Information for the Dentist

From Scan to Plan to Guide

With the advent of free software such as Blue Sky Plan it is now possible to design your own surgical drill guides and manufacture them using a 3D printer. In principle, you can do all the steps yourself. In practice however, you may find it more convenient and a better use of your time to let IDT Scans do some of the processes for you.

Requesting a CT or CBCT scan

The first step in the process is to obtain a CT or CBCT scan of your patient. If you do not have your own CBCT scanner, we can direct you to a suitable Imaging Centre. Please enter a Town or Postcode and our search engine will locate an Imaging Centre conveniently close to you.

Preparing your patient for the scan

Not all dental CT or CBCT scans are performed with the intention of ordering a surgical drill guide. However, if you think there is any possibility that a guide might be required, please consider the following points before requesting the CT or CBCT scan:

• bone-supported guides can be suitable for any patient, provided there is at least 3cm clear space between the existing teeth. Bone-supported guides fit directly on the bone and are very stable. However, the disadvantage is that you have to raise a large flap during surgery.
  
• mucosa-supported guides are suitable for edentulous patients only. Mucosa-supported guides can only be made for patients who have been scanned wearing a suitable (e.g., radio-opaque) scanning appliance or stent.
  
• tooth-supported guides are suitable for partially edentulous patients. In this case, an accurate intra-oral scan or optical scan of a plaster cast is needed. This is required to make sure the guide will fit accurately on the patient’s teeth.
• full arch scans (not sectional scans) are usually required for accurate registration of the optical scan with the patient’s teeth.

If you would like to discuss which type of guide is most suitable for your patient, please contact us before the CT or CBCT scan takes place.

Planning the implant locations

After the scan takes place, you will need to plan the implant locations using Simplant, InVivo Dental, Blue Sky Plan, or other suitable software. IDT Scans can assist you with this through our Implant Simulation service.

If you intend to order a surgical drill guide, please take the following factors into account:

• the implants need to be at least 4mm apart, otherwise there will not be enough space for the guide tubes.
• likewise, the implants need to be at least 2mm from any neighbouring teeth.

If you planned the implants using Simplant, IDT Scans can convert your planning file to Blue Sky Plan format, so that you can design your own surgical drill guide.

Designing the surgical drill guide

Once you are satisfied with the implant locations, you can design the surgical drill guide using Blue Sky Plan software. Once you are satisfied with the design, you can export the STL file to be printed on a 3D printer. Blue Sky Bio charges a small fee (typically around $20) for every STL file that is exported.

Please keep the following factors in mind when designing a surgical drill guide:

• if you intend to guide the pilot drill only you will need metal guide tubes to protect the plastic drill guide from the metal drills. These can be purchased from a number of suppliers including Blue Sky Bio.
• if you intend to guide a sequence of drills you will need to use drill keys. These can be purchased from a number of suppliers including Dentsply Sirona.
• if you intend to use depth control you will need to take the length of the drill into consideration when designing the guide.

IDT Scans can assist you with the above steps (or we can do the whole process for you). Please contact us to discuss your requirements further.

Manufacturing the surgical drill guide

In principle, you can print the surgical drill guide on any good quality 3D printer. In practice, there are a number of factors to be taken into account:

• It is important to use a bio-compatible resin, to avoid the possibility of an adverse reaction when the guide is in contact with the patient.
• not all resins can be autoclaved. For most patients, disinfection of the guide before use is satisfactory. However, if you prefer to autoclave the guide, it must be manufactured from a material that can withstand high temperatures.

IDT Scans recommends getting the guide manufactured by a registered Dental Laboratory as they can select the correct materials in compliance with the regulations.