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1. We will send you Dr. Amr’s 1 hour Lecture if you…
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2. The Prosthetic driven implant placement concept
Surgically
Driven
Implant
Placement
Mid1990s
Implants should be placed in the position
that serve the best prosthetic outcome.
Prosthetic Driven Implant
Placement
Correlation
between the ideal
prosthetic position
and the bone
architecture

3. Implant surgical guides
• The ideal surgical guide allows for:
1. Determination of the point of entry
2. Control the direction of drilling
3. Control the depth of drilling
4. Control the parallelism between implants
5. Fabrication of a temporary restoration for
immediate loading
6. Locate the implant position in the second
stage surgery

4. Computer based guides (Why?)
• Safety
• Accuracy
• Simpler surgical intervention
with shorter chair-side time
• Expanding the practice
• Levelling up the practice to the
world’s state of the art

5. It has been there for 20 years….
Its nice and easy……
Why isn’t it so popular???
What are the obstacles in
doing this??

6. COST
Complexity
Drawback of the conventional Guided systems

7. Does cooling affect the success rate
when using CAI guides???
 136 implants, 68 in the maxilla and 68 in the mandible placed
with Dentis Guide
 11 implants total failure 92% success rate.
 4 implant only failed in the maxilla 94% success rate.
 7 implants failed in the mandible 90% success rate
 Implant failure in the mandile is higher?????
• Yong L & Moy P 2008. They placed
78 implants with Nobel guide
• 7 failures (9%), 5 out of 7 were
longer than 10mm
• They correlated this to overheating
Guides definitely blocks the passage of irrigation causing
more heat generation

8. The simplified universal kit
8 x 2.3 mm starter drill
2.2 pilot drill (10, 12, 14) with
modified shaft design)
8x2.8 intermediate drillWe need only 11 instead of 40 tools
Cortical

9. Accesibility
Difficult or impossible to use in the
posterior region in partially dentate
subjects
Difficult to manipulate both the drill guide and
handpiece in many cases
(VERY AWKWARD)

10. Long waiting time
• Average of 10-14 days for
planning, fabrication and
shipping the guide from
known manufacturers
• You can not perform speedy
procedure

11. How will this work???
The open sleeves will allow side approach instead of occlusal approach
3 mm
Cutting flutes
Guiding
Shaft

12. Submerged broken tooth no 9:
Problem list:
1. Very thin labial cortex
2. Thin soft tissue biotype
3. The root inclination
LIP

13. Possible drilling directions

14. The surgical guide

17. Sleeves with facial opening.
Accessible in all regions & easy flow of the irrigation
How is the new system different?

18. Training and education
A 4-day comprehensive training including:
1. Patient selection and preparation
2. Scanning protocols for different cases
3. Biomechanical and technical guidelines for virtual planning
4. How to use the 3D printer
5. Preparing the guide for surgery and fabricating temporaries
6. Surgical room procedure “tips and tricks”
7. How to minimize errors and complications

19. Take home message
• CBCT is far beyond being an x-ray. To optimize the outcome prepare
your patient properly before making it
• Guided surgery is not a fancy dream anymore. Everyone can do it
simply precisely and economically
• Guided surgery is not about blind drilling. It requires education and
training to optimize the outcomes and minimize the errors

20. Thanks!