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implants the journal of oral implantology United Kingdom Edition

24 I I clinical_ guided implantology implants2_2012 (“osteotomy sleeve”), which has to be in- serted into the embedded sleeve and serves as a regular sleeve for the osteotomy drills (because it is internally smooth); a modified extender for drills; an externally threaded sleeve, longer than the osteotomy sleeve, that acts as a “bottle-neck”. For the osteotomy, I used a regular surgi- cal kit, not a dedicated one to precision, just modifying a plain extender to fit any oste- otomy surgical kits (general and not guided surgical kits). The extender should match up with the sleeve before the drill touches the bone. The prototype was realised with no endo-stop features in the extender; only lines indicate depth. The bottom end of the bottle- plug is provided with a helical gear (to match upwiththecorrespondingembeddedsleeve’s helical gear; the bottle-plug in the prototype device consists of two components, the cy- lindrical screwed part and the lid, and they are fastened together with a joint. The lid is integrated into the implant mounting com- ponent; thus, while the bottle-plug is being screwed onto the neck, the implant mount is entering inside the bottle-neck, forcing the implant downwards. The implant mount has a hollow to allow for an implant fastening screw (the same as used to fix implants and abutments, just longer, to allow for minimal screwdriver length, when it is necessary to unfasten the components at the end). The mount also has a gauge for a wrench at its top (but it can work for a handpiece driver as well). Once implant placement has been car- ried out, the mount can be unscrewed from the implant and vertically unfastened from the bottle-plug. At this point, the surgical guide can be removed easily, with no risk of hexundercuts.Thedevicemustresistthever- tical dislodging torque created when screw- ing the implant into the bone. A screwed bottle-neck performs well for this purpose and the lid must be fastened to the vertical part of the bottle-plug. SimPlant Pro Crystal (Materialise Dental) was used only to plan the implant position, but instead of using a surgical guide, a STL digital cast with analogue implant holes for placing analogues was used in the first case reported. A plain stone model with a (pre- sumably) correct analogue position was used for the second case reported. In both cases, the analogues were, screwed to the device, andthenthedevicewassecuredtoabite-like thing (using plain relining resin for the provi- sionals)toobtainasurgicalguide(nosurgical guidefixationtothebonewasconsidered;No guided tapping drill was used. This is some- thing that should be considered, especially in high density bone. It could imitate the im- plant, with sharp threads and narrow body, to be screwed to the bottle-plug, or a bot- tle-plug dedicated to the tapping step, with the tapping part integral to the bottle-plug itself. In both clinical cases, the device was Fig.4 Fig 4_Analogues in the STL model. Fig 5&6_Surgical guide created for stone surgery. Fig 7a&b_Assembly. Fig 7c_Assembly in the stone-based surgical guide. Fig 7d_Assembly in the STL-based surgical guide. Fig 8a_Surgical guide in the mouth. Fig.5 Fig.6 Fig.7a Fig.7b Fig.7c Fig.7d Fig.8a