Non-locking Maxillary Implants
What plate styles can we offer and in what thicknesses?
1 plate: 1.0mm. 2 plate: 1.0mm or 0.6mm. 4 plate: 1.0mm or 0.6mm.
How many holes per each side of osteotomy is required per plate?
2
What thicknesses are locking mandible plates offered in?
1.5mm, 2.0mm, 2.5mm, 2.8mm, 3.0mm
Which guides are considered marking guides? Cutting guides?
Marking – PA
Cutting – SLM
A genio only case is planned using mock dental models, what guide options can be offered to the surgeon?
PA occlusal, PA bone based, SLM bone based.
What is a design limitation on 1 plate and 2 plate styles compared to 4 plate styles?
Cranium holes must be in a triad configuration.
What plate thicknesses are offered for non-locking mandibular plates?
1.0mm, 1.5mm
What screw systems can be used in locking plates? For which plate thicknesses is each system used?
2.0/2.3mm screws for 1.5mm, 2.0mm, 2.5mm, and 2.8mm thick plates.
2.7mm screws only for 3.0mm thick plates.
What are standard areas of wrap / registration for both SLM and PA occlusal guides?
SLM – Canine, 1st premolar and 2nd premolar (if present), 2 can suffice if 1 tooth is missing. No teeth substitutions are allowed. Piriform wrap/tabs also provided.
PA - ~Half of the dental arch.
A surgeon wants custom plates for the case about to be shown; walk through the plate discussion:
Preferred plate style (1-plate, 2-plate, 4-plate? Plate thickness? Hole configuration? Should the plate cross over the segmental gaps…if so, how many holes should extend on the anterior segment per plate? Impaction? Screw system?
Which plates are considered “skeleton” vs “uniform” style? What is the primary difference between these two styles?
Skeleton – 1.0mm thick plates.
Uniform – 0.6mm thick plates.
Width between holes varies between the two styles. Width between holes is consistent in uniform style plates but decreased in skeleton style plates.
What are screw spacing requirements for 1.5mm and 2.0/2.3mm screws?
1.5mm screws – 4.5mm screw spacing
2.0/2.3mm screws – 5.5mm screw spacing
In which case/osteotomy types can locking plates be used for in orthognathic surgery?
Genio/SSO, Grafted mandible advancements (IVRO, Inverted L, Inverted Z with contact or grafting), or Bridging Osteotomies (no bony contact or grafting for IVRO, Inverted L, Inverted Z).
What are our standard slot sizes for SLM guides? PA guides?
SLM – 1.0mm
PA – 2.0mm
BSSO plates are requested for a double jaw case; what questions should be asked to gather all plate preferences?
Non-locking vs Locking? Thickness? # of holes on each segment? Location of holes – above/below nerve? Screw system?
What screw systems can be used in the midface?
1.5mm, 2.0/2.3mm
List the case/osteotomy types in which we can offer a 1.0mm and 1.5mm thick non-locking plate?
Genio/SSO, 1.0mm and 1.5mm. Grafted mandibular advancement, 1.5mm thick.
*Bonus*: Detail the screw systems allowed for each case types.
Which plate and case type is a 2.7mm locking screw system used for?
3.0mm thick bridging plate
What is the thickness of midface and mandible SLM guides? PA guides?
SLM – 1.0mm for midface, 1.5mm for mandible. PA 2.0mm for midface and mandible.
*Rule of thumb is SLM midface guides are half the thickness of PA guides for the body of the guide – lower profile*
Peek malar implants are being requested; what information needs to be gathered?
(1) Footprint
(2) Max projection and where
(3) Goal of PEEK
(4) Fixation holes and location
Describe how the impaction is being removed below and the advantages and disadvantages of this method?
*Image about to be shown*
Wedge/plane removal (not point interference).
Advantages: plates can be positioned more inferiorly on the cranium for less dissection, full bony impaction will be included within guide slots.
Disadvantages: Removing more bone than necessary to place anatomy in the final position.
For an inverted L case, the surgeon requests a 1.5mm nonlocking plate. What requirements must be met for this plate design?
2 bridging members/arms across the osteotomy, grafting/bony contact between segments.
*Bonus*: Which screw systems can be used for this case?
What plate requirement must be met for a 1.5mm locking plate to be used for a grafted mandible advancement?
2 bridging members/arms across the osteotomy.
What are ULP holes? How do they differ from standard low profile holes? When might they be used?
ULP = Ultra low profile predictive holes. Designed flush to the guide body with ring, compared to the standard 3mm low profile hole. Helpful in scenarios where predictive holes are difficult to access with a 90° drill (due to hole location commonly), ULP offers easier access for the drill to enter the predictive hole.
What plate types can be offered to the scenario below?
*Picture to be shown*
Nonlocking or Locking: 1.5mm* (*2 bridging arms required)
Locking: 2.0mm, 2.5mm, 2.8mm