The following instructions are specific for a CHROME GuidedSMILE edentulous case. Call 800.228.6663 and ask to speak to one of our experienced dental lab technicians regarding this magnificent service and technology. ROE offers chairside support during surgery anywhere in the USA. Please call to schedule one of our experience CHROME technicians.
Watch the CHROME GuidedSMILE surgery in the videos below to see it in action.
Please consider all instructions on this web site and from our laboratory as explanation of our product and its use. Do not use CHROME as a substitute for surgical skill, implant placement training, or prosthetic conversion. CHROME’s purpose is to serve as augmentation to a doctor’s skill and experience.
Double edentulous case documented by Dr. Isaac Tawil & Dr. David Peck
Surgical Instructions for the Edentulous Patient
Stage 1: Pin Guide
The Pin Guide is the plastic device that connects to the Fixation Base (CR/CO) via 2-3 CHROME Loc attachments. The Pin Guide’s function is to deliver the Fixation Base by using the patient’s ridge and palate as support. The Pin Guide must be successfully oriented into place to achieve a successful surgery.
- Use cold sterilization prior to surgery
- Passively assemble the Pin Guide (a) & Chrome Fixation Base (b) to feel the relationship between the two.
- Push in all the CHROME Locs, with Pin Guide fully seated
- Info: the Pin Guide is a duplicate of either the patient’s existing denture or a scan appliance.
- Seat Pin Guide (a) similar to seating a denture. This step is very important and sets the foundation for the remaining steps. If guide is not fully seating, make adjustments similar to adjusting a complete denture. Once seated, the patient should be able to occlude naturally. Slight occlusal adjustment may be needed. Reseat w/ Fixation Base (b).
- Remove the Pin Guide/Fixation Base assembly and numb the patient. Once injections are complete, seat the pin guide and keep pressure until the anesthesia swelling has dissipated and the denture is fully seated again. Verify that the denture is in the correct midline position, visually check for even blanching and occlusion, and remove.
- Lay labial facial flap from the crest of the ridge. Once complete, return the guide to the mouth, hold firmly and ask patient to bite. Drill the facial holes for the pins. Must use the provided Drill and Pins as they are calibrated with the guidetubes and plan. Drill to depth and place the pins. Use a mallet to ensure full seating. It is important to use the mallet only after all pins are hand inserted on edentulous cases—avoid torqueing the guide. Once all the sites are drilled and pins are placed, disengage the CHROME Loc plungers to remove the Pin Guide from fixation base.
- The fixation base remains in place for the entire surgery & parts pick-up.
Stage 2: Bone Reduction Guide / Fixation Base
The Fixation Base serves several purposes including support for the Osteotomy Guide, Nano-Ceramic, and final RAPID appliance pick-up. This guide is also the bone reduction guide. The Fixation Base must be secure and stable.
- Pin the Fixation Base to the reduced bone model and feel the transition from guide to bone.
- Notice that this guide does not contact bone. The guided is fully supported by the pins.
- Check to verify that the pins easily pass through each of the chrome channels and bone sites.
- With Fixation Base seated, extract teeth and reduce the bone to the top of the Fixation Base. Use tools of choice: rongeurs, burs, surgical saw, piezo
- If the Fixation Base was removed to perform extractions (try to avoid every removing the Fixation Base before surgery is complete), insert Fixation Base using finger pressure on each pin until they are mostly seated, then use the surgical mallet, ensure full seat of each pin.
- If posterior area has a step up due to bone reduction, use a bur to create a sloped transition. From reduced bone to non reduced bone.
Stage 3: Osteotomy Guide
Osteotomy guide controls the doctor’s fully guided kit. GuidedSMILE compliments nearly all fully guided kits. Follow kit provider’s protocol.
- Using the CHROME Locs, connect the Osteotomy Guide to the bone guide and ensure a passive connection.
- Test the Fully Guided Kit parts and ensure passive fit of each site.
- Study the enclosed GSI report for tool sequence, abutment rotation, images of Fixation Base, parts, etc.
- Insert Osteotomy Guide into the anchored Fixation Base. Use the CHROME Loc attachments to ensure the guided is fully seated.
- Perform osteotomy drilling and install implants according to specific implant company protocols.
- Place implants through the guide if fully guided kit allows. If tools torque, Osteotomy guide can be temporarily removed to relieve torqueing pressure on the handpiece. Otherwise, remove osteotomy guide and place.
- Once all implants are seated, remove Osteotomy Guide.
- Allow the last 1/4 of the implant to be above the bone crest and hand torque to final position aligning the flat side of the implant to one or the flat sides on the Hex of the osteotomy guide.
- Zero degree abutments (straight implants) are round on the Osteotomy Guide. Angle abutments have a Hex sites.
Stage 4: Carrier Guide / Abutment Orientetion Guide
- Carrier fits into the Fixation (d) Base and is held into place with the CHROME Locs (e) . Insert to test.
- The carrier serves to ensure the MUA abutments are in the correct position, the temp cylinders are in the correct trajectory, and to direct the driver to the MUA screws.
- Notice the direction of the square ‘access’ sites off each angled implant site. These squares provide the access for the driver. The driver will drop into the square and engage abutment the screw.
- At this point the implants are in place and in the correct rotation.
- Screw down the MUA abutments as indicated on the GSI report. There are images in the report that show the MUA screw access angle. The carrier (image above) also indicates the rotation of the MUA’s. Once they are placed in the correct rotation, the drive will be able to engage their screws. If the MUA’s do not line up with the squares, remove and rotate the implant into the proper direct / index, then seat the MUA’s—see callouts above.
- With all MUA’s seated, screw the Temp Cylinders to the MUA’s and verify their correct position and trajectory using the Carrier and ultimately the Nano-Ceramic. The Temp Cylinders should emerge vertically and near the middle of the holes in the Nano. If they are close to an edge but not touching this may be acceptable. If there is contact you have a choice of rotating the implant or adjusting the Nano. This has implications for the final restoration screw access hole position.
Stage 5: Nano‐Ceramic Pick-Up and Optional RAPID Appliance
- Seat the Nano-Ceramic (f) to the Carrier which is connected to the Fixation Base and ensure a passive fit.
- Notice the thickness of the Carrier and how it simulates the tissue thickness of the patient – Approximately 3mm.
- With carrier in place, use provided green gaskets and blue plugs fill blockout the temp cylinders and to fill the gap between the temp cylinders and the carrier.
- Coat the inside of the access holes of the Nano with provided resin bonding agent so acrylic will bond. Seat the Nano-Ceramic onto the carrier pegs. Backfill the voids around between the temporary cylinders and the Nano with Quick-Up. Do not allow any material to enter the temp cylinders! Once fully set (self cure, follow instructions), unscrew the cylinders and remove the Nano. Trim the cylinders with a disc or bur, fill all the voids / holes in the Nano, adjust and polish to finish.
- Optional: Screw down the second set of temp cylinders. Insert the RAPID (g) appliance and repeat the pick-up process. The new iJIG has replaced the need for the RAPID (contact laboratory for details)
- Remove the Fixation Base and carrier, place optional comfort caps, suture, deliver the Nano-ceramic prosthetic.
- Seat the Nano-Ceramic, adjust occlusion, capture photographs and share with the lab.