Osteotomy Guide

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What to test first?

Check kit early to ensure passive fit. Spoons should fit with little to no resistance. If the spoons are a little lose, ensure the top of the Osteotomy guide sleeves and the spoon are flush seated when drilling all sites. Be sure if there are divergent, very close implants, that the spoons will seat fully w/o touching one of the other sites. This would have been checked in the lab, but a verification is still suggested.

Where online can I order sleeves myself and not have to call in?

You will need to log into your ROE online account. Once logged in under lab products you’ll find the product CBCT Guide Sleeves. You can then choose your specifics (ex/ implant brand and quantity) then place your order. If you do not find the exact information, there is a notes section for more specific parameters such as height, ID (inside diameter), or OD (outside diameter), and specific implant systems and guided kit.

Spoons from the guided kit are tight how to adjust?

Adjust as minimally as possible. Use a metal-cutting bur and indicator in the guide tube to identify exactly where the contact it. Turn the Guide upside down and look up into the tube and visualization of the hang-up area should be evident. If the spoons are so lose that it appears the wrong design was made, clinical decision to move forward must be made. If the bone is very wide, proceeding may be ok.

Spoons are loose, how do you overcome?

Use the top of the spoon, make sure it is flat on the osteotomy guide and drill. If the ridge is very narrow use much more caution. Wrapping the spoon with Teflon tape is an option.

Trajectory of the site looks off. How do you test to ensure it is correct?

  • Assemble the spoon and drill and show the trajectory all the way to the bone. Often the sleeves seem lingual, but the sleeve is just the trajectory not the stopping point of the implants. In other words, the guide may look lingual, but it is in the position as designed.
  • Clinical judgment must be made if the guide clearly shows a wrong trajectory. Free-hand may be needed.

At what point do you bail and freehand?

  • Clinical solution: see the drill touching the bone first.

Implants have threads exposed, but the spoon is buried in the guide, what to do?

Perhaps the bone was reduced too much. Bone level must be an extension of the Fixation Base and not angle up or down from that plane. If this is the case, use training on treating exposed threads. If anatomically and prosthetically allowable, place the implant deeper using a hand driver.

Wrong implant sizes and parts are ordered? Can this be overcome?

Call the rep. Call the company to find the rep. Call doctors in the area with inventory! Find a compatible implant system and contact their rep. Try not to bail.

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