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CHROME Patient Records

Accurate and detailed patient records are essential to starting a CHROME GuidedSMILE case properly. This page will detail the necessary records for all patient types. Read this page throughly and if you have any questions please call us – 800-228-6663.

This page contains information on the following record aspects:

  1. Records Overview
  2. Appliance Fabrication
  3. CHROME Photographs

1. Records Overview

Single Arch or Double Arch ‐ Dentate against Dentate

  • Photographs: full face full smile photo, profile photo if Class II or III, and retracted photographs – front, left side, right side in occlusion!
  • CBCT of patient open biting on cotton rolls. Also, place cotton rolls between cheeks and teeth.
  • Maxillary & mandibular master casts or impressions. Must capture vestibule of the CHROME surgery arch(s)
  • CO or CR bite registration
  • Full GuidedSMILE CHROME Rx completed when uploading DICOM and photos

Single Arch ‐ Dentate against Edentulous

If CHROME is the Edentulous Arch:

  • Photographs: full face full smile photo, profile photo if Class II or III, and retracted photographs – front, left side, right side in occlusion!
  • Master casts or impression of dentate arch and impression of the dentate side of the denture
  • Place 6 radiopaque markers randomly on the tongue and cheek sides on the denture (SureMark.com, or gutta percha 2mm round)
  • Dual Scan CBCT Scan – ALWAYS IN OCCLUSION
  • CO or CR bite registration
  • Full GuidedSMILE CHROME Rx completed when uploading DICOM and photos

Double Arch Edentulous

  • Photographs: full face full smile photo, profile photo if Class II or III, and retracted photographs – front, left side, right side in occlusion!
  • Place 6 radiopaque markers randomly on the tongue and cheek sides on the denture (SureMark.com, or gutta percha 2mm round)
  • CBCT patient open biting on cotton rolls.
  • Bite should be worked out during denture fabrication. If opening is needed, maximum 3mm at the lab.
  • Full GuidedSMILE CHROME Rx completed when uploading DICOM and photos

IMPORTANT NOTES

  • Existing Metal Partial Denture in CHROME Arch – Metal frames cause scatter and must be removed for the CBCT. If partial is needed for establishing bite, capture in an impression for a study cast. If not, send master casts, opposing and bite and we may need to make our JC Try‐In or a bite block and set‐up for articulation, and perhaps a scan appliance.
  • Free‐end case with unstable bite – The bite must be established through bite blocks and set‐ups. Once the case can be articulated then CHROME can move forward.
  • Opening bite more than 3mm – 3mm is the maximum ROE will open in the laboratory w/o an open bite record being returned for verification. More than 3mm must be established clinically with CR bite. ROE can assist via our special JC Try‐In Repositioning Device.

Bite Tip: if distance between gingival zeniths of #9 & #24 is less than 17mm (Shimbashi rule) then opening may be needed. Same if intervestibular is less than 35mm.

Important: Master cast of CHROME arch must capture the vestibule; retracted photos must be in occlusion; questionable bites will delay a case.

2. Appliance Fabrication

Step One – Design Ideal Denture or modify existing

You may use the patient’s existing denture if the criteria below can be met. If not, duplicate the denture in clear acrylic and adjust as necessary.

  • Teeth are proper size, shape & length
  • Occlusion and vertical dimension are properly established
  • No metal components
  • Sufficient thickness (2.5 – 3mm)
  • Buccal flanges of sufficient length for scan markers / support anchor pins
  • Excellent fit to soft tissue
  • Hard reline only‐no soft reline
  • No radio-opaque components or coating (no barium sulfate)

Step Two – Fully Edentulous

Order SureMarks (www.suremark.com) or add gutta percha markers

  • 6 gutta percha markers
  • Place half lingual and half buccal
  • Place on varying horizontal planes
  • Place on flange, below gingival plane of the teeth
  • Use a #6 or #8 round bur to a depth of 1mm. Keep markers spherical in shape, no larger than illustrated.
  • Fill flush with gutta percha

Step Two – Partially Edentulous

Order SureMarks (www.suremark.com) or add gutta percha markers. If the patient is missing many teeth, has metal‐based restorations on most of the teeth, or the bite is being opened more than 2mm, order a Scan Appliance.

  • Send models and a bite to ROE with instructions on implant placement and future restorations
  • Doctor receives scan appliance, seats and adjusts if there is a rock or ill fit (must fit with NO rock)
  • Perform dual scan protocol

Patient CBCT Scan Instructions—Dual Scan Protocol

1st scan appliance in the mouth                                        2nd scan appliance alone

Scan 1

  • Seat appliance(s) and ensure fit with no rocking—if there is a rock, hard reline or adjust until good seating (NO soft relines ever)
  • Fully Edentulous scan appliance—important to bite IN OCCLUSION with No space between the opposing! No bite material, no cotton rolls.
  • Partially Edentulous scan appliance—important to place bilateral cotton rolls and capture the CT
    • Bite with medium pressure and do not move

Scan 2

  • Scan appliance by itself siƫng on any type of foam or scan table that is NOT plastic. Must sit above plastic scan table!

3. CHROME Photographs

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