The ROE Grammetry Digital Process – The OptiSplint Surgical Protocol

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For surgery. Basically the first thing you always start with is pre-op records. As you guys know, interval scans, CT scan, patient photos for the smile design, you go take that and do the smile design. You could prosthetically plan the implants, you’ll figure out where the implants are going. You’ll put your teeth there and make sure everything fits. In this case, we happen to do it with a Yomi robot. And so one of the things that you need to do to align the wax up to the implant positions that you’re going to be scanning is you need some kind of radiographic marker that you put in during surgery to align that wax up to the implant positions. In this case, we’re going to be using the Yomi, but you can use any radiographic marker, including the chrome guide as well, the bone foundation guide that you put in, so anything that’s going to be there before you remove the teeth, and then it’s going to stay there after the implants are in place.

That’s the fiduciary marker that you can use a scan to kind of align all that data together. So your first scan is always scanning that fiduciary marker with the patient’s current dentition, and then at that point you’re just placing the implants however you want, would want to place them, and you’ll place your multi-unit abutments. You can either scan immediately after you’ve placed the multi-unit abutments before you’ve sutured up the tissue, or you can wait until you’re sutured up the tissue to scan. Either way, it doesn’t matter in this case. So you’ll see it all the optisplints in the patient’s mouth. In this case we did it prior to closing, and then when you lute ’em together, you’ll just fill all that part on the front side of that optisplint with composite material or any kind of material that you want to use, any kind of acrylic material you want to use to kind of get that luting material in there.

You’ll lute it together. We have a little nice little carrying handle for the frame. You’ll put it in there. You’ll make sure every single part of that frame is touching some part of an one of the other scam bodies, and you’ll lute it together with that material really quickly cure it so it gets a nice firm hold on it. And then you’ll do the intro scan. I mean, in this case we scan it actually with a prime scan, and so we got a nice, beautiful scan of everything. From there, we do the alignment. So basically you could see that there’s a pre-op record of the patient. We’ll align that to the teeth. From there, we’ll align the fiduciary marker to the fiduciary marker with the scan of the optisplint, and that gives us an aligned implant positions with the prosthesis that we had pre-designed prior to surgery.

And at that point, all you have to do is align the implant positions in exocad and you’ll do the digital conversion. It is a behind the scenes part of things, but yeah, from there you’ll take that STL file from exocad, you’ll set it up to print. What’s nice about our system is you could literally print on any printer, anything could be done with this, with how you want to produce that prosthesis. One of the ways to verify, one of the ways that we could verify the accuracy and the passive fit of the prosthesis is to actually pour stone model from the optisplint that we took from the patient, put some analogs on it, pour stone model on it, and then once we’re done printing, we will clean and cure it. And then at that point we can just take ti bases and cement, use the model that we made spent, ti bases onto the prosthesis.

From there, once your ti bases are seated, you’ll characterize it. Of course, once you make ’em look nice, you want to take some photos for Instagram, show it off, but you can see it in your patient. And I mean, the really nice thing about being able to do it this way is you get a beautiful result on the day of surgery. It looks like a final. And in fact, what you’ll end up doing is you’ll end up using this first prosthesis as a temporary, as your first tryin. And so you’ve already, because you already have a verified jig that was used in the patient’s mouth that you picked up in the patient’s mouth, and as long as that same jig you’re going to try it in when the patient comes back for their final, as long as that jig still fits, the cast is still right, the digital records are still right, because all that is already right.

You don’t even need to do much more than just scanning the tissue with that jig and then scanning the bite, the new bite with that prosthesis. And because everything lines up in the digital record, you’re basically going to final from there. There really isn’t too much else to do. There’s no extra appointments or anything like that. The only time you really do need an extra appointment is if there’s a drastic change between your temporary prosthesis and your final, or yeah, if it’s going to be like something’s off, bite’s off, something like that. But it’s rarely ever that way. And so because of that, you’re really able to kind of get a really fast result because you’re going straight from on the day of surgery, you’re going straight to your first tryin, you’re kind of skipping that verification jig or whatever else appointments that you often have to do. So yeah, I mean you really can make your first prosthesis, especially when you cement those tie bases in the prosthesis on the model, you really get a very nice final looking result. And these are all temporaries.

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