9, 10.5, 12mm) and determined by the surgical guide manufacturer.
• If planning a cement-retained full arch case, consider implant sites with the greatest potential for stability in order to screw-retain these locations in combination with cement retaining others based on:
• Bone density readings (in Hounsfield Units) from CT Scan
• Potential implant length and position relative to the restoration

Preparation:

• Inspect the surgical guide for imperfections and reinforce potential weak areas of the surgical guide with acrylic.
• Try-in the Drill Positioning Handles in case the guide may need adjustments to allow the Drill Positioning Handles to fully seat.
• Clear the Master Tubes of any material remaining from the surgical guide manufacturer.
• Score the Master Tube notch position on the surgical guide to record the hex-orientation landmarks.
• Preparation of a master cast may be advised to confirm the planned position and restorative considerations of implants prior to surgery.
• Review the CT scan data for bone density to anticipate areas of poor bone quality and areas where implant stability may be compromised. During use, surgical guides provide little tactile confirmation of bone density.

Clinical Use:

• For flapless cases, use a Tissue Punch prior to fixation of the guide. Remove the guide and remove the tissue plugs. Then replace and fixate the guide. The Tissue Punch is not intended to be used at high speeds and should be used at no greater than 300–500rpm.
• All instrumentation should be advanced as far as possible through the Master Tube or the drill positioning handle guide tube before rotating. This will limit the possibility of damaging either the instruments or the tubes.
• Use irrigation on instruments prior to and during use to provide lubrication when passing through the Master Tubes and/or Drill Positioning Handles.
• Undersize the osteotomy to increase likelihood of initial implant stability (ie. when planning for a 4mm implant use 3mm as final Twist Drill; 5mm implant use 3.85mm as final Twist Drill. If necessary, increase the diameter of the final Twist Drill appropriately).
• Sequence the placement of implants in an alternating cross arch pattern, moving from one side to the other so as not to compress soft tissue.
• Place all implants close to the final vertical position with the handpiece, then use the hand ratchet to achieve final vertical position and hex orientation.
• Use Bone Profilers prior to placing abutments of any type. Use an oversized profiler when placing angulated abutments.