An accurate representation of the patients anatomy and bone structure is required in order to safely perform the procedure, which is done using a CBCT scan to evaluate the underlying bone structure, as well as the nerve pathways and surrounding soft tissues.
This is used in conjunction with an intraoral scan, or scan of a traditional impression to capture the patients gum and soft tissue structures as well.
Design and Treatment planning
Designing can be done either by using an outside provider, or it may be done in-house.
In-Office Designing Surgical Guide Design
This is done in a Splint CAD software. Below is the list showing our recommended options, however, our software accepts any design file formatted in STL, which means you can use whichever software you are most comfortable with: 3Shape Splint Studio, Exocad, Magics, D3splint.
During the planning phase, you will be choosing a pre-selected implant system, which has predefined settings for the types of implants being used. These settings are critical for later placement of the sleeves and guides being used, as they define the overall dimensions of the holes and their location on the printed guide.
Out of Office Surgical Guide Design
SprintRay Cloud Design helps and provides accurate Implant Planning and high-quality Surgical Guide Design, where you can upload patient's intraoral scan files, CBCT images, and your prescription. This process is done in 2 steps: first, you receive a link to a set of validated information regarding the implant planning guide design (such as a video summary, STL files, quality control images, and PDF files). Once the implant planning is approved, you will be sent the actual design file for the Surgical Guide. Once you receive the STL file of the designed Surgical Guide from SprintRay Cloud Design, you may go directly to step 3 (Fabricating Surgical Guide)
Printing - Special Considerations
The intelligent algorithm for automatic orientation in RayWare Cloud should automatically detect the intaglio surface of the surgical guide model, and orient it away from the platform. It is critical that there are no support structures on this surface, as it will interfere with correct fitment in the patients mouth.
RayWare Cloud will automatically select the and generate the preferred Support Type for the selected appliance type to ensure the simplest post processing.
For best fitment results, it is recommended to Edit any support structures that may interfere with the insertion of the surgical guide sleeves, with special focus on supports around the edges of these holes.
To edit the supports in RayWare Cloud, select the model by left clicking on it, open the Supports menu on the right hand side, and click Add/Remove Individual Supports
Once selected, rotate the view to the underside of the model to view the placement of the support strands, which are indicated with small blue spheres. Any support tips on the edges of the sleeve holes or shoulders should be removed and placed nearby on a non critical surface.
Examples of supports that will need to be removed and placed on non critical areas are highlighted in red below:
Left click on the supports you wish to remove, and place new supports by left clicking on the model surface.
Example of a properly prepared surgical guide below:
Once the support structures have been fixed, you can proceed with normal printing.
IFU's for surgical guide resins should always be followed. The general recommendation is to angle models by 20 - 30° with the intaglio surface facing up for best results. It is not recommended to have the surgical guide sleeve holes angled more than 45°, as accuracy issues can occur with certain model designs.
Issues to be aware of:
Surgical guides should never be printed with the intaglio surface facing down, as support tips left behind after remove will not allow the appliance to fully seat in the patients mouth:
Special care should also be taken to ensure that there are no supports on the sleeve surfaces that can interfere with fitment once clean and post cured:
Supports can be edited using the Edit Supports function in the Support Generation tool located on the left hand side of RayWare Desktop
Models should always be post processed per the recommendation in the resin Instructions For Use (IFU).
- For all SprintRay brand resins, Isopropyl Alcohol with a purity of 91% or higher is required for the washing process, per the FDA.
- If cleaning more than 2 or 3 models in the Pro Wash/Dry, longer wash and dry times may be necessary for best results.
- Always ensure models are completely clean before post curing in the Pro Cure units, and always select the correct profile for the resin being used.
The 3D printed Surgical Guide must be properly cured to the resin manufacturer’s specifications before use. This will help obtain the complete curing as well as the best mechanical properties and accuracy. Since this is a very important step, ProCure and Pro Cure 2 are preset with all the settings according to the resin’s specification regarding time and temperature.
Once the post curing is completed, we need to remove all the supports by using a flush cutter. Try to cut as close as possible to the appliance surface to minimize the smoothening and polishing procedure.
Smooth the Surgical Guide
At this step, we use a fine Scotch-Brite™/ Fuzzies™ polishing wheel to grind down the remaining knobs from the support-removal step (3.9) and smooth out the surface of the appliance. The polishing wheels are used at a low speed (about 10,000 to 12,000 rpm).
Assembly and Sterilization
The last step in this workflow prepares the printed Surgical Guide for surgery. At this step, we want to make sure the surgical guide is polished, the sleeve is assembled properly on Surgical Guide, and fully sterilized. Below, we will show you the steps involved in Assembly and Sterilization.
Assembling the Surgical Guide sleeve
The Surgical Guide sleeve helps avoid any damage to the surgical guide. A Surgical Guide sleeve is fitted into the corresponding surgical guide drill hole. Make sure to select a proper and compatible sleeve at the time of treatment submission.
The Surgical Guide is then autoclaved at 134° for 5 minutes. You may use a sterilization pouch for sterilization. If disinfection is required, use non-chemical products. If this is not possible, IPA solution is recommended for 5 minutes to disinfect.
Delivery to patient
The completed surgical guide is delivered to the patient, fitment is verified, and used during surgery