CE certified Class 1 medical devices
dispositivi medicali certificati CE Classe 1
info: alberto.bottacini@hcs-italia.it
HCS Italia +39 389 067 3169
Toltac® System: how to start?
Because it allows the use of the usual instrumentation, the use of the Toltac® system does not require a real learning curve. All it takes is a clear understanding of what help it can provide and attention to a few details in the preparation of the operation, and the system will help the operator in an extremely discreet manner from the very first use.
WHAT I NEED TO KNOW BEFORE I START USING TOLTAC® SYSTEM
Before surgery:
1) what does it give me, the Toltac system?
It guides me in the right direction for implant site preparation. It allows me to operate even in the case of a reduced oral opening, seeing what I am used to seeing in freehand surgery and irrigating the drills correctly.
2) what does the Toltac system NOT give me?
It does not give me a depth stop: by allowing me to see the notches on the drills, it allows me to manually sink them exactly as planned, but it does NOT stop me.
It does not allow me to apply brute force in preparing the implant site. Or rather: if necessary I can apply the force I want on the drill with which I'm drilling the bone, but always maintaining the direction given to me by the Toltac® system: any twisting movement with respect to this direction, as in any guided surgery system, risks causing deviations of the implant axis with respect to what is planned, dislocation of the template or even breaking the template itself.
WHAT DO I HAVE TO DO BEFORE I START USING TOLTAC® SYSTEM
1) Take some time to test the components: attach Toltac® drivers to each of the drills you intend to use for Toltac® guided surgery by inserting them into the handpiece that will be used: this allows you to check which Toltac® driver to use for each drill, depending on the neck length available.
2) The higher the collar is, the less clearance the drill neck has in relation to the driver, and therefore the more stable the guide the driver can provide. If necessary, thin out the collar for attachment to the cutter. Reducing the height of the collar of the Toltac® driver 2.55 mm should only be done if absolutely necessary and should be the minimum necessary for complete insertion of the bur into the handpiece. If, on the other hand, a shank height of more than 2.55 mm but less than 5.50 mm is available, the collar height of a Toltac® driver 5.50 mm may be modified: again, the reduction must be the minimum necessary for complete insertion of the drill in the handpiece.
3) Try sliding a standard Toltac® driver several times in a Toltac® guide attached to a template in order to familiarise yourself with the reciprocal sliding of the two Toltac® components and the tolerances that allow them to function.
4) Try sliding a Toltac® flat driver several times in a Toltac® guide fixed on a template in order to familiarise yourself with the lateral insertion mode and the type of guide that this allows (only in the mesio-distal direction) and with the accessory guide on the other plane (vestibulo-lingual) that is obtained by sliding the Toltac® flat driver while keeping it adherent to the bottom of the groove of the Toltac® guide.
5) Try placing the Toltac® drivers upright and inverted on the drills in order to understand the possibility that the Toltac® system gives of engaging the Toltac® guide more or less early and sliding them several times in a Toltac® guide fixed on a template. This inversion gives the possibility of working with long drills in small mesio-distal spaces, such as in single anterior or premolar teeth.
6) If desired, in order to familiarise oneself with the system and/or to check the procedure, it is possible to carry out a simulation of the procedure by having the laboratory produce a 3D-printed model of the arch to be treated in PMMA, applying the template and milling the model in Toltac® wizard with the drills planned for the procedure.
7) Start with a simple first surgery, a partial edentulous, with the insertion of only one or two implants: this allows more attention to be paid to the first use of the Toltac® system, as well as to the details of the surgery.
8) Before the scheduled date of surgery, carry out template tests on the model and on the patient.
IMPORTANT - DO NOT CARRY OUT ANY WORK ON THE TOLTAC® SYSTEM UNLESS YOU HAVE THOROUGHLY FAMILIARISED YOURSELF WITH THE DYNAMICS OF THE SYSTEM. IF IN ANY DOUBT, CONTACT YOUR SUPPLIER BEFORE CARRYING OUT THE SURGERY.
WHAT DO I HAVE TO DO BEFORE I START USING TOLTAC® SYSTEM
1) Pay attention to the correct positioning of the template at the beginning of the procedure and, if it is not fixed with pins, involve the assistant in constantly checking its correct positioning throughout the procedure. If the template is moved, there is a risk that the milling of the implant seat will take place in a position other than the planned one.
2) VERY IMPORTANT! One of the advantages of the Toltac® system is that it allows the depth of implant insertion to be chosen precisely during surgery: the Toltac® system does NOT have depth stops, so the operator's attention must be paid to the drilling depth of each implant site, because the drill will stop where the operator stops it, NOT stopped by the Toltac® template + drivers system. If desired, bone stop drills can still be used if available.
3) If you wish, ask your distributor for assistance from a Toltac® expert in person, by video call or telephone, so that you can ask him or her for any tips on using Toltac® components (e.g. use of Toltac® driver straight or reverse, for more or less early guidance, use of Toltac® flat driver, etc.).