How does the surgical protocol differ on a GuidedSMILE revision case?
Revision surgery follows the familiar CHROME stackable sequence, with several deliberate differences driven by the presence of existing implants and an existing prosthesis.
1. Screw down instead of tissue supported
Wherever multi-unit abutments exist, the guide is screwed directly to them. This is the answer to the fixation base wobble problem, and it produces a guide that could not be more solid in the mouth.
Screw technique:
- Vortex screws are the reference product, and ROE's system works with D Rosen, SEG, and other screws as well.
- Screw the guide in, wait a couple of minutes, then tighten a little further as tissue pressure releases.
- Once it is fully seated and torqued, you will be drilling in the planned position.
- Verify left and right balance of engagement before torquing down.
2. The existing prosthesis comes out
| Reason | What happens if it stays in |
|---|---|
| Handpiece clearance | The handpiece collides with the posterior teeth |
| Access to posterior sites | You cannot reach implant sites located underneath the prosthesis |
| Guide position and draw | To clear the existing teeth, the fixation base must sit far labial, which loads the pins and introduces wobble |
| Undercuts | Excessive undercut usually rules out a bone-supported guide as an alternative |
Wobble is unacceptable in a pterygoid case, on a dentally savvy patient, or when threading implants between existing implants. A tissue supported guide should not be used in any of these situations.
3. Stage the implant placement to stabilize the guide
- Lay the labial flap first, then seat the guide.
- Hold the guide firmly in position while it is pinned or screwed.
- Place the easy anterior implants first, typically one to three of them, and secure the guide to them. This locks in both facial and occlusal trajectory before the difficult sites are prepared.
- With the guide fully stabilized, prepare the posterior sites and pterygoids.
- Leave existing implants in place during the procedure wherever possible for stabilization. ROE lists this alongside pre-engineering from the teeth down as a core predictability principle for revisions.
4. Engineer generously, especially for parafunction
Revision plans routinely add implants beyond the minimum. For bruxers and parafunctional patients, additional implants and pterygoids are added deliberately for symmetry, AP spread, balance, and long-term load distribution. The additional lab cost of planning a few more sites is modest relative to the cost of a second failure.
5. FP1 and tissue considerations
When preserving bone with an FP1 design, do not design with tissue pressure. Open the embrasures further than seems necessary and allow the tissue to grow into place. Tissue commonly fills in within a couple of weeks.
6. The case acceptance benefit
Revision patients tend to have a high dental intellect. They have been through treatment, they are on the fence about more money, more surgery, and more risk, and they are skeptical. Being able to show a patient the plan and commit to placing a specific implant in a specific location is a genuine case acceptance tool. The precision is what earns the yes.
For pterygoid and zygomatic protocols, see GuidedSMILE Zygo. For restorative finishing, see the Printed Try-In.
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Contact Information
For immediate chairside support or troubleshooting assistance, contact ROE Dental Laboratory:
- Phone: (216) 663-2233
- Email: info@roedentallab.com