Frequently Asked Questions
Introduction To The GRS Guide System
Q: I'm new to the GRS Guide System and would like a brief video overview of what your system does and how it works. Can you help?
A: Absolutely, view our series of brief GRS Video Tutorials.
Q: How does the GRS Guide System work?
A: GRS surgical guide fabrication is remarkably simple and can be performed in any dental office or laboratory. A surgical guide is fabricated – with or without the use of dental planning software – through vacuum/pressure forming, 3D model/guide printing or a combination of both technologies. Depending on fabrication method, GRS Guide System components are incorporated into the completed surgical guide. For example, if the surgical guide is fabricated using 3D printing, then only the GRS surgical ring is needed. If instead a surgical guide is vacuum/pressure formed, then a convenient GRS vacuum/pressure-forming assembly (locator pin, surgical ring, and protection cap) is used to create the surgical guide, with the locator pin and protection cap being removed during the fabrication process as demonstrated in the GRS Surgical Guide Fabrication Video.
After completion of the GRS surgical guide, GRS insertion and removal tools are used to quickly and easily insert and remove GRS surgical drill sleeves from the surgical guide. Select the surgical drill sleeve diameters corresponding to the drill sequences recommended by the applicable implant manufacturer in order to achieve the optimal osteotomy diameter for implant placement. If post-osteotomy guidance is needed to insert an implant, then utilize the corresponding diameter surgical drill sleeve to insert the implant directly through the surgical guide for precise implant orientation.
If impressions are desired at the time of implant placement, then a fixture level impression can be made utilizing an impression coping for each implant and the GRS surgical guide as an impression tray. Simply remove all GRS surgical drill sleeves from the surgical guide, make any adjustments necessary to provide room for the impression coping, and then make the impression using the material of choice.
Q: Can the GRS Guide System be used for partially edentulous and fully edentulous cases?
A: Yes. The GRS Guide system is a universal implant solution and works equally well for simple, partially edentulous single implant procedures or complicated, fully edentulous multi-implant procedures requiring bone screws to affix the surgical guide to the alveolar ridge.
GRS Surgical Guides
Q: How are GRS surgical guides fabricated?
A: GRS surgical guides can be fabricated using traditional vacuum/pressure forming, modern 3D model/guide printing or a combination of both technologies.
Q: Who can create a GRS surgical guide?
A: Anyone! Whether fabricated using a stone model and traditional dental vacuum/pressure-forming machine, or through the use of more sophisticated implant planning software and 3D printing technology – or any combination thereof – anyone can quickly, easily and inexpensively create a GRS surgical guide in any dental laboratory or dental office.
Q: Can GRS surgical guides be fabricated in a dental office or laboratory without the use of surgical planning software, digital impressions or a scanned soft tissue model?
A: Yes. GRS surgical guides can be easily and inexpensively fabricated using traditional methods familiar to all dental professionals. After carefully considering function, aesthetics, soft tissue type, bone architecture, nerve and sinus location, X-rays, and all other relevant patient information, drill a 2.35mm or 3/32" hole in the desired location and orientation in a patient-specific stone working model. Next, insert the GRS locator pin into the hole and secure the GRS surgical ring and protection cap assembly atop the locator pin. Complete the GRS surgical guide fabrication process by placing the stone soft tissue model containing the GRS vacuum/pressure forming assembly (locator pin, surgical ring and protection cap) into a vacuum/pressure forming machine and follow standard vacuum forming protocol.
After trimming the GRS surgical guide to easily fit on the stone model, insert the drill sequence's first GRS surgical drill sleeve into the surgical guide. Next, insert the corresponding diameter surgical drill through the surgical drill sleeve until it bottoms-out in the 2.35mm or 3/32" hole in the stone model. Then, slide a GRS adjustable drill stop onto the surgical drill until it stops atop the surgical drill sleeve and tighten the set screw. Remove the surgical drill/surgical drill stop assembly from the surgical guide and place it into the GRS depth gauge to register the overall length from surgical drill tip to surgical drill stop. Finally, set all remaining surgical drills in the sequence to this same length.
Q: Do vacuum/pressure-formed and 3D printed GRS surgical guides use the same surgical rings?
A: No. Vacuum/pressure-formed GRS surgical guides utilize external retention type GRS surgical rings. 3D printed GRS surgical guides utilize smooth type GRS surgical rings secured in place using a light-cured dental adhesive.
Q: What components are necessary in order for me to fabricate a GRS surgical guide?
