Trouble with BioHorizon Bone Surgical Guide and Drill kit?
Has anyone else experienced issues when using a bone surgical guide for the Biohorizon Implant system when placing the implants through the guide? It seems that the driver gets stuck in the guide and can’t be removed without taking off the guide.
22 Comments on Trouble with BioHorizon Bone Surgical Guide and Drill kit?
New comments are currently closed for this post.
Sb oms
11/1/2017
Talk to your rep
One question though:
Why do you need the guide one your osteotomy is finished?
Do you really need the giude in place to seat the implant?
Nick
11/1/2017
I routinely use them for all-on-4 cases. Sometimes These cases are done at time of extraction material and sometimes after healing period. So when placing them I like to know 2 things.
1. That implants are alll the way down for enough clearance for the final prosthesis
2. When they are placed with extraction sockets sometimes you can't find the ostemotmy so easily
Raul R Mena
11/1/2017
Either improperly designed or improperly printed.
Jay Reznick
11/1/2017
If the guide was not fully seated during drilling, when you place the implant through the sleeve (assuming that it is now correctly seated) , it will bind because the angle is off very slightly. Or, if the guide was seated during drilling but not when the fixture is placed, the same will happen. You need to be very diligent and pay attention to details when doing guided surgery, because of the precision of the technique.
Merlin P. Ohmer, DDS, MAG
11/1/2017
Guides are just that, guides. They do not replace a well planned and well diagnosed surgery. Be ready to proceed is planning and guide fails.
Nick
11/1/2017
I am not saying I am not ready or that I don't plan. I actually am able to handle a case of the guide doesn't work out. I am saying that the driver binds and wanted to know if that was a design flaw from the company or maybe I was doing something wrong somewhere. I make sure all my guides are fully seated before proceeding. But still
Sometimes have this issue
Jay Reznick
11/1/2017
I actually worked with BioHorizons to design their guided surgery kit. I have used it hundreds of times. In the initial design, there was an occasional issue with binding. The implant mounts were redesigned a few years ago to prevent this. If there is binding with the current kit, it is because the guide was not stable or fully seated either during drilling or during fixture placement.
Nick
11/1/2017
Thank you so much. I will pay attention next case to make sure this is done better
Bruce Smoler, DDS, FAGD,F
11/3/2017
I do tend to find more than I like, a tight fit, but certainly your points are completely valid. I do tend to stop a fraction of a millimeter short now. When me or the clinicians I mentor, do not stop short, there is a firm seat and almost a swedging effect. This friction fit of metal on metal can make the removal of the guided driver a bit more taxing. Is this clearly explained? Its not a counter to your response, just a point of clarification...
Eric Ruckert
11/1/2017
I find guides usually unhelpful. I just want a mark on the cast to see where to start. I can use my clinical skills to determine the undercut, the quality of bone, the "real" bony surface, I use parallel pins to help, etc. I have 1097 implants in as of today, and only 7 failures, of which 4 I successful redid. I am not tooting my horn, I just use the anatomy skills we all are trained with. I have a cone beam, but use it about 3 times a year for implants. (And I have done one arch ten implant cases for denture cases, one for a 24 year old amelogenisis imperfecta patient) with only hand and eye guides. Worked well.
I do not think guides are helpful for someone who understands basic angles or parallelism we are all taught in lab and crown and bridge. The latest and greatest is not necessarily the greatest. I am not any better surgeon than you, I just work with my educated judgement. Although guides, scans, will be marketed to you by those selling.
docjj1
11/2/2017
Amen! Same analogy to going to ED and doc ordering all sorts of tests and scans even before examianation of the patient. The art of physical diagnosis has been lost. Tests and other studies should help confirm your clinical diagnosis. Same is true for use of all this technology for implant surgery. Surgical skills have been lost with total reliance on the technology, labs and guides. So much cost is added to a case to the surgical practitioner AND the patient for routine cases for all these scans, surgical guides, etc. instead of using our 3D perception once learned in dental school. Sad statement on our profession.
