#AskT-Bone – Ep38 – Getting started with CEREC guides


Welcome back for another episode of #AskT-Bone on the T-bone Speaks Podcast!


I am sitting outside, it’s fall, I mean it’s late September and I am super excited to hopefully be done with the hot weather. I’m trying to avoid my kids, and having to put them to bed because that takes a long time. So, I am hiding outside and letting my wife do that and hopefully I won’t get into too much trouble for that, but I’m pretty sure I will. So, just give you an update on kind of what’s going on. Today we have a question from TJ in Alabama and it reads:


Hey T-Bone! I love your podcast and admire the work you’re doing –Thank you very much– and I also look forward to hearing you at SIROWORLDSo, obviously SIROWORLD was a little over a month ago, so hopefully I met your expectations there, and thank you for coming I have a question about implant systems. I’m trying to get into guided surgery with CBCT and  CEREC, I already have both of technologies, and I’m wondering which implant system you use. I’m not asking for an endorsement per se, just asking which systems are the easiest to integrate into CEREC guides in guided surgery. I would also like to know what all is needed to use their guides in an implant system. I know I need the implant system but doesn’t have to be a guided system and then do I have to have CEREC keys?


So, let’s answer these questions. So congratulations on having some of the best, absolutely best technology out there with Cone Beam and CEREC. I think this should be a great opportunity for me to plug our training, here in Raleigh. We have a wonderful program called ultimate 3D, it’s a Hands-On weekend dedicated just to Cone Beam and CEREC integration, how to do CEREC guides, how to create an efficient implant workflow that’s get done in 3 visits, how to properly plan implants, how to add properly plan anterior implant, immediate implant, and do some minor grafting there as well. So it’s a good program if you have interest in that certainly visit our website at www.3d-dentist.com and you can get more information on that.


In our practice 95% of the work that we’re doing is done with a Nobel Active Implant from Nobel Biocare. There’s a couple of reasons I’ve chosen this implant system. One, it is relatively Universal, like all implants it have a standard surgical kit, but unlike all implants they also have a guided kit, so that allows me to do guided surgery. It’s a well-supported guided surgery kit, so, you know it has, fundamentally everything can be done that’s not limited to just the small and medium implants, but also their wider 5.0 implants and soon to be there by 5.5 implant so they have that. Also use that implant, my number one reason honestly for using that implant is because of the threat page design, you know, over half the implants replaced immediate placement, so we’re looking for a primary stability. So I’d like to have an aggressive implant in that situation, and the Nobel Active Implant certainly fits the bill there. It is not the only one but it’s, you know I would probably say it is less than a handful of good implants that are really aggressive like that, so that’s what I use. And then also it allows me to do anterior cases, posterior cases, overdenture cases and even all full arch cases and especially in all full arch cases with the multi-unit abutment. So, for me it’s a very universal system I would tell you, it would be not appropriate for me not to mention some of the other systems out there, Straumann is a good system, it’s fully guided. Astra is a good system, it’s fully guided. My only concern with the Astra system is that is not a very aggressive thread implant so, I question how good it would be on an immediate placement, especially when you’re trying to undo size your osteotomy, so those are my main recommendation, I know our friends over at Blue Sky Bio have a good product, they don’t have a guided kit per se at this time, they have a guided workflow, which certainly it’s a hodgepodge of different things, but I know that those guys are working on that. And BioHorizons also has a guided system as well.


So, those are ultimately the implants that I would recommend using. Personally, again I like the Nobel Active because of its aggressive nature, so that’s kind of where I am with that.


Now in terms of what you need for a CEREC Guide. So with guided surgery what happens is the they print, let’s call it a night guard just for ease of state. They produce a stent that has a hole in it. And that hole then fits a sleeve and that’s sleeve is specific to the implant brand that you’re doing. So of course they can’t make a universe where all the holes are  the same size then you can use any implant you want it with the hole. Each implant system, each manufacturer makes their hole a different size, and what that means is the guided kit from Nobel won’t work with an Astra surgical guide. So just like you have that situation, the CEREC guide in it itself also has, for them they had to make Universal hole sizes that work across multiple implants, so their actual hole size, the tube size doesn’t match any specific implant system. So what they have done is they have made their own keys for each guided system. So for example if you want to use Astra with CEREC guide you would buy the Astra guided kit and the CEREC Astra, CEREC guide keys. So if you want to use Nobel with the CEREC guide you buy the Nobel guided kit and then you would also buy this Nobel keys for CEREC guided from CEREC, from Sirona, distributed through Patterson.
So hopefully that kind of answers that question as well. So that’s pretty much it! That answers this question! So, TJ hopefully that helps and I look forward to hopefully seeing you at other programs or lectures, and thank you very much!


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