workflow with Toltac® System
1. data acquisition
Make the CBCT exam and the model scans according the Toltac® data acquisition protocol.
In the case of full edentulism, it is preferable to make a duplicate of the pre-existing prosthesis with radiographic markers and freshly relined base, or at least a freshly relined base plate on which to apply a diagnostic template during the CBCT scan to stabilise it; this will then make it possible to make a model for planning scans and on which to test the accuracy of the surgical template. The authorised Toltac® technicians are available to design together with the clinician the diagnostic systems (diagnostic wax-ups, templates, duplicates, etc.) most suitable for their case, to make the operative procedure smoother and simpler in the diagnostic and surgical phases.
2. template test
The template must be tested on the model, in order to check if the priniting was correct; sometimes a few retouchings* are needed to correct small printing defects of the template, if it does not exactly match with the model.
Then the patient is recalled by the surgeon in order to test the matching precision of the template and do further small retouchings**. Later the template may be sterilized and surgery may be performed when planned by the surgeon.
* If more than a few small retouchings must be done, it may be matter of a printing problem: in this case the problem must be reported to HCS that will make available to the Client the assistance service.
** If the template matches well on the model but not with the patient's jaw it means that there were some problems with the impression (e. g. unstable teeth, dragging of the impression material...) or in the scanning. The assistance service is available also for solution of this kind of problems.
NOTE: Testing the template prior to surgery on the model and on the patient is absolutely necessary in order to perform surgery according to the Toltac® protocol. Testing the template during surgery in order to save a session may confront the surgeon with problems that may prevent the operation in Toltac® mode or make it more complicated and risky.
Template's test on the model
Template's clinical test
you can download here the Toltac® surgical protocol
If planned, prepare the surgical flap as you prefer, fix the template carefully checking its correct positioning through its inspection windows. If preferred, you can fix the flap sides to the template with a suture and have a "freehand" flap's retraction. If on the other hand you planned a flapless intervention, you can guide also the mucose punch with Toltac®.
You can download the Toltac® surgery protocol from this page.
Implant site preparation with the help of Toltac®.
As first, use the Toltac® unidirectional 5.5 mm driver to drive a long necked pointing drill (e.g. sphere, lanceolate...) and by inserting it into the sliding furrow of the Toltac® guide carefully mark on the bone surface the position of each planned implant.
If the mouth's opening of the patient is not wide enough, use a Toltac® flat driver carefully.
Follow your usual freehand surgery's workflow just fixing the Toltac® driver to every drill's neck before using it. Toltac® driver is asymmetric (its guiding portion has a long and a short end), thus you can select the position you prefer (normal or upside-down) in order to engage the Toltac® guide more or less early. You can decide it during surgery, by simply changing the driver's orientation according your needs and according the size of each drill you are using.
driver in normal position or upside-down
If you feel that the Toltac® standard driver would need a bigger mouth's opening than your patient has, you can select the Toltac® flat driver in order to proceed with surgery.
The view of the surgical site provided by the Toltac® system allows the depth of the implant preparation to be checked with normal measuring probes to verify that the desired depth has been reached.
You can fix your implant by guiding its holder with a Toltac® driver or, if you prefer, by freehand technique. In this case, if you feel it more comfortable and your implants are not too aggressive (=they passively follow the prepared implant's site) you can remove the template before inserting the implants.
Visual alignment of the mandrel with the Toltac® guide enables the correct direction to be maintained during manual implant insertion
A USEFUL TIP. To increase the precision and operating comfort of the procedure, it is very useful that a finger of the surgeon's hand not holding the handpiece is used to push the handpiece head and/or the part of the Toltac®driver not engaged in the Toltac®guide, helping it to move in an axial direction: in this way, both hands will help to hold the bur in position and facilitate its descent into the site under preparation.
Toltac® gives you much more but never changes your habits. You can have an help in flap's retraction, in the implant's site preparation, in the implant's positioning. For all implants or only for some. For all drills or only for some. It depends on you, on the help you need in each case and in each moment.