Page 57 - CEREC Q3|2013

quarter 4 | 2013 | cerecdoctors.com | 55
[In response to Jeremy Bewley]
No question that the Optiguide is easier, quicker, more
efficient and more accurate (as a percentage of total cases)
than the CEREC Guide. However, the two-scan protocol
you are referring to is typically done by clinicians who are
trying to decide which cases they want to tackle themselves
based on their experience level and which ones they don’t
want to deal with. A very prudent approach and nothing
wrong with it — but this is certainly not the norm.
[In response to Charlton Ho]
My practice is different than yours since my patients are
specifically referred for implant therapy and most are sedated
during the surgical procedure. While the CEREC Guide was
initially advertised as a way of doing everything including
consult, guide fabrication and surgery in one day (and while
that is still possible as Darin has shownwith the beautiful case
he published in the recent cerecdoctors.com magazine), this
approach has not worked for me. In my office, we do every-
thingover 2-3appointments, andmyassistant does everything,
includingall labwork, theCERECdesign, andtheGalaxisplan.
I just look at the Galaxis plan and modify as needed, she mills
andmakes the guide, I snap it in and start drilling.
Jeremy Bewley
I agree, Farhad, but in the initial example above of
taking two scans, then the only reason to expose
yourpatient toanot-insignificant amount of radiation(I think
it says 867microsieverts onmy XG3D inHDmode) a second
time is to save the clinicianmoney at the expense of increased
exposure to the patient. Not a practice I personally find best
serves my patients. This is why I think, if you’re set on using
CEREC Guide, then you should always assume you’re going
to use one and limit CT scans to one. Alternatively, a clinician
may choose to pursue the Optiguide route.Why should inde-
cisionon case selectionbe a qualifier for additional exposure?
Daniel Vasquez | Oceanside, Calif.
Emil, it’s not about whether we can place it
freehand or guided, is about the confidence you
have placing them in the right position, I have been placing
implants over 12 years. The difference today is, my surgery
is like a good theatrical play, behind scene there is lots of
practice and planning to make sure the day of the play
everything goes nice, simple and smooth. As a GP, it’s nice
to be able to place implant as good as you guys.
it is more expensive than stone. This is all done by my
assistant. She heats up the thermal plastic. Now, either you
or your assistant can make the guide quickly. This should
take less than 5-10 minutes tops to fabricate the radio-
graphic stent. This gets transferred to the patient, and they
are scanned. While the scan is being constructed, I image
the arch and design the restoration for export. From there
it is uploaded to the CT and design is done.
Jeremy Bewley
This is why I’m mainly using Optiguide. If you
capture a CBCT first, then decide you need a
guide, you have to expose your patient again if you want to
use CEREC Guide. I think the only way to use the CEREC
Guide is to always assume you’ll need one and go to the
trouble of making the thing first. I don’t like the idea of
exposing a patient to radiation multiple times just to fabri-
cate a guide that saves you a few bucks.
Farhad Boltchi | Arlington, Texas
[In response to Emil Verban]
Very valid question Emil ... and I am not sure
there is a right or wrong answer.
I haven’t prepared a post space in over 20 years now, but I
canremembermaking sure that Iwas constantlyguidedby the
gutta percha during the preparation. You don’t have that type
of indicator when you are drilling into bone, especially when
doing it flapless (notmy favorite approach evenwhen guided).
I do think that guided surgery is being oversimplified by
many clinicians and by many companies. Aside from the
caseswith tons of bone and tons of keratinized tissue, which
I rarely see in my practice anymore, IMO guided surgery is
actually more difficult and requires more experience than
freehand surgery. After nearly 20 years of placing implants
as a specialist, I canprettymuch freehand any situationwith
a non-restrictive guide, and I could certainly do without the
increased cost and overhead. But, despite all this, nowadays
I place 99% of my implants via a guided approach.
Why? Decreased surgical time in the majority (not all)
cases, especially fully edentulous cases, decreased bone
grafting needs, and — this last one is a bit whacky — prac-
ticing for the future when we can immediately load every
implant due to new-and-improved implant designs and
surfaces placed via a more precise guided approach and
precisely fitting pre-fabricated temps.