Guided Surgery Planning
Recently I was able to attend a program on guided surgery at Blue Sky Bio Academy, by Dr. Armen Mirzayan. I was particularly interested in attending this course, as the topic of guided surgery planning and guided appliances is an area that we are receiving an increasing number of questions from our clients and prospective clients. Certainly, more general dentists are adding implant placement and restorations as the mainstay of their practice development strategy.
As general practitioners begin to get more involved in implant treatment procedures, it is a natural progression to get more involved in placing implants using guided protocols. There are a variety of workflow options that are present in today’s market.
However, most of the choices available are closed proprietary systems that lock you into a specific workflow and only one choice for how and where you get guides produced. The Blue Sky Plan software is the most open system available at this time. Dr. Mirzayan’s introductory course on guided surgery using the Blue Sky Plan was truly empowering to all of the attendees.
Blue Sky Plan
Prior to Dr. Mirzayan’s course, I had gone through the Blue Sky Bio tutorial a few times and practiced using the software. While it is very intuitive, it is also rather deep and has options that are not readily apparent. That is where having a coach like Dr. Mirzayan is very beneficial. He has “done it all”, struggled with learning from scratch, and even spent money on surgical kits that he does not use now. All of this is imparted in the course so that you can benefit from his experience and get a jumpstart on successfully using an essential tool like Blue Sky Plan.
Armen covered all of the basics like how to upload your CT scan and an .stl model into the system and how to stitch them together. But more importantly, how to identify if you have a good stitch that will give you the most accurate placement and best fitting guide.
Placing The Implant Into The Plan
One of the best pearls was when he was teaching on selecting and placing the implant into the plan. There are the standard implant selections out of the Blue Sky Bio library. Using the fully guided kit is pretty simple once you have done it a few times. But what if you want to use another surgical kit? Armen showed how to place a “custom” implant and guide tube placement. This feature allows you to define the length, occlusal, and apical diameters of the implant that you want to place, and the guide tube inner diameter, height and offset from the implant platform. This allows you to custom design your surgical choices. You have to know your surgical kit and where you want the depth to be, but this allows you to design a guide that meets your customized choices, such as if you choose to do your surgery partially guided, like only using a pilot hole or alternate kit with any implant.
How To Design The Guide
Finally, he covered how to design the guide and save it as an .stl or .bsb file to send to the lab or to a printer.
My primary takeaway was that the Blue Sky Plan software is reasonably intuitive, but as with any tool, being coached and mentored by a master is invaluable.
Burbank Dental Lab welcomes any dentist that desires a reliable lab to fabricate guided surgery appliances, whether it is for a single implant site or a multi-unit site for an edentulous patient. However, it is our experience that participating with Blue Sky Bio Academy and Dr. Mirzayan for at least Level 1 courses, will save you hours of headache.
The Basic Workflow
- Fabricate a wax-up of the case to be planned. (Mandatory for edentulous cases)
- Create a CT scanning guide (and bite for larger cases)
- Create an .stl of the arch, either with an intraoral scan, or a scan of an impressed arch.
- Import in both CT (.dcm) and .stl file of arch scan, and stitch them in Blue Sky Plan.
- Define mental nerve.
- Select and place implant(s) and teeth.
- Check placement in various 3D views
- Design guide
- Save as .bsb or .stl file to send to the lab or your printer.
Our Goal at Burbank Dental Lab
At Burbank Dental Lab, we strive to be an elevated resource for many aspects of your everyday clinical needs and questions. We have tried to develop a base level understanding of your clinical procedures including guided surgery planning like Blue Sky Plan. We also recognize the need to recommend educational opportunities like those with Blue Sky Bio Academy.
Digital Dental Symposium - Washington, D.C.
There is one such opportunity on March 16 & 17 in Washington D.C., at the Digital Dental Symposium. We highly recommend this opportunity, with programs on sleep apnea, IOS scanning - Printing - Milling, Digital Dentistry, and Perfect Implant Placement. Check it out here.