How important are guides in BIMAX

[imnotincelcore]

Realistically, how important are guides when performing a BIMAX?

Of course, if you have major deformities, you will need them. But is it worth the extra cost when you just need a standard procedure?

 

[NZb6Air]

100%

 

[imnotincelcore]

100%

You mean you need them 100%? But shouldn't a decent surgeon be able to do it without?

 

[NZb6Air]

You mean you need them 100%? But shouldn't a decent surgeon be able to do it without?

100% worth it cause they give 100% precision which is guaranteed stick to the plan and less risk of fucking up, less surgery time, less trauma to the surrounding tissues, etc.
However, most bimaxes are done without them yes, doesn't mean it's optimal, it's not even that bad either for standard LF1 (it's mandatory for LF2 etc) but i'd rather go with guides

 

[imnotincelcore]

100% worth it cause they give 100% precision which is guaranteed stick to the plan and less risk of fucking up, less surgery time, less trauma to the surrounding tissues, etc.
However, most bimaxes are done without them yes, doesn't mean it's optimal, it's not even that bad either for standard LF1 (it's mandatory for LF2 etc) but i'd rather go with guides

Thank you. Do you know if guides and implants can be designed by the same company? I was told that guides will cost an extra 7k, do you think that is reasonable?

 

[NZb6Air]

do you think that is reasonable?

no

 

[Deleted member 88357]

Thank you. Do you know if guides and implants can be designed by the same company? I was told that guides will cost an extra 7k, do you think that is reasonable?

7k€ extra for guides is kinda mental

i got quoted 16k€ for trimax with segmental lefort, cutting guides and peek gonial implants

 

[imnotincelcore]

7k€ extra for guides is kinda mental

i got quoted 16k€ for trimax with segmental lefort, cutting guides and peek gonial implants

Lol I know. My surgeon probably orders them from a very overpriced company. Hence I was wondering if you can also get them from your implant designer.

You make implants, do you maybe know something about this? @RealSurgerymax

 

[RealSurgerymax]

Realistically, how important are guides when performing a BIMAX?

Of course, if you have major deformities, you will need them. But is it worth the extra cost when you just need a standard procedure?

Custom guides are only useful with custom plates in my opinion. 3D printed custom guides and splints in plastic cost about $10-150 to make and are inferior to actual titanium custom guides and custom plates.

Custom guides are not necessary when you are with the older goats who are proficient at old school surgery like Raffaini. But personally I would never have traditional/non-custom jaw surgery. Most users here who care a lot about movements should get custom if they actually want the planned movements. Custom jaw surgery will ensure the surgery goes to plan without noticeable deviations or changes happening by accident - which in traditional jaw surgery is often.

So are they needed? No. They're a luxury like having the newest iPhone or newest car with all the new features.

7k€ extra for guides is kinda mental

i got quoted 16k€ for trimax with segmental lefort, cutting guides and peek gonial implants

Many surgeons will answer yes about custom guides and plates when they are really misleading you when they are really just using (maybe) plastic guides and plastic splint.

7K for actual custom guides and custom plats is not unreasonable. Youre probably just getting flimsy 3d printed guides in the office or a custom splint with traditional plates for 16k at any experienced/proven surgeon. Custom titanium bimax kit definitely costs $5-10K from all companies so unless his price for traditional jaw surgery is $8k I don't think so.

vs.

You make implants, do you maybe know something about this? @RealSurgerymax

My service Surgerymax CMF makes implants, guides and custom plates. That will cost $5K USD for bimax and $6k USD for trimax.
I know this is on the lower side compared to big companies like KLS, Stryker, and DePuy.

 

[Lonenely sigma]

My service Surgerymax CMF makes implants, guides and custom plates. That will cost $5K USD for bimax and $6k USD for trimax.
I know this is on the lower side compared to big companies like KLS, Stryker, and DePuy.

Wait, so 6k for everything, or 6k for plates + something for the surgeon performing the surgery?

 

[RealSurgerymax]

Wait, so 6k for everything, or 6k for plates + something for the surgeon performing the surgery?

6k for the guides and custom hardware kit + surgeon, anesthesia and hospital fees

 

[Morphеus]

6k for the guides and custom hardware kit + surgeon, anesthesia and hospital fees

How long is your waiting list? 6k seems like an absolute bargain for this…

 

[Oberyn]

Custom guides are only useful with custom plates in my opinion. 3D printed custom guides and splints in plastic cost about $10-150 to make and are inferior to actual titanium custom guides and custom plates.

