Surgical Guide Scanning, Design Approval & Try-In

🔍 Overview / Background

This appointment ensures that all necessary digital and radiographic data are available for accurate, prosthetically driven implant planning. It includes imaging, scanning, file export, and guide design review. Students must complete digital tasks and collaborate with the lab/surgical team to confirm final approval prior to surgery.

📌 Reference: For detailed scanner setup, infection control steps, scanner locations, and STL export procedures, see the “Intraoral Scanner Protocol” section under Diagnostics & Digital Workflow.

Appointment: Scan and Design

📸 1. Imaging & Intraoral Scanning

• Order a CBCT for the arch of interest
  • Use a cotton roll to separate arches during scan
  • Export DICOM file via MiPACS and save using appropriate file naming ([StudentID]_[PatientInitials]_CBCT)
• Perform a full-arch intraoral scan using CEREC Primescan or Omnicam
  • Include interocclusal registration
  • Save and export scan in STL format

💻 2. File Submission & Merging

• Merge STL + DICOM in planning software (e.g., Simplant)
• Submit all files to lab or in-house digital planning team
• Complete any required Lab Script / Work Authorization for:
  • Surgical guide fabrication
  • Digital wax-up (if not completed in Appointment 1)
• Await guide design notification (typically via email link from Simplant)

INSERT VIDEO LINK: “How to Merge STL and CBCT in Simplant”

📧 3. Guide Design Review & Approval

• When prompted via email, open the “Approval Request” link
• Review virtual plan using Simplant Editor
  • Confirm alignment of implant to virtual wax-up and ridge
  • Evaluate implant angulation, depth, and proximity to anatomical structures
• Confirm plan with restorative and surgical faculty before approving
• Approve the case in the platform

🖨️ 4. Surgical Guide Fabrication

A. If fabricated by Simplant (Dentsply Sirona):

• Guide will be shipped to and delivered at the College of Dentistry
• Confirm delivery and pick up from designated lab/faculty member

B. If printed in-house (optional):

• Export Surgical Guide STL
• Submit to faculty or assigned technician for 3D printing via Formlabs or equivalent

📄 Documentation & Axium Notes

• Document CBCT + intraoral scan completion in Axium
• Note that implant planning was initiated and design review is pending
• Record approval date of surgical guide and next scheduled appointment (surgery or impression)
• Code: D0470.3

🧑‍🏫 Faculty Sign-Off Required

• CBCT quality and arch separation
• Accuracy of intraoral scan
• Implant plan review in Simplant
• Approval of surgical guide fabrication

Appointment: Surgical Guide Try-In & Evaluation

🔍 Overview / Background

This appointment ensures that the surgical guide fits accurately and passively, matches the implant plan, and is ready for use in the surgical phase. The evaluation may take place intraorally or on a 3D-printed model prior to surgery. Improper fit or instability must be corrected before proceeding.

📌 For details on STL export, Simplant approval, and guide delivery, refer back to Appointment 2: Surgical Guide Scanning & Design Approval.

✅ Surgical Guide Evaluation Checklist

1. Preparation

• Confirm surgical guide is labeled with correct:
  • Patient name and ID
  • Arch and tooth number
  • Guide type (pilot, partial, or fully guided)
• Bring:
  • Printed cast (if applicable)
  • Wax-up and planning screenshots
  • Implant component request form (if needed)

• Medical history, CC and BP review. Explain protocol to patient

2. Try-In & Fit Evaluation

🔍 What to Look For in the Fit:

• ✅ Passive Fit:
  • Guide should seat fully without pressure or binding
  • No blanching or deflection of soft tissues
  • No resistance during seating
• ✅ Stability:
  • Should be stable under light finger pressure
  • Should not rock or lift with lateral movement
  • Suction or light “snap” fit is acceptable
• ✅ Intaglio Surface Contact:
  • Verify full contact with key teeth or tissue landmarks
  • Edentulous areas should align with ridge without gaps
• ✅ Sleeve Position & Access:
  • Drills can be inserted without interference
  • Sleeves are parallel to planned angulation
  • No encroachment on lips, cheeks, or opposing arch
• ✅ Correct Orientation:
  • Sleeves match intended tooth site
  • Any reference notches or windows align with anatomy

🛠️ 3. Faculty Review & Adjustments

• Present findings to faculty
• If minor soft tissue interference is found:
  • Adjust with faculty permission (rotary or light trimming)
• If major misfit is found:
  • Document
  • Report to digital planning team for re-design and re-fabrication

📝 4. Documentation

• Note in Axium:
  • “Surgical guide evaluated for fit and stability. Cleared/not cleared for use.”
  • Specify whether try-in was intraoral or on model
• Store the approved guide with surgical kit or return to lab/faculty as instructed
• Code: D6190.4 – Surgical Guide Printed

🧑‍🏫 Faculty Sign-Off Required

• Guide fits passively and securely
• Sleeve location and access verified
• Implant site matches plan and wax-up
• Guide approved or flagged for rework