CHROME Dentate Surgery

Surgical Instructions for the Dentate Patient

Stage 1: Pin Guide

Pre-Surgical Checks

• Use cold sterilization prior to dentate surgery
• Assemble the Pin Guide (a) & CHROME Fixation Base (b) & passively assemble to feel the relationship between the two.
• Push in all three CHROME Locks, with plastic guide fully seated.
• Place Pin Guide assembly on the tooth model to observe how the tooth structure contacts the guide in the windows.
• Notice which teeth the guide uses for support. Guides may require some teeth to be extracted prior to seating.

Dentate Surgery Steps

• Seat Pin Guide (a) w/ Fixation Base (b) , and use the windows to ensure full seat. This step is very important and sets the foundation for the remaining steps. If guide is not fully seating review these questions: Did the patient have restorations since planning?; Did the plan call for some extractions prior to beginning?; Is the tissue holding up the guide? If no to these questions, adjust the guide until seated, then remove.
• Lay full facial, and partial lingual flap. Once complete, return the guide to the mouth and drill the facial holes for the pins, holding the Pin Guide firmly in place. Must use the provided Pins and Drills as they are calibrated with the guide tubes and plan. Drill to depth and place the pins. Use a mallet if needed to ensure full seating. It is important to use the mallet only after all pins are hand inserted. Once all the sites are drilled and pins are placed, pull out the CHROME Loc plungers to remove the Pin Guide.

Stage 2: Bone Reduction Guide / Fixation Base

Pre-Surgical Checks

• Pin the Fixation Base to the reduced bone model and feel the transition from guide to bone.
• Notice that this guide does not contact bone. The guided is fully supported by the pins.
• Check to verify that the pins easily pass through each of the anchorage sites.

Dentate Surgery Steps

• Extract teeth and reduce the bone to the top of the Fixation Base.  Ensure a smooth, horizontal plane of bone following the upper plane of the Fixation Base. This must be a smooth transition or the Carrier Guide will not seat.
• If the Fixation Base was removed to perform extractions, insert Fixation Base using finger pressure on each pin until they are mostly seated, then use the surgical mallet to ensure full seat of each pin if needed.
• If posterior area has a step up due to bone reduction, use a bur to create a sloped transition.

Stage 3: Osteotomy Guide

Pre-Dentate Surgery Checks

• Using the CHROME Locs, connect the Osteotomy Guide to the bone guide and ensure a passive connection.
• Test the Fully Guided Kit parts and ensure passive fit of each site.
• Study the enclosed GSI report for tool sequence, abutment rotation, images of Fixation Base, parts, etc.

Dentate Surgery Steps

• Insert Osteotomy Guide into the anchored Fixation Base. Use the CHROME Loc attachments to ensure the guided is fully seated.
• Perform osteotomy drilling and install implants according to specific implant company protocols.
• Place implants through the guide if fully guided kit allows. If tools torque, Osteotomy Guide can be temporarily removed to relieve torqueing pressure on the hand piece.
• Once all implants are seated, remove Osteotomy Guide.
• Option: for rotational accuracy, use a hand driver for the last few turns of the implant to align the driver indicator to align with the notch  on the Osteotomy Guide.
• Zero degree abutments (straight implants) do not have a notch on Osteotomy Guide and rotation rotation indexing is not needed. Angle abutments have a square indicator on the osteotomy guide.

Stage 4: Carrier Guide

Pre-Surgical Checks

• Carrier Guide fits into the Fixation Base (d) and is held into place with the CHROME Locs (e) . Insert to test.
• The Carrier Guide serves to ensure the MUA abutments are in the correct position, the temp cylinders are in the correct trajectory, and to direct the driver to the MUA screws.
• Notice the direction of the square ‘access’ sites off each angled implant site. These squares provide the access for the driver. The driver will drop into the square and engage abutment the screw.

Surgical Steps

• At this point the implants are in place and in the correct rotation.
• Screw down the MUA abutments as indicated on the GSI report. There are images in the report that show the MUA screw access angle. The Carrier Guide (image above) also indicates the rotation of the MUA’s. Once they are placed in the correct rotation, the drive will be able to engage their screws. If the MUA’s do not line up with the squares, remove and rotate the implant into the proper direct / index, then seat the MUA’s—see callouts above.
• With all MUA’s seated, screw the Temp Cylinders to the MUA’s and verify their correct position and trajectory using the Carrier Guide and ultimately the CHROME Provisional. The temp cylinders should emerge vertically and near the middle of the holes in the CHROME Provisional. If they are close to an edge but not touching this may be acceptable. If there is contact you have a choice of rotating the implant or adjusting the CHROME Provisional. This has implications for the final restoration screw access hole position.

Stage 5: CHROME Provisional Pick-Up and optional RAPID Appliance

Pre-Surgical Checks

• Seat the CHROME Provisional (f) to the Carrier Guide which is connected to the Fixation Base and ensure a passive fit.
• Notice the thickness of the Carrier Guide and how it simulates the tissue thickness of the patient – approximately 3mm.

Dentate Surgery Steps

• With carrier in place, use provided green gaskets and blue plugs fill blockout the temp cylinders and to fill the gap between the temp cylinders and the Carrier Guide.
• Coat the inside of the access holes of the Provisional with provided resin bonding agent so acrylic will bond. Seat the Provisional onto the carrier pegs. Backfill the voids around between the temporary cylinders and the Provisional with Quick-Up. Do not allow any material to enter the temp cylinders! Once fully set (self cure, follow instructions), unscrew the cylinders and remove the Provisional. Trim the cylinders with a disc or bur, fill all the voids / holes in the Provisional, adjust and polish to finish.
• Optional: Screw down the second set of temp cylinders. Insert the RAPID Appliance (g) and repeat the pick-up process. The new iJIG has replaced the need for the RAPID Appliance (contact laboratory for details)
• Remove the Fixation Base and carrier, place optional comfort caps, suture, deliver the CHROME Provisional.
• Seat the CHROME Provisional, adjust occlusion, capture photographs and share with the lab.