Oleg Amayev
11/2/2017
Surgical skills not lost. Technology is the future. If you don’t want to use technology then go back in old times and stop using anesthesia, antibiotics, X-rays, titanium implants( in old time they used to make teeth from wood, there was no zirconia or porcelain crowns)
You people don’t understand that technology is only to help us make better decisions, not to eliminate the knowledge that you gained. There is no way you can know 100% the size of the bone( you can estimate, yes) but without CT scan there is no way you will know how exact anatomy and exact placement of the implant. Yes, I did more than 1000 Implants and I do implants every day and I can see how much guided surgery improves dentistry.
Jay Reznick
11/1/2017
Check with your BioHorizons rep to make sure you have the latest implant mounts.
Raul Mena
11/1/2017
Eric,
You ares my kind of dentist.
Nothing is better than a well trained implantologist with good handðŸ–🿠EyeðŸ‘Brain cordination
Erik
11/1/2017
I have had the placement driver bind to the point of where I was worried about explanting my new implant. This has happen many times but in soft tissue guided models for me. I don’t know the solution other than to hold the guide in place while pulling the placement driver loose.
Jay Reznick
11/2/2017
Erik- with a tissue supported guide, you definitely do not get the same stability as with a tooth-supported guide. Guided surgery is successful when the guide is placed exactly in the planned orientation and does not move. For a case with lack of tooth support, I recommend that you plan the guide with at least 3 skeletal fixation screws or pins. That will keep the guide stable so that it cannot move or tilt in use.
Erik
11/2/2017
Thank you Dr. Resnik. I always use 3 fixation pins on mucosal supported edentulous cases. Hope to see you in Orlando January.
Geoff
11/1/2017
Every one has a different skill set ......but to have all possible information and avoid possible issues the better . The guy asked about binding and got lectured on placement protocols.
Moe
11/2/2017
@Geoff,
I had to tell you, I laughed out loud after your comment succinctly captured a lot of the threads on this site. We all learn a lot from this site and I am thankful for this being a great resource, but your last sentence was too funny, "The guy asked for...".
I am not sure if you were trying to be funny but I feel the same when sometimes (I read on other threads here), when someone asks an honest question, and he/she gets lectured about other issues. All well and good, but sometimes you want another, Fellow, hopefully more experienced, doctor to help you out of your situation. Bounce things off so to say off a colleague. And so many times it turns into patronizing the questioner (Sometimes it is definitely Warranted, when you see someone is going to unwittingly, harm the patient, definitely keep that up!) rather than we all remembering our first several times doing a particular procedure and being unsure.
Always a good read, the material here, though.
Thanks
Oleg Amayev
11/1/2017
Surgical guide is ideal tool to place implants in ideal position and to obtain best esthetic result. I was placing implants without guide in a past and I am not saying it didn’t worked, Yes ut worked. But to get ideal position and excellent result you need a guide. I don’t care how well you know anatomy, we all learned anatomy and we deal with it every day. So don’t say if you know anatomy you don’t need need guide this is absurd. Another reason for guided surgery it is less traumatic to our patients, if you did flapless technique with guide I am sure you know what I am talking about. Also in the past comments : why we have to place implant through the guide if we already made osteotomy. The reason for that is if we have soft bone then implant placed without guide may not go into correct space, by using guide we can be sure the implant placed in exact position as was planned.
Make a guide and make your life easier and patients comfortable.
Jeffrey Backer
11/3/2017
When you trial fit the implant mount through the surgical guide extra orally does it still bind? And does this happen every time? Does this occur when you're using the surgical guide for single implant cases tooth born surgical guides? Or only on soft tissue supported multiple implant surgical guides?
Chaz
11/4/2017
Fun listening to you all. Here's my take - technology is the future and will only get better. To think of what the possibilities will be is mind blowing. Just heading home from a Pikos Symposium - all the great surgeons and prosthodontics are using and exploring the use of guided surgery and pushing the envelope. Even smile designing is incorporating digital protocols to help design great smiles for large cases utilizing monolithic restorations Seems silly to remain in the dark ages when there is so much potential out there - education, as always, opens the mind
That's my take
