top of page

Guided Surgery Case Records

Successful guided surgery planning begins with complete and accurate records. The information below outlines the records required to begin planning for each guide type. Providing these materials at the time of case submission allows our team to begin planning immediately and helps ensure a smooth, efficient workflow.​

Tooth-Borne Guide Records

Planning Philosophy

For tooth-borne guides, implant planning is performed using a prosthetic-driven, top-down approach. This means implant positioning is guided by the final restorative outcome rather than bone availability alone whenever possible.


Minimum Required Records

  • Full arch intraoral scan of the surgical arch

  • Full arch CBCT

  • Case Details: 

    • Implant sites​

    • Planned final prosthetic

    • Planned extractions

​​

​

Recommended for Accurate Prosthetic Wax-Up

When antagonist scans and bite records are provided, we can generate a more accurate prosthetic wax-up and refine implant positioning based on occlusion. Without these records, implant planning can still proceed, but prosthetic refinement may be limited.

​​

  • Opposing (antagonist) full arch scan

  • MIP bite record

​​​​

Tissue-Borne Guide Records (Edentulous Cases)

Dual Scan Protocol

Dual scan protocol is an excellent workflow when done correctly. It results in accurate well fitting guides that offer cleaner tissue modification, and flexible prosthetic conversion options. Dual Scan refers to using 2 separate CBCT scans and matching the data to create a guide that is a duplicate of the patient's existing denture. 

 

Before Starting you will need the following

  • A well fitting denture that has a hard reline and is made of a monolithic material (denture base cannot contain barium sulfate)

  • ​Radiographic markers (Suremark stickers, Gutta Percha)​

  • Bite registration material 

​
Quick note on why these are necessary.
Dual scan protocol essentially relies on 2 principles.

  • First the denture has an intimate fit to the tissue. The guide, when done right, will have the exact same fit as the denture. If the denture is ill-fitting and doesn't orient well, the guide won't either. 

  • The denture must be a monolithic material (acrylic, fully resin printed) with a hard reline. This is because the denture is also scanned with a CBCT and converted based on density into a solid and accurate 3D model. In order to do this we create upper and lower HU (Hounsfield Unit) density threshold to isolate the denture. Acrylic and silicone reline material are far enough apart in density, that is is not possible to convert a soft relined denture into an accurate model. 

​

Required Records

  • CBCT Scan 1 – Patient Wearing Denture

    • The patient should be scanned while wearing a well-fitting all-acrylic denture with:

    •  Radiographic scan markers placed (stickers or gutta percha)

    • A bite registration in place

    • No soft reline material present

  • CBCT Scan 2 – Denture Alone

    • The denture should then be scanned separately:

    • Using the same radiographic markers

    • Positioned on a radiolucent surface (often the foam platform included with CBCT units)

  • Case Details

​​

Bone-Borne Surgical Guides

High Visibility & Accuracy

Typically reserved for the most complex cases, where there's no room for error. Direct fit to the alveolar ridge adds a level accuracy and precision that's hard to match. In all other guide types we use various ways of matching 2 records to create reference points for where the bone is. Bone-borne, while invasive, gets us directly to the crest, leaving no margin of error. In order to ensure the highest accuracy of fit, CBCT quality matters here more that other methods. 

 

Minimum Required Records

  • Full arch high quality CBCT

  • Case Details

​
Highly Recommended Additional Records

  • Edentulous Patients

    • Denture scan (Dual scan)

  • Partially Dentate Patients

    • Diagnostic wax-up model scan 

    • Intraoral scan if partially dentate

Design Only Cases

We require the exact same records for design only cases.

We strongly recommend you allow for a few extra days on your first case. We have custom calibration methods that exceed industry standards for our 3D printed resins. We ask that you print the provided model and surgical guide files for fit checking before surgery. If there is any fit discrepancies, we will redesign with compensations for your 3D printer and store those for future cases.

Common Record Issues That Delay Planning

The most common issues we see when cases are delayed include:

​

  • Missing antagonist scans and bite record for complex tooth-borne cases that require wax-ups

  • Inaccurate intraoral scan data (overlapping scan areas, accidental soft tissue over scan, missing scan data in critical areas)

  • Soft relines present in dentures during Dual Scan Protocol

  • Denture not fully seated during Dual Scan, particularly in the posterior. Never use a bite fork for denture patients, it will fulcrum the denture. Always use the chin rest.

  • CBCT scans that do not include the full arch

  • Missing case information. Only you know the treatment plan. With prosthetically driven planning, the end goal determines a lot of factors regarding placement and angulation of implants. 

Need Help?

If you are unsure what records are needed for a specific case, feel free to reach out before submitting.

We are always happy to review cases, discuss planning strategies, or help determine the best guide type for your situation.

​

Living Tree Dental Lab
(865) 509-4509
connect@livingtreelab.com

bottom of page