Grammetry Workflow Options: The CombiGuide

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The next modality is the CombiGuide where we really set the case up for success. Let’s go through that whole protocol. CombiGuide is, in our opinion, the ideal way to go through a geometry case with CombiGuide. We work with you to determine prosthetic thickness, implant placement, position depth rotation, et cetera. Everything. This is part of our CHROME GuidedSMILE system. But in this case it’s just osteotomy placement and bone reduction leveling. The metal, as you’ll see, serves as the constant. We’ll kind of go through that. How do you start one of these cases? This would be just like any guided surgery case. You would start with ROE Dental Lab cone beam teeth apart, iOS scans, upper, lower in occlusion and photographs. This was a case completed by Dr. Grant Olson, one of our key KOLs for CHROME GuidedSMILE.

He was nice enough to share this nice workflow with us. So thank you very much for that image here. This is a case being planned. So we took all the records, we designed the case, got it. Ready for the online meeting. We met Dr. Olson online, planned the implants, planned everything about the case. And then based on that, we fabricated the pin guide, the fixation based osteotomy guide and off he went to surgery. And repeat on the slide. These are the tools you need. Okay? And then with a CombiGuide, let’s go through the process. So we already have pre-surgical files. You uploaded those to us to make the surgical guide. So you don’t need to scan. We already have these at the laboratory. All right, step one, the pin guide.

This patient has already been reflected above the metal. Okay? So full labial reflection pin guide goes in seats, the fixation base. Once the fixation base is seated, you will capture a labial digital impression of this. And you’ll capture just the teeth, the bone, and the fixation base. If you find there’s an issue with this, you can always put screws in the pallet, the retromolar pads, wherever. Let not worry about that. We know this works. Okay? That’s your first scan. Now, once it’s digitized, teeth come out, bone is leveled down to the fixation base. We carefully plan this as the bone reduction level. Okay? Then, and I put this in here just as the reminder before, with teeth, after without teeth, the constant is the fixation base. This is the tad, this is the screw. This is everything you need to preserve the bite.

Next step, osteotomy goes in, implants are in, multi units are placed, and now we have even a better constant. Okay? Something easy to scan. Now the teeth are gone, which is the carrier guide. The carrier guide sits on the fixation base. This is the night transition for digitally acquiring from the OptiSplint or from the healing collar out to the fixation base. Okay? So you would scan this platform, not all of it, just some of it. And this won’t be in a clear color. It’ll have some texture to it when it arrives. And you scan it very scannable. You’re not scanning blood and movement underneath. So, kind of skipping back and forth here between live surgery and visualization here but at this point, you have an option, okay? When this is in the mouth, you can put healing collars on this.

Put healing collars, put the carrier guide and scan away. And then you’ve captured the position that’s not for implant placement. This is not for componentry. This is only for preserving the bite and transitioning back. Okay? Now you have an option here. You can either scan the OptiSplint in the mouth, or you can scan the healing collars. You have a choice, whichever one you want to do, both work. And at that point, you’re finished. And this is all that’s uploaded to the right of the green bar, because the left of the green bar, we already have this scan. This is what we used as mentioned before, for the planning of the guide. So this is 1, 2, 3 scanning. The file of the fixation base in a teeth, the file of the fixation base superior guide, and the healing collars.

And then a scan of the OptiSplint outside the mouth, either with an iOS or with a lab scanner. Totally optional. This is totally optional. I’m throwing this in there because if you have a lab scanner, you can go to whatever degree you want to go to a finals or COA at any point. Okay? Now this, this image here could be on top of here, perfectly fine. Scan it in the mouth, but as we know, we want to keep adding more and more accuracy. So these will be the three scans that you upload. Doctor completed a case last week. He is one of our KOLs as well for this process. He, if you know T-Bone, you know his experience. He is on the top tier A-list.

He is one of our KOLs for CHROME GuidedSMILE, for CombiGuide, for lots of things. And he is going through this process with us, with grammetry. He’s adopted grammetry. In fact, you’ll see on the last slide, um, we are having a two day event with him and his partner in two different locations teaching this protocol. I’ll talk about that. Okay? Thank you very much for documenting this case T-Bone. Let’s, just real quickly, let’s cover what he did. Okay? We went through the whole process of designing the guide, all those first stages and we won’t go through all that. But in surgery, once he set the fixation base, he took out his prime scanner. He scanned the fixation base, scanned the teeth to preserve the bite, right? So that we have the tooth position, we have the fixation base.

And then he went through the whole process, the whole surgery, put the OptiSplints in, luted them together, scanned again with his scanner. Look at the beautiful scans that that scanner takes. It’s really incredible. It’s really one of the best out there and those were the two scans that he needed. That’s it. Now, I know we’re going to teach an extra oral scan moving forward, but this is how he did it. A high degree of accuracy. And this is what he sent us on the day of surgery, full face, full smile, left and right images. Now we, of course, we already had these because we worked out the whole CombiGuide. So everything on the left we already had and on the right is what’s uploaded on the day of surgery, the STLs. All right? And based on that and his lovely photograph, we designed the prosthesis behind the lips within the smile, right?

That’s almost mandatory at this phase. And let’s just go through this to the layers. So, so we have a prosthesis already designed, but here we are. That’s middle of surgery, picking up the fixation base and the teeth scanning the OptiSplint in the mouth, bringing it together with the opposing, because we have the fixation base and designing the prosthesis. Okay? Very important. Just to clarify, in case you’re just for protocol, when he scans this here, this scan, this scan also includes the bite, right? We want the opposing teeth. Now do we have to, we don’t necessarily have to, because we have this scan at the laboratory and we can follow this bite registration that we’ve already already made. So it’s an optional scan. You can take a bite registration in surgery. Not always the easiest thing to do, but that’s an option. Okay? Bite or no bite during surgery.


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