A: If you’re fabricating a vacuum/pressure-formed GRS surgical guide, then you will need a GRS vacuum/pressure-forming assembly (GRS locator pin, external retention type surgical ring and protection cap). If you’re 3D printing a GRS surgical guide, then the only components necessary are a smooth type GRS surgical ring and a size/color matching surgical guide analog.
Q: What are the diameters of the three GRS surgical rings available for use with 3D printed surgical guides?
A: The dimensions referenced below represent the outside diameters of the three GRS surgical rings:
- Narrow (Red) Surgical Ring - 0.247" / 6.28mm
- Regular (Green) Surgical Ring - 0.285" / 7.24mm
- Wide (Blue) Surgical Ring - 0.350" / 8.89mm
Given the qualitative difference between 3D printers and the numerous other variables affecting printer accuracy (e.g., material, laser focal range, build speed, etc.), you may find that slightly narrowing or enlarging the 3D printed hole diameter may be necessary.
Q: How do I fabricate a vacuum/pressure-formed GRS surgical guide?
A: Prepare the surgical model to receive the GRS vacuum/pressure-forming assembly by either physically drilling a 2.35mm or 3/32" diameter hole in the soft tissue model at the surgical site with the desired orientation for implant insertion, or utilizing implant planning software to 3D print a model containing a precisely oriented hole. Then, place the model containing the vacuum/pressure-forming assembly in the vacuum/pressure-forming unit and cover it with a piece of thermoforming plastic material ranging from .060”/1.5mm - .12”/3.0mm thick to create a GRS surgical guide that takes into consideration both the tooth and soft-tissue support of each case.
Q: How can I increase surgical access when vacuum-forming a GRS surgical guide?
A: Thanks to their incredibly firm and secure fit, a unique feature of vacuum-formed surgical guides is that significant increases in surgical access can be achieved by utilizing the following techniques on a case-by-case basis:
- Remove up to 1mm of the soft tissue model or 3D printed GRS model in each osteotomy site prior to fabricating the surgical guide. This will offset the thickness of the GRS locator pin platform in which the GRS surgical ring is supported.
- Assess the clinical phenotype of the attached gingiva, and, where appropriate, the GRS surgical ring can be made to compress the attached gingiva 1-2mm when the surgical guide is firmly affixed to the supporting teeth. So, in addition to removing 1mm to compensate for the GRS locator pin platform, an additional 1-2mm can be removed from the model prior to fabricating the surgical guide to compensate for the supporting oral tissue phenotype.
- If a full-thickness flap is planned, clinically measure the attached gingival thickness (attached gingiva surface to crestal bone) in each osteotomy site and remove the measured amount from the model prior to guide fabrication. Additionally, remove another 1mm to compensate for the GRS locator pin platform as noted in the preceding paragraph.
A: 3D printed vacuum/pressure-formed GRS surgical guides can be trimmed using instruments commonly found in most dental offices/labs, including: electric heat knives, lab knives w/razor blade tips, 4" curved scissors, 8" curved shears, carbide trimming burs, separating discs, border polishing burs (course, medium and fine), and Scotch-Brite polishing brushes (course, medium and fine).
A: Yes. The GRS Guide System was designed to suit your preferred work flow and the fabrication methods utilized by dental offices worldwide. In order to meet all surgical needs, there are three (3) different techniques that can be utilized to fabricate GRS surgical guides:
1.) Stone Model • Vacuum/Pressure Forming: After careful consideration of functional and aesthetic goals and all anatomic features/limitations, drill either a 2.35mm or 3/32" hole in the desired location(s) and orientation(s) in a patient-specific stone working model. The GRS vacuum/pressure-forming assembly (GRS locator pin, surgical ring and protection cap) is then secured in each hole and a simple GRS surgical guide is vacuum/pressure-formed.
2.) Implant Planning Software • 3D Printing • Vacuum/Pressure Forming: Utilizing open platform implant planning software (download a free Windows or Mac copy of Blue Sky Bio's Blue Sky Plan), precise implant depth and orientation are digitally established. Next, the CT-Scan images utilized in the implant planning software are merged with a digital soft tissue model to accurately represent a patient’s anatomical features and implant position(s).
When using Blue Sky Plan: (a) select the "Implant List" panel, (b) activate a virtual tube for each implant, (c) select the "File Tab," (d) select "Export To," (e) select the "GRS Model" button to render a soft tissue model with a 2.35mm hole to the planned orientation and depth at each implant location (please note: in preparation for vacuum/pressure forming, Blue Sky Plan digitally modifies the diameter of each implant in the model to 2.35mm without affecting the actual planned implant case), (f) select the "File Tab" then select "Export Data" in order to export a .STL file of the GRS model, and (g) 3D print a GRS model using rapid prototyping technology.
