Edentulous Workflows for Grammetry using the CombiGuide

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This video is going to describe Grammetry or photogrammetry using a denture as a way to transfer the bite and the tissue position, and it’s going to use CombiGuide for the bone reduction and for the osteotomies. This case has already been through the whole process of cone beam, uploaded dual scan, and met with the doctor online. This is the package that we’re sending for the surgery: we’re going to send along a few key things that we make for our patented metal bone reduction and osteotomy guide. This is CombiGuide, part of the CHROME family, and what the doctor will do is lay a crestal flap and flap forward so that the labial bone is exposed, and then these two parts here are assembled, which are the pin guide and the fixation base.

They’re assembled, seated with the patients in occlusion, and you drill these facial sites and anchor this into the bone for most of the surgery. Then the doctor will reduce the bone down to that red line that we mark on the model, flatten the bone, and once that is finished then the osteotomy guide is seated. Drill all the holes, place the implants, place the multi-unit abutments, and at that point the metal comes out of the mouth for an edentulous case because at this point we will use the denture as the reference as opposed to screws or teeth or anything else that’s a customary photogrammetry or Grammetry case. Once the metal comes out, the healing collars are placed on each one of the sites, the tissue is sutured around the healing collars, and then the denture is seated over the healing collars and it is adjusted until it passively seats the tissue and closes in a bite; there’s a little bit of work involved in making sure that this fits right to pass its passive and that the bite is right. Once it is, then this is loaded up with impression material, and it’s seated over the healing collars to pick up each one of the healing collars as a negative impression. Then the denture is removed from the mouth, and it is scanned 360 before being seated back in the mouth. Scan the opposing, scan the bite, upload with photographs, and off we go to a prosthetic design.

Now, that was one option. The other option is to, at the very end, scan the opposing and then seat this to pick up the intaglio and healing collars, and then scan the bite. Then the denture can be removed, and if your scanner has the ability to, then you can scan the teeth here where the bite was and then keep scanning this 360 degrees. That way you don’t have to take it back in the mouth like the first version. So that is Grammetry or photogrammetry using the CombiGuide for bone reduction and implant placement; a really nice combination.


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