## 2 The First and Second Parts of Making the Surgical Guide for TADs
### Part 2: The Procedure of Making the Surgical Guide for TADs
#### 2.2.3 Digital TAD Guide Production Process  
Below is the procedure, devised with the help of an outside laboratory team of dental technicians. The application name software will be introduced, but another commercial brand can also be used. It was necessary to reveal the names of the products to make it easy to understand since otherwise practicing clinicians will find it difficult to follow the instructions. Our laboratories use intraoral scan data as follows:  
1. For dentition, STL and CBCT (DICOM) data are superimposed using 3-Matic SLT10.0 (Materialize, Leuven, Belgium). The 3-Matic application has been used to evaluate the three-dimensional root monitoring of root movement during orthodontic treatment [64] without exposing radiation in controlling the position of the roots. 1. STL and DICOM data are superimposed using a 3-Matic application, as shown in Figure 6. 2. Mimics (Materialize, Leuven, Belgium) is used to extract the roots of the mesiodistal teeth where the anchor screws are to be implanted and converted into 3D as shown in Figure 7 The method has been described by [PERSON] using a 3D surgical plate for corticotomy [65,66]. 3. Making three-dimensional images and analyzing them using the Geomagic Studio 5 software (Raindrop Geomagic, Inc., Morrisville, NC, USA) is necessary. We created cylinder data of the same size (@1.6 \(\times\) 8.0 mm) imitating the screw (product of TADs, brand OSAS by DEWIMED) to be placed as shown in Figure 8. 4. The CBCT, intraoral scanner, and cylinder data are loaded into Mimics and a placement simulation is performed, shown in Figure 9. 5. At this stage, the orthodontist performs the simulation to the best bone quality that will guarantee the success of the implantation. The process below shows the simulation performed by the doctors. The soft tissue thickness will also \begin{table}
\begin{tabular}{c c} \hline \hline
1. & Superimposed SLT and DICOM data \\ \hline
2. & Designing a surgical guide in 3 Shape Ortho System 2021.1 \\ \hline
3. & 3D printing. \\ \hline
4. & Cleaning, washing, and cutting \\ \hline
5. & Checking and testing the surgical guides to the models \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Checklists of the procedures to make the surgical guides. The plan is sent back to the laboratory, and the technician then confirms whether the simulation is visible for the 3D surgical guide printing. Figure 11 shows that, to begin with, the printing, the first step is to apply the data from 3-Shape to an easy printing program. Figure 8: The virtual 3D image of the TADs was made according to the size of the screw itself. Figure 9: The simulation of the virtual TADs of the virtual model. * Appliance designer of 3-Shape, Copenhagen, Denmark, was used to simulate the drill, and the surgical guide to make the TAD placement position easy and straightforward, as shown below in Figure 12.  
Figure 11: The data was transferred to the 3-Shape program. Figure 10: The TADs were manipulated in the program and the final stage. * After cleaning/drying, the support is removed (Figure 16), and the guides are ready for the post-cure process as some part is not cured. The ProCure (SprintRay, Los Angeles, CA, USA) makes the guide's final cure (Figure 16a,b). The after-cured result is shown in Figure 16c. * The model is made from the STL to check the fitness of each guide to the model, paying attention to the area of the brackets to avoid any retention. In the bracket areas, window is made that also will benefit checking fitness during the implantation (Figure 17a,b). The surgical guide for both the pre-drilling and the screw placement guides are ready to be used at this point. The external oblique line, where the buccal shelf is, presents the most-used surgical guide: it has thick cortical bone, and, in many cases, the mucosa is an intact, attached mucosa. Even if the area is covered with flabby mucosa, the surgical guide's bottom side presses the mucosa. It prevents the mucosa from moving during the drilling and insertion of the TAD procedure.