Margarida’s First IEXCEL Case — When the Guide Doesn’t Move
- Andre Chen
- Jan 31
- 4 min read
Updated: Feb 3
Guided surgery is not just about technology — it is about method, fixation, and trust in the protocol In this case, the Straumann iGUIDE system enabled a precise, step-by-step workflow: three implants, minimal deviation, and a team that grew stronger with every case.
It has been raining for more than two weeks.
One of those miserable days when your body feels absolutely everything.
My joints were still destroyed from last Wednesday’s climbing session — 6B+, then 6C, then another 6B+… and to finish, one more 6C.
Beautiful, but it completely broke me. I could barely walk the next day.
I woke up with that arthritic feeling of someone who clearly overdid it.
As Elena’s aunt always says:
“After 40, if you wake up with no pain at all… you’re probably dead.”
Well… I’m definitely alive. That pain in my foot only disappears after warming up — sometimes it even cracks.
And still…
Today was one of those days when surgery runs exactly the way it should.
Today was a special case.
Margarida’s first experience with the new Straumann IEXCel implants.
And the fact that someone with no previous experience in guided surgery can successfully perform a case like this is proof of how far implant dentistry has evolved. Of course, to get here… we went through many mistakes along the way.
We planned everything for an iGUIDE static surgery case, step by step, strictly following the guidelines of the new Straumann surgical kit.
And what a case it was.
First contact: tissue, flap, control
We started with a circular punch incision. Even when we know we are going to raise a full-thickness mucoperiosteal flap, I still like to begin with the punch.
Why?
Because it ensures that the drills can progress without interference from the keratinized mucosa. We’ve seen it before: the drill simply doesn’t advance because it hits soft tissue.
The alternative would be a crestal-to-palatal incision — but that usually means more difficult healing.
Everything clean. Everything controlled.
Then came the real moment of truth.
During the week, I was with Sofia and Soraia fighting to calibrate our 3D printer. We printed dozens of times and never achieved the result we wanted.
But Sofia’s determination made it possible.
We managed to get the guide ready… literally at the last minute.
And when we placed it…
perfect fit.
Absolute fixation
And we did what defines the success of static guided surgery:
absolute fixation.
Two pins.
One distal, using the new self-tapping iGUIDE fixation sleeves — extremely intuitive, easy to use, and providing a major increase in guide stability.
The second pin was placed parallel to the implants, using the older fixation system in the premolar area.
In that moment, the guide stops being “just a guide.”
It becomes a rigid structure.
No oscillation.
No movement.
No margin for error — or at least, a dramatically reduced one.
The protocol becomes music when it is respected
We needed to place an implant in site 24:
BLX 3.5 × 12
We used the profiling drill, and then entered what I consider the most beautiful ritual of guided implantology:
2.2 mm drill to 6 mm
then to 8 mm
then to 10 mm
finally to 12 mm, reaching the planned depth
This progressive depth sequence with the 2.2 mm drill greatly reduces the risk of angular deviation inside the sleeve and makes the osteotomy far more accurate and faithful to the plan.
In this case, for a 3.5 mm implant, we stopped at 2.2.
And placed the implant.
Immediate stability.
Perfect repetition: 26 and 27
In site 26, we placed a TLX 3.75 × 10.
Same logic.
Same respect for the protocol.
Punch.
Profiling drill.
Prepilot.
Progressive pilot drilling (depending on depth).
Then the 2.8 mm drill.
Implant placement.
And exactly the same workflow for site 27.
Three implants.
Three challenging positions.
Three insertions with an accuracy that felt almost like laboratory-level precision.
The final outcome
We placed all three implants with:
excellent primary stability
minimal deviation
a clean, safe, and predictable execution
And above all…
a team growing.
Margarida is experiencing her first IEXCel case and realizing that when planning is serious, and the guide doesn’t move…
The surgery becomes almost inevitable.
On a day when the body felt heavy, the rain wouldn’t stop, and the joints kept complaining…
Implant dentistry reminded me of something else:
Precision does not depend on the weather.
It depends on the method.
The teamwork of the last few days allowed three people to fully control the system and perform a guided surgery by the book, with an outstanding deviation from the planned outcome.
Today was one of those days.
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