Digital Workflow for Guided Surgery Appliance & Implant Restorations – Part 1

The radiographic scanning appliance and scanning bite are placed in the patient's mouth during the CBCT scan appointment and will create orientation markers within the CT image. (Figure 1 above) This facilitates the accurate orientation of the 3D CT file and .stl file of the optical scan to be used in the surgical planning of the implant cases. The purpose of the scan appliance is to show the desired prosthetic positions of the restorations in the digital plan. This allows for the surgical plan to be restoratively driven. When a partially edentulous patient is scanned, it is not required to use a scanning guide. However, it is still important to make an appliance that represents the diagnostic set-up of your planned restorative work. Not doing so may lead to a compromised final prosthetic result. Again, radiopaque markers are used to evaluate the position of the proposed restoration to the existing bone.

It is also important to have a scanning index/bite, to ensure that the patient occludes in a predictable manner during scanning. This will enable accurate positioning of the abutment and crown, and facilitate the correct access hole vector. This index must be made of radiolucent bite material so as not to obscure the borders of the dentition.

Digital Surgery Planning 

The planning and guide design steps are two distinct phases of creating a guided surgery appliance. The guide design is finalized by the creation of a finished .stl file, which is the 3D print file for the guide itself.