I Place GUIDED Implants in EVEN the Toughest Cases!

[@mmwosu]

Just placed two with a type 4 guide and returned to my desk to find a new Dr Stanley video! Keep preaching the good word sir, it works and it works better 👍

[@Stanleyinstitute]

That is awesome! Thanks for sharing.

[@roxisole]

Thank you for reinforcing our faith in Guided Implantology. Sir, kindly share your views on Stackable Guides in your next video.

[@Stanleyinstitute]

Sure, I will as soon as possible.

[@Fimp136]

Dr could you tell us you opinions on zirconia post implants? I have read they fracture more easily but I have also heard they are stronger now and being made in 2 pieces is key? Also what are some good zirconia implant brands? I have heard of Nobel and straumann but looking to see about others. Thanks

[@GoldenWoman8]

What’s the name of your practice? I’m looking for a good dentist. Thanks

[@Stanleyinstitute]

Thanks for the interest. www.Stanleysmiles.com

[@linearmemories]

Hey Doc, are you 3D printing your own guides? I’m thinking of a situation where perhaps due to error, the guide does not fit properly. Are you rescheduling that patient? How do you approach this complication?

[@Stanleyinstitute]

Great questions. We print our own guides, and they occasionally require slight adjustments to ensure a proper fit. However, they never “not fit.” If they were to break, which is highly unlikely due to the new materials and designs, we would reprint them or reassign the patient.

[@patpawlowski7635]

Dr Stanley, I encounter all the time where the guide sleeve does not fit between the adjacent teeth and the lab (Vulcan) wants to make me a pilot guide only, usually maxillary premolars. Any ideas to allow for the type 4 guide to be used? I often have them switch to use the smallest guide sleeve so at least I can drill fully guided, but then place the implant without the guide

[@martinchrom4444]

Same problem here

[@mmwosu]

Sleeveless guides if your implant system allows for it. MegaGen R2Gate is one such system that I use. Sleeveless 3D printed guides, never had one not fit.

[@martinchrom4444]

@@mmwosu Man, I completely forgot about this option! Thanks!

[@Stanleyinstitute]

This is a common recommendation from dental labs that design cases for the dental community as a whole, and I strongly disagree with it. First and foremost, a type 2 pilot guide is not the same as a type 4 fully guided. The reason behind this is the “knock-out” error that accumulates with each subsequent drill and eventually with the implant placement itself. This error occurs when the drill is knocked off the dense, compact bone into the soft, spongy bone. It’s important to remember that these two bone types have stiffnesses that are 10 times different. Even Arnold Schwarzenegger would struggle to keep a drill or implant on track without a type 4 guide. Therefore, the notion that the guides are even remotely comparable in terms of outcome is flawed. Secondly, this interference with the master cylinder and the adjacent teeth happens approximately 10-20% of the time. Fortunately, there’s a simple solution to this issue. Just modify the master cylinder with a large, fat diamond bur. This adjustment takes only seconds and works flawlessly. I’ve even made adjustments to the guide sleeve itself for a type 4 guide in a lower incisor location. Thanks for the comment and I will do a video on this topic with some images to help explain the solution.

[@patpawlowski7635]

@@StanleyinstituteI was just planning a lateral incisor with Vulcan, same story of “not enough mediocre-distal space” for the gray guide sleeve, I told them I would adjust it myself and they still said it was impossible. Pretty frustrating

[@SP94395]

What I honestly think it is, is that unguided practitioners have only had negative experiences or views on guided as their past guides were inaccurate, so think unguided is the same without the 'faff'. Otherwise I couldn't see any other reason as to why people would dismiss guided.

[@mmwosu]

This. Technology has advanced considerably, and I agree a lot of those that poo-poo guided are basing their opinion on outdated experiences

[@Stanleyinstitute]

Agreed.

[@swapnaneil27]

Guided implantology is great but saying it can be used everywhere is a gross overstatement.

[@effefffffffffffffffffffff]

Maybe an addendum of "everywhere a freehanded implant can be placed" would be appropriate.

[@Stanleyinstitute]

Now, that’s amusing! But joking aside, it’s not entirely accurate. With a guide, one can consistently implant implants in areas that freehanded dentists would be hesitant to explore. It’s not uncommon to hear people say, “For easy cases, I place implants freehand, but when the case is challenging, I use a surgical guide.” What determines a “tough case” is limited bone volume, poor soft tissue, and vital structures near the desired implant location. In such cases, the guide can precisely place the implant within 200 microns of the desired location. We are diligently working to replace outdated beliefs with practical workflows that cater to everyone’s needs.