Guide Right Vumedi Webinar PART 1 In Office 3D Surgical Guides For Placing Short Implants EDITION 2
Vumedi Webinar Part 1 In Office 3D Surgical Guides For Placing Short Implants Edition 2 Vumedi_Webinar_PART_1_In_office_3D_Surgical_Guides_for_Placing_Short_Implants__EDITION_2 Vumedi_Webinar_PART_1_In_office_3D_Surgical_Guides_for_Placing_Short_Implants__EDITION_2 4 2014 pdfdoc 258413772373414384 3:
2014-04-23
: Pdf Vumedi Webinar Part 1 In Office 3D Surgical Guides For Placing Short Implants Edition 2 Vumedi_Webinar_PART_1_In_office_3D_Surgical_Guides_for_Placing_Short_Implants__EDITION_2 4 2014 pdf
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4/23/2014 DéPlaque Guide Right ™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place In-office 3D Surgical Guides for Placing Short Implants Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com Application of In-office Guide Right™ Surgical Guide System for Accurately Placing Short Implants Presenter Sean W. Meitner DDS MS Clinical Associate Professor, Department of Periodontology, the Eastman Institute for Oral Health, Rochester, NY USA Periodontal and Implant Practice, Pittsford, New York USA Research / Development DePlaque-Guide Right, Victor, NY Presenter James L. Soltys DDS Clinical Associate Professor, Department of Prosthodontics, the Eastman Institute for Oral Health, Rochester, NY USA Practice Limited to Prosthodontics, Victor, NY USA Moderator Max J. Cohen DDS Clinical Instructor, Oral Rehabilitation, Georgia Regents University, College of Dental Medicine, Augusta, Georgia USA; General Dentistry Practice, Dunbury, Georgia USA Part 1 In-office 3D Surgical Guides for Placing Short Implants 1 4/23/2014 Is There a Need for Short Implants? speaker discussion Need for Guided Implant Surgery for Short Implants fully guided vs partially guided surgery Introduction to Guide Right™ Surgical Guide System description of guide components: purpose & use Case Examples use of the Guide Right™ guide system: fabrication, evaluation, correction & placement using surgical guide for short implants Is There a Need for Short Implants? speaker discussion What is the long term success rates of shorter implants? Stefano Sivolella Et Al, Splinted and Unsplinted Short Implants in Mandibles, A Retrospective Evaluation With 5 to16 Years of Follow-up. Journal of Periodontology; April 2013; Vol 84 # 84. • • • • 109 patients with 280 implants 7 or 8.5 mm long X 3.75 or 4 mm diameter Smooth surface or rough surface in the mandible. Exclusion from the study of patients were those who: • smoked more than10 cigarettes a day • had history of radiation treatment, • had leucocyte disorders, • uncontrolled diabetes, • severe clinching, • bone grafts or localized GBR prior to implant placement SURVIVAL RATE OVER 16 YEARS Machined surface implants ► 94% Rough surface implants ► 96% CONCLUSIONS Different implant lengths, diameters & surface treatments did not appear to influence the prognosis of the implant. 2 4/23/2014 Study to compare the preservation of marginal bone when using 4 mm diameter implants 6 mm with 11 mm implant length Zadeh H, Palmer R, Wenstrom J Gulje F, Chen S, Stanford C, Lindhe,J A randomized Controlled study comparing 6 to 11 mm implants loaded 6 to 7 weeks after placement. Marginal bone level alterations were compared 6 and 12 months after implant placement. at the time the abstract was presented • 89 implants were followed for 6 months • 54 implants were followed for 12 months at the time the abstract was presented Conclusive evidence indicates that treatment with short implants had no negative effect on maintaining marginal bone levels when compared to standard length implants. Rise in injury to inferior alveolar nerve Unfortunately the placement of dental implants has led to the rise in incidences of Iatrogenic injury to the inferior alveolar nerve or its mental branch leading to temporarily or permanently altered sensation for the patient and may lead to the liability claim against the practitioner. A recent study from Tel-Aviv, Israel Givol et al J Perio, April 2013 92 cases of nerve injury were examined 76% were related to surgical procedures: with information based on Peri-apical or Panorex X-rays 24% were related to operators based on CT scans Current Use of and need for