Custom guides are not necessary when you are with the older goats who are proficient at old school surgery like Raffaini. But personally I would never have traditional/non-custom jaw surgery. Most users here who care a lot about movements should get custom if they actually want the planned movements. Custom jaw surgery will ensure the surgery goes to plan without noticeable deviations or changes happening by accident - which in traditional jaw surgery is often.

So are they needed? No. They're a luxury like having the newest iPhone or newest car with all the new features.


Many surgeons will answer yes about custom guides and plates when they are really misleading you when they are really just using (maybe) plastic guides and plastic splint.

7K for actual custom guides and custom plats is not unreasonable. Youre probably just getting flimsy 3d printed guides in the office or a custom splint with traditional plates for 16k at any experienced/proven surgeon. Custom titanium bimax kit definitely costs $5-10K from all companies so unless his price for traditional jaw surgery is $8k I don't think so.

View attachment 3175268
vs.
View attachment 3175270View attachment 3175288




My service Surgerymax CMF makes implants, guides and custom plates. That will cost $5K USD for bimax and $6k USD for trimax.
I know this is on the lower side compared to big companies like KLS, Stryker, and DePuy.

Why plastic guides are inferior to titanium ones? I believe most surgeons use plastic guides and titanium plates correct me if I'm wrong.

 

[longjohnmong]

>3D printed custom guides and splints in plastic cost about $10-150 to make and are inferior to actual titanium custom guides and custom plates.

Inferior to what degree? What's the margin of error free hand vs. plastic guides vs. titanium guides?

 

[RealSurgerymax]

Why plastic guides are inferior to titanium ones?

Because they're flimsy and bend to the bone contour, crack when you screw them down, etc

I believe most surgeons use plastic guides and titanium plates correct me if I'm wrong.

No they do not. Depuy, Stryker, and KLS are all titanium guides.

Believe me we have experimented with many plastic guides in Istanbul. I 3D printed several trying to save the patient some money thinking they're interchangeable. They're noticeably worse. Ive tried every variation multiple times and felt with my own hands how well or how poorly they lock into place.

Resin/plastic on left titanium on right. Titanium is definitely better. Tried resin & titanium for BSSO and LF1 guides as well. The first guides we ever used were plastic/resin. And resin genio guides of many types:

You can see the guide being warped under the screws. As you can see it got the job done but with extra hassle. No one will notice 0.5mm off on their chin because of a warped guide. But 0.5mm on the lefort/maxilla, that will translate to 2-3mm difference at the chin level since it gets magnified.

Ive tried making the guides bulkier to give them more strength and then it obscures half the visual field for LF1 and BSSO. Low profile is key to elegant custom surgery.

Im not saying titanium guides are a necessity or that guides are even mandatory at all but Giant is all about being the best there possibly is. Not the best bargain.

 

[Deleted member 74669]

Because they're flimsy and bend to the bone contour, crack when you screw them down, etc

No they do not. Depuy, Stryker, and KLS are all titanium guides.

Believe me we have experimented with many plastic guides in Istanbul. I 3D printed several trying to save the patient some money thinking they're interchangeable. They're noticeably worse. Ive tried every variation multiple times and felt with my own hands how well or how poorly they lock into place.

View attachment 3176893View attachment 3176895
Resin/plastic on left titanium on right. Titanium is definitely better. Tried resin & titanium for BSSO and LF1 guides as well. The first guides we ever used were plastic/resin. And resin genio guides of many types:
View attachment 3176902
You can see the guide being warped under the screws. As you can see it got the job done but with extra hassle. No one will notice 0.5mm off on their chin because of a warped guide. But 0.5mm on the lefort/maxilla, that will translate to 2-3mm difference at the chin level since it gets magnified.

Ive tried making the guides bulkier to give them more strength and then it obscures half the visual field for LF1 and BSSO. Low profile is key to elegant custom surgery.

Im not saying titanium guides are a necessity or that guides are even mandatory at all but Giant is all about being the best there possibly is. Not the best bargain.

Is wearing elastics for class 2 necessary for getting bimax
Should I just not wear them? What do your patients do