For your convenience we also offer the expert services of the GRS Surgical Guide Lab. Our facility is dedicated to fabricating case-specific, highly accurate GRS surgical guides and 3D printed surgical models with implant holes for use in drill stop measurement and fabricating vacuum/pressure-formed GRS surgical guides. Completed GRS surgical guides and surgical models typically ship within 1-2 days, depending on case complexity. A GRS surgical guide and 3D printed surgical model will be delivered with every order.
3.) Implant Planning Software • 3D Printing: Precise implant location, depth and orientation are digitally established using open platform implant planning software (download a free Windows or Mac copy of Blue Sky Bio's Blue Sky Plan). Next, the Cat-Scan images utilized in the implant planning software are merged with a digital soft tissue model to accurately represent a patient’s anatomical features in relation to the aesthetics and function of the implant position. A GRS surgical guide is then virtually designed within Blue Sky Plan by following their simple guide fabrication steps. Thereafter, the surgical guide is exported as an .STL file and fabricated using 3D printing technology. After the surgical guide is 3D printed, a smooth type GRS surgical ring is inserted into the surgical guide above each planned surgical site and bonded into place using a medical/dental grade dual-cured and/or light-cured adhesive.
Q: What kind of adhesives can be used to bond a GRS surgical ring to the surgical guide?
A: Medical/dental grade adhesives suitable for bonding thermoplastics that are certified ISO-10993 and/or USP Class VI are recommended for creating an optimal bond interface between 3D printed resins and single-use GRS surgical rings. Adhesives meeting these standards include: Loctite 4304 (light-cured), Loctite 4310 (light-cured), Loctite 202152/Prism 4104 (self-cured), and Master BondUV10TKMed (light-cured). Contact your preferred implant manufacturer, dental laboratory or thermoplastic supplier for additional recommendations.
Q: How do I test drill sleeve retention in a GRS surgical guide?
A: By simulating a surgical environment. Wet all surfaces of the GRS surgical ring(s) by submerging the entire surgical guide under water. Then, place the surgical guide back on the model and use a GRS insertion/removal (IR) tool to insert a drill sleeve or surgical guide analog of the same color into each surgical ring. Insert and remove each drill sleeve/analog 2-3 times to confirm proper retention.
Q: When ordering a GRS surgical guide from a lab, do I need to indicate which implant drill system I’m using?
A: No. The GRS Guide System was designed for universal compatibility with all major drill implant systems. However, since GRS surgical rings/surgical drill sleeves are available in three (3) distinct sizes (Narrow/Red, Regular/Green, Wide/Blue), the lab must be informed of the desired surgical ring size(s) so that the correct surgical ring(s) can be positioned at each implant site.
Q: If I don't want to fabricate my own GRS surgical guides or order them through my usual lab, can you fabricate them for me?
A: Yes, the GRS Surgical Guide Lab offers a fast, affordable surgical guide fabrication service. Our facility is dedicated to fabricating case-specific, highly accurate GRS surgical guides and 3D printed surgical models with implant holes for use in drill stop measurement and fabricating vacuum/pressure-formed GRS surgical guides. Completed GRS surgical guides and surgical models typically ship within 1-2 days, depending on case complexity. A GRS surgical guide and 3D printed surgical model will be delivered with every order.
Q: What’s the best way to sterilize a GRS surgical guide?
A: All GRS components are autoclave and chemiclave safe, but should never be heat sterilized. Additionally, the material comprising the surgical guide itself – most 3D printed materials and virtually all vacuum/pressure-forming materials – may be susceptible to autoclaving temperatures/pressures resulting in deformation. We therefore recommend cold sterilization techniques or that you contact the laboratory/manufacturer of the surgical guide material in order to obtain their recommended sterilization protocols. Some 3D printed surgical guides are autoclave and chemiclave safe. However, in order to avoid distortion, the laboratory fabricating the surgical guide - or the materials manufacturer - should be consulted prior to performing any sterilization process.
Currently, cold sterilization is the most universally adopted method for disinfecting removable oral appliances. Effective cold sterilization methods include: (1) submerging the entire GRS surgical guide in an ethylene oxide solution containing no more than 15% alcohol for not more than 30 minutes, or (2) submerging the entire GRS surgical guide in a 70% ethanol solution for a minimum of 15 minutes.
GRS Surgical Drill Sleeves And Drill Stops
Q: Does the GRS Guide System use drill handles to guide the drills?
