Steps in Fabricating a CEREC Guide

Some slides from my CERECGuide presentation.  I like using CERECGuide for under two units and I especially love it for immediates.

There are three major components to a CEREC Guide.  The Thermoplastic Tray Material (I prefer the beads), a block/reference body set, and the Sirona Key Set specific to the Implant you are using.

Patterson Part numbers for the Blocks and Thermoplast:

Patterson Part Numbers for the Drill Sets:

Just some requirements to use CERECGuide.  One misconception is that you need inLab or an inLab MCXL.  This is NOT true, you only need the size 20 burs and a MCXL.

The first step is to make sure you can even do CERECGuide.  The small Reference Body is actually sort of big!  So I like to try in the ref body and just make sure it fits before doing the case.  In the example above we ended up using Emil’s Drill Stops instead of using the guide.

I like using Mach 2 as a model material as it sets in 2minutes and the Termoplast won’t lock on and break the teeth.  Set the Reference body while the Thermoplast is translucent and line it up along the central fissures of the adjacent teeth.  Cool in cold water and place in the mouth.

After Scanning, plan your implant.  Right Click and select Edit Sleeve.  Select Sirona CERECGuide.  Next click the Reference Body Tab and locate three fiducials using the lever to make them as clear as possible.  The Computer will find the rest.

A big area of confusion is the D2 value.  The D2 is the height of the Guide Platform:

Pretty simple and you only have to do this once.  Measure your drill.  If you have a stop, measure from the cutting tip (Y) to the stop.  If you are using a standard drill, measure from the cutting tip (y) to the handpiece head or laser line if you are using length markings.  I prefer the handpiece head but it can get in the way.  Subtract 1mm for the thickness of the Guide Handle.  Drill ’till you can’t drill no more.  I have the Nouvag MD-20 and the ID long Drill: D2=22.5mm

A very common problem is either placing the implant too deep or using too short of a drill.  The result is that the top of the guide is placed below where the block can be milled and you get this cupped out Drill Body.  In the Cross Sectional View the D2 is visualized as a orange line.  We need at least 5mm from the line to the base of the Reference Body.

By either placing your Implant coronal or using a longer drill (you may need an extender with ID) you can “pump up” the drill body:

Go to order the Guide and Select the Option on the bottom.  Confirm you have the correct block, D2 and Implant Length.  You export as a .cmg dxd into the CEREC program and it takes you to the Mill Preview.

Remove the sprue and pay attention to the notch in the thermoplast and the extension in the Drill Body.  Drill a hole in the thermoplast to allow your drill to pass through.  When you place the Drill Body it should be flush with the underside and “click” in.

There is no Implant Direct Sirona Key Set.  I would get the Nobel and just figure out which key fits.  I know, its big bucks.  Also there is no key for the 2.3mm pilot so either go to Salvin and get a 2.0 pilot or just buy the Nobel Guide Pilot.  It has different length markings so pay attention to the D2.

There is no official stance on if you can use CERECGuide fully guided, meaning placing the implant through the guide.  I’m kinda over fully guided so I remove the Guide and place it visually.  Ok gotta go pay the bills, more tomorrow.