Something Up My Sleeve: Alternative to Pilot Guides, Legacy Digital Guide Case

I have to confess that I have been spreading mis information!  In areas that are tight I’ve always taught my docs that you should use a pilot guide.  Going back and forth with Sicat on this case the technician suggested that rather than just having control of the pilot, they could use a “sleeve in sleeve’ system thats key-less and could give me control of my 2.3, 2.8 and 3.4!  On an immediate 4.7 by 13 Legacy thats basically all the drills I would use.  In this case we also used a 3.7 by 11.5 with a traditional key system from ID.  Patient has an existing bridge from 13-15 with #13 not right for this world.  Sectioned bridge after sending to SICAT and Burbank for a digital guide.

 

The Sleeve in Sleeve system by SICAT has been around forever, I just never used it.  There is a 2.3 and a 2.9 insert and the sleeve is about 3.5 in diameter which works great with the 2.3, 2.8, and 3.4 drills.  Drawback is that these pop out easy and my patient almost swallowed it and we couldn’t use the isolate due to gagging.  Used the regular ID keys on #13. Laid a flap from 11-15

 

Really smooth surgery.  Felt a big defect on #13 buccal so we know we are grafting.  HA on #13 only because we tried ordering SBM and they were out.

 

Curvetted out the defect on #15 medial and grafted with DFDBA.  Note two colors of Villet sutures.  No reason, just mixing it up! :}  Actually we ran out of white which is what I prefer especially in the anterior .