A: No. The GRS Guide System was specifically developed to eliminate the need for the cumbersome drill keys/handles utilized by other systems. GRS Guide Technology™ utilizes a revolutionary, patented snap-in/snap-out surgical drill sleeve system that allows dental professionals to focus on the procedure rather than overcoming position and orientation issues caused by keyed/handled systems.
Q: Is the GRS Guide System compatible with conventional implant drills and surgical guide specific drills?
A: Yes. The GRS Guide System was specifically designed to accommodate most pilot/twist drills and implants with diameters ranging from 1.1mm-5.30mm. As a result, dental professionals can continue using their preferred surgical system(s) and incorporate additional systems if desired. The GRS Guide System is also compatible with the guided drill systems utilizing guide features built into the drill that are offered by many contemporary implant manufacturers.
Q: How do I determine which drill sleeve and drill stop to use with each drill?
A: All GRS drill sleeves and drill stops are color coded and laser etched with their respective diameters for ease of identification and use.
Q: Can the GRS surgical sleeves be removed using a surgical drill?
A: Yes. GRS drill sleeves are secured into GRS surgical guides by a snap-fit interface and are intended to be inserted and removed solely with the GRS I/R tool. However, in some instances the GRS drill sleeve will be removed with the drill while the drill is being removed from the mouth. This should not be cause for concern, because the GRS snap-fit design secures the surgical sleeve into the surgical guide while simultaneously allowing surgical sleeve to rotate within the surgical guide, thereby protecting the surgical guide from being damaged by oblique torque during the surgical process. The surgical sleeve will simply disengage if an abundance of surface contact is created between the drill and surgical sleeve during an off-angle, high torque removal, thereby protecting both the surgical guide and patient from the potential consequences of a compromised surgical guide. A vertical, unencumbered path of insertion and removal of the drill through the surgical sleeve will securely maintain the surgical sleeve in the surgical guide. In the event that the surgical sleeve is removed along with the drill, simply remove the surgical sleeve from the drill using a sliding motion.
Q: How do I set the GRS drill stops at a surgery-specific position?
A: The GRS depth gauge was designed to make accurately setting drill stops fast and easy. The GRS depth gauge’s setting slider is marked from 0mm – 40mm in 0.10mm increments. Position the desired GRS drill stop in the GRS depth gauge’s drill stop channel and slide the corresponding diameter drill through the drill stop until the drill’s tip contacts the slider. Tighten the drill stop’s set-screw and the process is complete. As an added benefit, GRS surgical drill stops affix to the shank (non-cutting section) of most drills, thereby maximizing surgical drill length.
Q: Can the GRS drill sleeves and drill stops be sterilized for multiple uses?
A: Yes. Simply clean, disinfect and sterilize the GRS drill sleeves and drill stops by autoclaving in accordance with applicable infection control guidelines. Although autoclaving is the recommended method for sterilizing all GRS components, heat sterilization should be avoided.
GRS Depth Gauge
Q: How do I use the GRS depth gauge?
A: The GRS depth gauge was designed to make accurately setting drill stops fast and easy. The depth gauge’s setting slider is marked from 0mm – 40mm in 0.10mm increments. After determining the overall length from drill tip to drill stop, position the GRS drill stop in the GRS depth gauge’s drill stop channel and slide the corresponding diameter drill through the drill stop until the drill’s tip contacts the slider. Tighten the drill stop’s set-screw and repeat the process for all drills in the drill sequence.
Q: How do I clean the GRS depth gauge?
A: Wipe down the GRS depth gauge’s surfaces using standard of care disinfecting techniques and sterilize by autoclaving. Chemiclaving is not recommended and heat sterilization should be avoided. Disassembling the GRS depth gauge into its component parts is not necessary for sterilization purposes and should be avoided.
Reusable vs. Single-Use Components
Q: Which GRS Guide System components are reusable and which components are designed for a single use?
A: GRS surgical drill sleeves and stops, as well as the insertion/removal tools, surgical cassette and depth gauge, are designed to withstand repeated sterilization/use/storage cycles and will provide years of reliable use. All reusable GRS components are 100% autoclave safe.
As for GRS single-use components, surgical rings may be autoclaved at any time but preferably not until they've been incorporated into a GRS surgical guide so both can be sterilized simultaneously (Note: verify autoclavability of surgical guide material prior to sterilizing to avoid damage and/or deformation). Locator pins and protection caps are autoclavable at user's discretion, however sterilization is not required due to their primary use in lab applications.
