Long edentulous space. Use the Large closer to the front with the “T” to the buccal as I knew there would be no getting it past the ascending ramus:
Emil recommends a specific hand piece that works with the stops. The handpiece is a Saechin, Emil can give you the link
. Its different from my Nouvag. Because we are not using handles, we do not need to subtract the thickness. To be honest the D2 does not really matter as the stop will hit the bone. But one thing I did notice was that if you did not punch out enough tissue, the stop would get held up and you would be short. So I got clever! By assigning the D2 to 25mm and still using the head of the handpiece of the stop, I know for sure that I am down to length as the head will hit at the same time the stop will hit the bone. Clear as mud!
Scanned and located the ref bodies. We have good bone in #2, but #3 could be expanded and lifted. I planned to get the 2.3 to length and expand palatally with the expanders. Note the buccal view that the ref bodies do not have to be parallel as long as the implants are contained with in them with their drill paths. D2 set to 25mm
Constructed the Guide and it fits great.
Punched tissue. Sorry about it being out of focus:
Again, Emil can describe this better than I, but there are longer stops and shorter stops. The shorter stops allow for more length of the drill. You want to actually start with a longer stop that allows you to have more of the stop guiding you and let the small amount of drill “countersink” the initial. This is pictured in the upper right. Then after the “countersink” is started, follow up with the shorter stop.
After I got to the 2.8 I stopped and switched to the expanders, feeling around with the ball ended probe. Although the sinus was nice and intact, I was not digging my socket graft. The crestal bone was “mushy” with graft, so I I curretted it out and will graft over it after I place the implant. You can see the curretted out defect on the mesial of the expander.
Implants placed and grafted. The defect really extended to the palatal on #3 hence the palatal releases.
Planned and placed. Overall I give Emil’s stops a thumbs up! A nice alternative to handles in CEREC Guide and certainly gives a solution to not having a dedicated Implant Direct stop kit from Sirona. Thanks Emil!!!