72
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CERECDOCTORS.COM
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QUARTER 1
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2016
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D I S C U S S I O N F O R U M
DOUGLAS SMAIL, OMFS
Great looking case!
I guess my kids won’t get any X-mas presents,
Daddy needs a mill next year!
JEREMY HELDT
Nice case Marko, thanks for sharing. Did
you immediately provisionalize as well?
Also, based on my limited understanding of CEREC
Guide 2, I was wondering how it would be possible to
do a small edentulous space like #25. Since the Guide
2 requires a minimum diameter space to accommodate
the sleeve, I’m pretty sure it wouldn’t fit in a #25 eden-
tulous space for a guide. Would a supra-occlusal placed
sleeve be an indication for that type of case as well?
ERIC PROUTY
Perhaps, yes, Jeremy, and if the drill doesn’t
go to length at least it gets you started at the
right angle.
FARHAD BOLTCHI (FACULTY)
@ Jeremy: Yes, you can use a supra-occlusal
sleeve position to solve the two situations you
are alluding to (immediate implant placement, narrow
spaces). However, as Mike mentioned above, you would have
to have long drills and then use the Verban Drill Stop tech-
nique (which I describe in detail in the third Academy online
webinar), or place a shorter implant or just get your drilling
started and do the rest free-hand.
@Ross and John: In some software (such as Co-Diagnostix
and BSP) the guide is designed in the implant planning soft-
ware and there are tools within those software programs to
virtually “extract” a tooth.
SICAT can obviously do this as well, but I don’t know if they
do it in their “master Galaxis” software or in their CAD soft-
ware. In our situation, the guide is designed in our CAD soft-
ware: i.e., the CEREC SW4.4. If you put the sleeve where there
is a tooth on the virtual model, then the software thinks it has
to mill both the sleeve and also mill the guide such that it fits
over the existing tooth since the software doesn’t know that we
will be extracting the tooth. The mill will start milling fine until
it gets to the part it has to mill the sleeve and the part of the
guide that fits over the tooth (which the software thinks will
still be there), then it will error out (typically indicating that the
carbide burs are defective). I wasted four blocks and four sets
of carbide burs trying this out during my testing (
photos below
).
It’s a different story with a subgingival or subcrestal sleeve
position. In that scenario, the software will alert you that there
is an intersection between the model and the guide sleeve. You
then have the option in the software to grind the sleeve support
out (if you want to do the case flapless for example) or to leave
it (and flap the case). Either way the guide will mill out fine.
JOHN PASICZNYK
Thanks for the explanation, Farhad. Makes sense I
guess. I’ll play around with virtual extraction and
see if I can make that work for these cases.
JEREMY HELDT
Completed our first Guide 2 case today! Seems like
it came out well. (Note: I have the Nobel Guided
Surgery kits with drill stops). The Sirona sleeves were pretty
tight and had to work a little to get them in and out, but I guess
tight is what you want them to be anyway to reduce error. The
onlycautionwiththat is theguidesleevesSironamakesare fairly
pliable and could get bent, and possibly even break off when
removing from the Guide 2. Maybe they did this on purpose for
situations that might need some bending? Placing the sleeve
supra-occlusally for the extract and immediate worked and
