Triple scan technique (Dr. Gross)

A new and effective protocol for computer guided planning and flapless

implant placement for partial edentulous cases

Dr. Michael GrossImplantologist and international lecturer

Scientific consultant for dental implant industry

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

3D planning with visualization of radiographic denture

3D scan of radiographic denture alone and alignment on 3D scan of patient bone

3D Scan of patient bone wearing radiographic denture with x-ray markers

File transfer over internet of planning data

Precise 3D planning of position and angulation of implants and guide pins

3D relation between planned implant positions and radiographic denture

Fabrication of surgical guide converting radiographic denture

Radiographic markers in denture included with guttapercha or Cavit

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

Guided surgery and immediate loading

• Dual scan protocol was developed for edentulous cases with immediate loading

• Promoted for teeth-in-a-day with prefabricated restoration

• This requires implant placement over surgical guide and therefore titanium sleeves in surgical guide

• This requires development of guided surgery kit with many components – costs –

• If not all planned implants have required primary stability, prefabricated restoration is useless

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

Simplified instrumentation for expanded indication

• Reduced instrumentation for compatibility• Eliminating the need of implant specific surgical

guide kit – universal guidance of 2mm and 3 mm drill with depth stop

• Eliminating the need of titanium sleeves – use of titanium drill guide handle 2mm and 3mm which is introduced in surgical guide

• This expands indication because collision of titanium sleeves with close or inclinated implants is eliminated

• In extremely narrow situations use of 2mm guide sleeves for use with 2mm drills

Simplified instrumentation for expanded indication

• Reduced instrumentation for compatibility• Total inventory needed:

1.1 drill guide handle 2mm / 3mm

2.1 drill 2mm short with depth stop

3.1 drill 2mm long with depth stop

4.1 drill 3mm short with depth stop

5.1 drill 3mm long with depth stop

6.1 drill 1.6 mm for guide pin

7.3 guide pins (reusable)

Costs: total only 712 US$ + shipping

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

Triple scan technique

• Most of implant cases are partially edentulous

• Radiographic partial denture for dual scan has disadvantages– Fixation on residual teeth poor if not extended over

them

– Visibility of residual teeth compromised if covering them

– Gingival contour of neighboring teeth and edentulous areas can only be estimated as underside of denture

Triple scan technique

• Solution for partial edentulous cases

1. CT or CBCT scan of patient without any appliance in open occlusion

2. Optical scan of master cast (can be modified and imported at any time after CT or CBCT)

3. Optical scan of master cast with diagnostic wax-up (can be modified and imported at any time after CT or CBCT)

4. Alignment of both optical scans with 3D model of bone

Triple scan technique

• Solution for partial edentulous cases

1. Implants can be backward-planned on cast with diagnostic wax-up with visualization of available bone, excellent details of teeth and soft tissue

2. Relation of implant and soft tissue depth can be verified with visualization of master cast without wax-up, excellent details of teeth and soft tissue

3. Relation of implant to crestal bone can be verified with visualization of bone without cast

4. Fabrication of tooth-supported surgical guide over master cast without wax-up

Dual scan technique

• Indication for totally edentulous cases

Dual scan technique

• Indication for totally edentulous cases

Dual scan technique

• Indication for totally edentulous cases

Dual scan technique

• Indication for totally edentulous cases

Dual scan technique

• Indication for totally edentulous cases

Dual scan technique

• applied for partially edentulous cases

Dual scan technique

• applied for partially edentulous cases

Dual scan technique

• applied for partially edentulous cases

Dual scan technique

• applied for partially edentulous cases

Dual scan technique

• applied for partially edentulous cases

Dual scan technique

• applied for partially edentulous cases

Triple scan technique

• applied for partially edentulous cases

Triple scan technique

• applied for partially edentulous cases

Triple scan technique

• Implants planned on wax-up cast

Triple scan technique

• Implants relation to soft tissue

Triple scan technique

• Implants relation to bone

Triple scan technique

• Tooth-supported surgical guide

Triple scan technique

• Extraction case, modified cast

Triple scan technique

• Extraction case, modified cast

Triple scan technique

• Extraction case, modified cast

Triple scan technique

• Extraction case, angulation needed because of proximity canalis incisivus

Triple scan technique

• Extraction case, would be collision with master sleeves, no problem with drill guide handle

Triple scan technique

• Multiple changes on cast after CT scan, extractions and root canals done, planned extractions

Triple scan technique

• Multiple changes on cast after CT scan, extractions and root canals done, planned extractions

Triple scan technique

• Multiple changes on cast after CT scan, extractions and root canals done, planned extractions

Triple scan technique

• Multiple changes on cast after CT scan, extractions and root canals done, planned extractions

Triple scan technique

• Multiple changes on cast after CT scan, extractions and root canals done, planned extractions

2 mm guide multiple extraction case with tooth-supported guide over 3 teeth as strategic support

Lecture program

• Classic protocol : dual scan technique

• Guided surgery and immediate loading

• Simplified instrumentation for expanded indication

• Triple scan technique and case scenarios

• Clinical support and education

Clinical support

• CORTEX guide - Complete service for 3D planning and fabrication of surgical guides

• Provide surgical instruments at low-cost

• Online help with skype and teamviewer

• Simple data transfer over dropbox

• No physical shipping needed

• Free planning and viewing software Nemoscan

Clinical support

• CORTEX guide - Complete service for 3D planning and fabrication of surgical guides

• Turn-around time for guide fabrication 3-5 business days after final approval of planning

• Different shipment options

Clinical support

• CORTEX guide - Complete service for 3D planning and fabrication of surgical guides

• Costs for complete service per case (regardless number of implants):– One jaw, one guide: 500 US$ plus shipping– Both jaws, two guides: 650 US$ plus shipping

Tel.: +1-809-736-9040Cel.: +1-829-548-6135Santiago – Llanos de GuraboC./a Jacagua entrada km 7Res. La Senda, casa 5dds.michael.gross@gmail.com

Contact:

Dr. Michael Gross

CORTEX guide

www.cortex.dominicanhealth.org