Guided Surgery “Only 2-3% of implants being placed used surgical guides.” Scott Gantz DDS; personal communication Several studies have shown that placement of implants with CT-based drill guides is more accurate than with freehand drilling. Yet CT-based guides are used in only 10% of cases. Benedict / Haber Wellesley Hills, MA; Barriers to Adoption of CT-Based Surgical Guides; 3 4/23/2014 Guided Surgery Why is it not used? • Requires additional prep time • Not familiar with guides available • Challenges with surgical guides available Challenges with Current 3D Surgical Guides Most require off-site fabrication Cost. Usual time delay of several days to a week May result in difficulty fitting the patient when placed at the time of surgery Too restrictive: partially vs fully guided surgery Why use short implants? • The more complex the procedure the higher the risk of complications. • sinus elevation • vertical ridge augmentation • nerve damage • Human factors (less stress, fatigue, risk for complications, grafting , etc.) during the surgical procedure. 4 4/23/2014 Best Practices for Short Implant Success Implants should be placed within the envelope of available bone to increase clinical success. Pre-surgical 3D radiographs facilitate evaluation of the proposed angle of the long axis of the guide sleeve and proposed implant placement in two Planes. 3D Radiographs allow us to determine if planned implant placement conflicts with the adjacent roots, the maxillary sinuses, nerves, and if it is within the envelope of available bone. Surface area of short implants increases with the square of the radius. o Wider implants have greater surface area Restoration of Short Implants Need for Guided Implant Surgery for Short Implants fully guided vs partially guided surgery 5 4/23/2014 DéPlaque Guide Right ™ Surgical Guide System Comparison with ▪ without guide used in implant placement planning implants placed WITHOUT a guide #21 implants placed WITH a guide #19 #29 #30 Start With Precision. Place With Confidence.™ Introduction to Guide Right™ Surgical Guide System A Geometric approach to guided implant placement description of guide components, purpose & use Guide Right™ Surgical Guide System A System of Components for the fabrication & correction of diagnostic & surgical guides in three dimensions In-office or lab fabrication Evaluate with 3D imaging Allows linear and angular correction Enables precision implant placement Cost effective 6 4/23/2014 Basic Fabrication & Correction of DIAGNOSTIC & SURGICAL Guides Featuring GUIDE RIGHT COMPONENTS standard, magnetic, 2- piece guide posts, cylindrical & open guide sleeves GUIDE POST BENDING TOOL angular correction linear correction • offset guide posts FABRICATION with Triad gel DIAGNOSTIC guide SURGICAL guide CONE BEAM X-RAY software Required to evaluate & correct Guide Right™ COMPONENTS used in Fabrication of DIAGNOSTIC & SURGICAL Guides Guide Posts: standard · magnetic offset · 2-piece Guide Sleeves: Pilot Drills Pin-vice Guide Post Bending Tool cylindrical · open Standard Guide Posts for fabricating diagnostic guide Straight Straight Guide Post 18 mm x 9 mm x 3/32 in. Straight Guide Post 30 mm x 2.9 mm x 3/32 in. 7 4/23/2014 Magnetic Guide Posts Straight 3.0 mm od Offset 3.0 od X 0.5 mm os 3.0 od X 1.0 mm os 3.0 od X 1.5 mm os 3.0 od X 2.0 mm os 3.0od X 2.5 mm os 3.0 od X 3.0 mm os For use with Open Guide Sleeves 2-Piece Guide Post used with (3-5 mm) cylindrical guide sleeves Cylindrical Guide Sleeves Anterior Straight Cut 3.0 mm x 8 mm Posterior Angle Cut 3.0 mm x 8 mm Large Diameter 4.5 mm id x 5.0 mm Large Diameter 5.3 mm id x 5.0 mm 8 4/23/2014 Magnetic Guide Post • Open Guide Sleeve • Pilot Drills 4.0 mm Open Guide Sleeve (short) 4.0 mm x 10 Magnetic Guide Posts 4.0 mm x 1 mm Offset Magnetic Guide Post 2.0 mm x 5.0 mm Pilot Drill 2.0 mm x 10.0 mm Pilot Drill Drills used with straight hand piece 5/64” drill 3/32” Pin vice Used to carefully enlarge the 5/64” hole to 3/32” by hand. If the hole is oversized it will compromise accuracy of the guide. 