What are the purposes of it?
Bone reduction verification, MUA angle guide, delivery of the prosthetic and RAPID appliance, spacer for reflected soft tissue, verification that the driver is going in the right direction on angled implants (note the black square on angled sites – see instructions for specifics), tissue reflection.
What if the implants are not protruding directly under/through the sites?
This could mean any number of things went awry: Pin Guide was not seated correctly; angle implants are too deep or too shallow changing the connection position; implant chose a different path if they were inserted by hand, not guided; decide if they are placed in an area that is not acceptable – take an x-ray to verify that they are in an acceptable position and make a judgment to move or leave. The plan called for the implants to emerge in a specific position, and the fix is to modify the Carrier Guide and the prosthetic for pick-up. Be sure the Temp Cylinders do NOT contact the Carrier Guide or the prosthetic during the pick-up.
What if the angle implants, MUA’s and Temp cylinders are not aligning through the holes?
Verify that the implants are in the correct position. This can be observed visually through the carrier guide. If looks good, then the angled implants may be inserted in the wrong rotation. If it is, then the implant must be rotated, as little as just a few degrees. This should ‘right’ the MUA and Temp Cylinder. Also, verify that the abutment screw is in line with the black square on the Carrier Guide. This square is where the driver passes through to deliver the abutment screw, in the same trajectory as the implants. If the implant has been placed with the correct indexing to the hex on the Osteotomy Guide, then the MUA may need to be removed and placed in one rotation clockwise or counterclockwise. The best course of action is to follow the implant guided kit to deliver the implant exactly as the Hex indicates.
Do you have to use the Green Gaskets?
YES. Must block out the pick-up material so as not to lock in the prosthetic. Can use light body, gloves for rubber damn, wax, other similar easily removed material.
What if Carrier Guide is not seating? Do you force it?
NO, do not force or bend. It will break and be detrimental to success. Three main reasons it will not seat: 1) something is in the CHROME Loc box. Carefully inspect and clean 2) bone was not reduced sufficiently and is ‘holding it up’ 3) soft tissue is in the way. Make a stitch, or reflect more if needed.
What do you look for that might be holding it up?
- Something is in the CHROME Loc box. Carefully inspect and clean
- Bone was not reduced sufficiently and is ‘holding it up’
- Soft tissue is in the way. Make a stitch, or reflect more if needed.
Can the prosthetic or RAPID be used early on to check occlusion?
Yes, checking occlusion early is a good trick to know if there will be adjustment and to judge how the surgery is going so far, to see that everything is stacking correctly.
What if Carrier Guide breaks?
If the CHROME Loc insert breaks there should be two remaining that work. That is sufficient. If more break, then hold down the Carrier Guide through the remaining procedures. If the guide broke in half, reinforce with acrylic on the INTAGLIO side, not the occlusal side. Do not want it raising the prosthetic. There is a gap under between it and the bone. This part can be reinforced.
What if there is not enough torque on the implants?
This is very critical. The prosthetic must not be loaded if the torque does not meet the minimum number. We recommend using and ISQ device to check NCm’s. If you do not plan to load, at least pick up 3 of the Temp Cylinders on the MUA’s for tripoding. This is a good index for the delivery of the prosthetic in two to three months. The remaining implants can be picked up later. There is NO WAY to do this once CHROME removed. Anything in the future is floating and cannot be picked-up. Pick up the RAPID appliance at this point as well if possible.