Universal Pilot Drill Guides for Overdentures

[@faededreality]

Thanks for the awesome video! Could you please link the video that you are talking about where you scan the denture and position it in the blue sky bio program? Thanks a lot!

[@silviatoneva5278]

Hello! Do you have a video for blue sky about how to make a guide for miniscrews for orthodontic purposes?

[@jocjernigan]

Awesome video Cory! Would you say there is a substantial difference in amount of resin used between scan appliance guide and traditional ST guide?

[@goodguy467]

Hi cory . thanks for such an informative video. I am based in australia and going to put my first implant case of 46 . I want to use this pilot guide drill protocol using dentate guide. I am planning to use4.8 x 10 mm implant straumann. My question is once we have used the 2.2mm drill to the full length of the implant and take the guide off. will the other drills follow that same trajectory ? is there a chance of deviation from that path?Please help. thank you

[@Jacksonabean]

Hello from the States! Cory was obviously very busy as he's typically quite responsive. I hope you've found the answer being a year ago so for other folks curious about the same, the basic answer is yes. The sequential drills will follow your initial osteotomy if you let them by keeping your pressure in an apical/axial direction. In fact, if you don't upsize too much, they just "want" to follow your pilot with minimal pressure. Your issue comes when the drill "bottoms out" in the osteotomy when it stops moving apically yet continues to spin. The biggest knock on a guide like this is that it blocks your coolant from contacting the bone which can lead to overheating and you'll know this occurred when you see an endo-type lesion at the tip of your implant for years to come. Try to avoid this by knowing what depth you're going to and be ready to get up out of there with a pumping action (and refrigerate your coolant when it's not in use). Of course only using the guide for the pilot really helps this not happen and placing elsewhere in the mouth (D2-D4 bone quality) allows you to underprep your osteotomy which means you aren't reaching the same terminus. You won't underprep in the anterior mandible or placement will be more difficult and you risk over compression of the already scant vascularity. I hope this makes sense and message Cory on his more current videos for a quick response. Good luck!

[@Bahramiish]

That was very helpful. Which Biosky Implant would be the closest to Straumann BLX and Neodent Helix?

[@Jacksonabean]

Again, not directed to me but let me take a stab at a good answer. If you look at the Neodent Helix and Straumann BLX, you can see the tapered tip that is larger than 2.2 mm at all diameters so in essence, it doesn't matter. As he mentioned in the video, they have an equivalent to the Nobel Active so you could be "safest" by choosing that model but really, it makes no difference. The Helix is the most universal (my opinion) in that it would be the offspring of a Drive and a Titamax. ;) The BLX is one of the major reasons Straumann purchased Neodent which allowed the Drive to be "ripped off" and Straumann to enter the full arch, immediate placement, immediate load marketplace. In other words, it shines in poor bone quality and not in the very dense bone like the video above. So the short answer it, it doesn't matter as the 2.2 mm pilot from Blue Sky won't overprep the tip of your osteotomy so just grab anything out of the catalogue. Now, to answer your question with a question would be...... Why would you, the clinician, pay for a BLX if you already know about the Neodent Helix? :)

[@Bahramiish]

@@Jacksonabean Well for immediate singles I still prefer the BLX over the Helix, in almost every other case the Helix has the upper hand. Then again, sometimes you need that peace of mind, that a 3,75 diameter Roxolid can be used in every single indication without any issues.

[@Jacksonabean]

@@Bahramiish I can't say that I understand the "peace of mind" comment if you care to explain. I've placed Straumann for twenty years now and they have fantastic rep support. I realize there's clever marketing that says certain implants are made of better titanium but a brief foray into implant manufacturing makes you realize all of it comes from Carpenter and the higher costs becomes difficult to justify. In my experience, clinicians that have "graduated" to an implant with the same or better clinical indications and costs 1/3 the price, typically don't opt to pay more. Alas, we all have our preferences and placing what works best in your hands is definitely the right choice, no matter the cost.

[@Bahramiish]

@@Jacksonabean well the roxolid as an alloy of titanium and zirconia behaves like titanium grad 5, therefore being more fracture resistant that grade 4 titanium. at the same time titanium grade 5 is an alloy of ti and aluminium, which can be bad for a few reasons. so indeed the straumann roxolid is just stronger than my helix gm. if a roxolid implant breaks, you get the implant replaced + 1000 euros to make up for it. straumann is pretty sure that it basically won't happen as long as you follow the indications. and the 3,75 blx can be used for absolutely every indication.

[@Jacksonabean]

@@Bahramiish I'm surprised to hear that implant fracture has been an issue for you. I've placed narrow Neodent implants in compromising positions like long distal cantilevers violating the Malo full arch protocol (compromised bone volume) and have yet to have one implant fracture. These are implants that have been in the mouth for years. I have, however, had Straumann tissue level implants break as well as some Astra implants many years ago but never a Neodent, not even a 3.5. With that being said, I don't ask the implants to do things that seem unsafe. In my opinion, making the implants stronger might be time better spent improving the prosthetic components. Best of luck.