The Pin Guide ensures that the surgery starts accurately. Its only purpose is to accurately deliver the Fixation Base.
Dentate Pin Guides seat securely on the teeth and are verified via occlusal windows. The Pin Guide is held down firmly to maintain its position while the fixation pins are set. Due to tooth undercut, not all the windows need to be seated, just the occlusal/incisal
Seat using indicator and adjust until all the windows on the Pin Guide are in contact with the teeth. Caution, due to tooth undercut, not all of the window needs to be seated, just the occlusal/incisal. View how the Pin Guide seats on the model. This should be repeated intraorally.
If the teeth are mobile, they may need to be manipulated into the Pin Guide similar to how they were impressed.
Modify the Pin Guide or extract teeth that do not impact the seating of the Pin Guide.
Refer to the included implant report. We make notes on extractions. Remove the specific teeth noted on the GSI form, due to mal-occlusion or draw.
If aggressive adjusting clearly changes the fit and seating accuracy of the Pin Guide, this may be cause enough to stop the surgery and capture new records to start over.
Flap the tissue until the Pin Guide seats. In other words, flap earlier on this arch. This is due to the initial impression not capturing the full vestibule, or the bone reduction is beyond the vestibule. Once seated, inspect and adjust if needed.
Must use manual clamping (fingers) to hold the Pin Guide and Fixation Base together. Pin Guide and Fixation base insertion accuracy is vital to the success of the case. The surgery could also be put on hold for a new Pin Guide to be ordered. The case should be returned to us to ensure accurate assembly.
Does it fit into the Fixation base passively? Do the CHROME Loc plungers easily and almost passively insert? If not, there could be material inside the CHROME Loc box preventing such. This could also mean that someone heat cleaned the guide. Use a narrow bur and open the hold on the Pin Guide CHROME Loc loop until the plunger seats.
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This probably means the model is not accurate, or perhaps the Pin Guide is fabricated with errors. The case must start with a fully seated Pin Guide. The case may have to be delayed. This is a clinical call based on how far off.
The pin can be re-seated. It will not function as the others. It will pull out every time, so please use care when pulling so as not to drop in the mouth. The plunger will still work.
Must use manual clamping (fingers) to hold the Pin Guide and Fixation Base together. Pin Guide and Fixation base insertion accuracy is vital to the success of the case. The surgery could also be put on hold for a new Pin Guide to be ordered. The case should be returned for us to ensure accurate assembly.
The protocol is to not flap first. Seat the Pin Guide, drill all the sites, remove the Pin Guide, flap and re-seat and insert pins.
Alternatively, the flap can be made first. If so, carefully follow the instructions that are provided with each case. This is a ridge incision first, top of ridge flapped forward. Must use care with swelling from anesthesia. Must ensure the Pin Guide is very accurately seating even though there is no labial support.
Just like a denture, using indicator and finding the perfect seat. Be sure to account for swelling from inflammation from the anesthesia. Hold FIRM using two people or more, solid, consistent pressure. Do not use a surgical mallet until all the pins have been pushed in as far as they will go with finger pressure. Using a surgical mallet too early can put uneven pressure on the assembly of Pin Guide and Fixation Base.
This is critical. If the Pin Guide moves the teeth, the implants will be in the wrong position. Let us know early in the planning. We will fabricate a Pin Guide with opposing bite integrated. The patient will be closed biting on the Pin Guide while the facial pins are being seated. If there is no bite designed in the Pin Guide, use the palate for stability, or on lowers try to use the tissue.
If the Pin Guide is a replica of the denture, seat the Pin Guide and mark the nose and chin to verify final prosthetic accuracy. If this is a double arch, the Pin Guide will probably have a bite integrated, so the vertical is not centric and this technique cannot be used.
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