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Each individual insert is divided into four distinct section:
The wide square handle with the orientation indicia indicate the direction of the guide post; The middle sleeve holder is the round section just beyond the square section. The sleeve holder holds the middle sleeve that directs the drills that determines the implant direction. It is this metal sleeve that is ultimately going to be bonded to the pre-made jig; The third section, the widest section is referred to as the ‘platform stop’. When the metal sleeve is placed over the sleeve holder, it can go as far as the platform stop; The final section is referred to as the ‘measuring post’. This narrow, tapered end has 3 mm calibrations that are used as a reference to calculate the vertical height of the bone and the socket. Excess of 3 mm sections are cut off to ensure that the platform stop is level with the crest of the socket or level with the gingiva just about the socket.

There are direction bumps or indicia on the handle of many of the inserts. When the arrow is aiming downwards, it means that the tip of the mesaruing post is actually behind the handle. When the arrow is facing upwards, it means the tip of the measuring post is in front of the handle.

When the elongated rectangle slopes down from the top right to the lower left, it means that the tip of the measuring post is to the left of the handle. When the elongated rectangle goes from the top left to the lower right, it means that the post tip is to the right of the handle.

Ideal positioning: How to use the inserts
Each insert has two main functions. The function of the measuring post is to use as a reference to measure the available bone height on x-ray and the round sleeve guide is to direct the metal sleeve and position it correctly into the jig.
The insert is ideal when the sleeve guide (the round, cylindrical section) is aiming in the direction of the ideal location in the bone where you would like the implant to be placed. The platform, the widest section, should be level with the gingiva and the measuring post should approximate the depth of the socket. The length of the measuring post and the depth of the socket should be almost the same.
There will be daisy elastics around the measuring posts and these daisy elastics will engage the socket wall and hold the inserts steady so that the metal sleeve can be bonded to the pre-made jig with ease.

In order to place the metal sleeve correctly, the measuring post should be stable, firm and centered in the socket. In order to achieve this, daisy elastics are placed around the measuring post. These daisy elastics will center the post in the socket and not traumatize the bony wall.

When placing the elastic on the measuring post, hold the insert close to the free end where you’re attaching the daisy elastic. Do not remove the daisy elastic from the large circle where all the daisy elastics are attached. The daisy elastic must be attached to the circle.

Push the free end through the hole in the center of the daisy against your fingertip. When the end of the measuring post goes through the hole in the center, only at that point in time will it detach the elastic from the round circle where they are all attached.

We’ll hold it towards the end and rotate it slowly, pushing the point through the daisy. Do not hold the insert on the other end. If you hold it too far from the end where you are placing the elastic, the measuring post will snap. Inserts should be adapted to match the sockets where they’re being used. The post length approximates the depth of the socket. The platform (which is the widest part of the post) should be level with the gingiva or slightly above the socket crest.

To adapt the post length, remove 3 mm sections. Cut them off with your burr, with a scissors and try to snap them off with your fingers. Place the insert in the socket and check the length of the measuring post to the length of the socket. In this instance, we can see that the insert is 6 mm too long, so we remove the insert from the socket and cut off two 3 mm sections. And then we can place it back into the socket and we will see that the platform is now level with the gingiva.

When you have attached the metal sleeve to the jig, you can then take an x-ray of the entire assembly in the mouth. You’re going to use this x-ray to calculate the bone height and the depth of the socket. The 3 mm calibration show up very clearly on the rather opaque insert. Each insert has two main functions. The function of the measuring post is to use as a reference to measure the available bone height on x-ray and the round sleeve guide is to direct the metal sleeve and position it correctly into the jig.

The inserts are selected from the kit (and the drill) at a predetermined site on the jaw bone. The straight red insert will center the implant in the same location as the extracted tooth. The calibrated tapered end is centered in the socket by the orange elastic around the post. This end is cut to length so that the wide platform is leveled with the gingiva above the socket crest. The middle sleeve on the insert is then bonded to the premade jig.

The green insert will position the implant drill parallel to the socket interseptal bone. The blue insert will angle the drill away from the socket’s center as required in the anterior teeth with limited facial bone. The purple insert is useful on divergent root sockets.

Ideally, we would like to see the implant emerge centered in the space that was occupied by the extracted tooth. An insert will be selected to place the drill exactly into the ideal location centered between the adjacent teeth. The longest, straightest socket will be selected, the measuring post will be cut to length and will be placed into the socket.

All Safegide inserts and verification point show up well on x-ray, so it is easy to calculate drill depth with the Safegide system. It is important to drill to an exact depth so that no vital or sensitive anatomical structures are damaged and your implant is correctly placed.

Drill stops are not universal. You need to select the type that matches the manufacturer of the drill that you are using. Also, when you place the drill stop onto the drill, you place it on the latch shaft side. You do not slide it over the cutting end of the drill.

Drill stops come in a range of sizes. In order to calculate the ideal drill stop size, one adds up the height of the metal sleeve, the gingiva and the bone and any additional depth where one intends placing the implant. One totals up all these measurements and subtracts that from the length of the drill that emerges from the hand piece. That difference will give you the height of the stop to place on the burr.

The metal sleeve on the drill guide will direct the drill exactly where it is supposed to go. When the plastic drill stop hits the metal, it will prevent the drill from going any deeper into the bone.

– Dr Howard Katz

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