9 4/23/2014 Correctable Magnetic Offset Guide Post used with open guide sleeves 3.0 X 0.5 mm offset (up to 5 mm offset) 2-Piece Guide Post Correctable Lower Piece with Upper Removable Piece The bottom half of all Lower Pieces of the 2-Piece Guide Post are designed with 4 flat sides corresponding with the mesial, distal, buccal & lingual surfaces of the tooth. The flat surface allows holding the guide post In the bending tool for accurate corrections, In bucco-lingual, mesio-distal or both planes. 2-Piece Guide Post Offset Lower Piece The Offset Lower Piece is designed with a series of offset shapes to allow corrections in 0.5 mm intervals in any direction to change the linear position of the surgical guide sleeve. 10 4/23/2014 2-Piece Guide Post Upper Removable Piece available in many diameters starting from 1.3 mm for mini implants / drills up to 6 mm diameter 2.7 mm Guide Right™ Guide Post Bending Tool • A straight 3 mm magnetic guide post is placed in the block of the bending tool. • The 3 mm stylus is placed over the post. • Pressure is applied to point of stylus moving it to the 9° correction indicated according to the protractor reading. Guide Right™ GUIDE POST BENDING TOOL SINGLE BEND review Step 1 Place bending tool plate on a secure flat surface with the degree increments at the top & the stainless steel bar with the v-cut at the bottom. Step 2 Locate 3/32” hole in the center of the v-cut and place the bottom half of the guide post into the hole. Tighten the set screw. Step 3 Locate the hole in the bottom of the stylus that you will use that will fit over the top half of the guide post (3.0 mm, 4.0 mm or 5.0 mm). Step 4 Fit the stylus over the guide post securely with the point directed at zero degrees and the bottom of the stylus in contact with the V block. Step 5 Using the stylus as a lever, bend the guide post to the degree of angle of correction. You may need to ease the point of the stylus beyond the point of the desired degree. Step 6 Loosen screw and remove guide post and the stylus to find the guide post bent to the desired angle. 11 4/23/2014 Guide Right™ BENDING TOOL COMPOUND BEND overview Step 1 Position a straight or offset guide post in the bending plate, tightening the set screw against one of the flat surfaces on the lower half of the guide post. Step 2 The 1st bend can be made to the right or left direction. Step 3 The set screw is loosened and the guide post is rotated 90 ° next flat surface. Step 4 The 2nd bend in the second plane is made after rotating the guide post up away from the surface of the bending plate to register the stylus point back at 0 degrees. Step 5 Slide the stylus support bar down under the stylus until it supports the stylus. Tighten the side screws before making the second bend. Step 6 The second bend can be made in either direction according to the x-ray. Step 7 Remove the stylus and place the guide post back in the cast with the appropriate side indicated by a mark facing the buccal or lingual surface. Be sure the post is in the correct position. If the post needs to be corrected by a linear movement an offset guide post can be used. Off sets available in the 3 mm guide post: 0.5,1,1.5, 2.0 ,or 3.0 mm. Case Examples Use of the Guide Right™ guide system: fabrication, evaluation, correction & placement using surgical guide for short implants Placing Short Implants with Guide Right™ 3D Surgical Guides fabrication, evaluation, correction , verification & surgical guide placement 12 4/23/2014 Case 1 Short Implant site # 3 • • • • Fabrication DIAGNOSTIC guide Evaluate using invivio5 software No correction necessary Fabricate SURGICAL guide • 5 x 6 mm implant • 5.2 mm upper piece guide post • 5.3 mm cylindrical guide sleeve Single Implant Case #3 featuring 5 X 6 mm implant 2-Piece Guide Post • Invivo5 Evaluation Diagnostic Guide Surgical Guide DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate diagnostic guide ▪ ▪ ▪ ▪ ▪ evaluate correct re-fabricate surgical guide verify place 13 4/23/2014 3/32” drill positioned in 3/32” hole drilled in cast 3 mm guide post with 3 mm straight guide sleeve positioned in proposed implant site for the DIAGNOSTIC guide • Cast lubricated with petroleum jelly. • Guide sleeve cleat positioned to the palate • Triad® gel added to 3 mm guide sleeve & adjacent teeth to form the DIAGNOSTIC guide 14 4/23/2014 DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate diagnostic guide ▪ evaluate ▪ ▪ ▪ ▪ correct re-fabricate surgical guide verify place Creating a Guide Right™ Surgical Guide Use of Invivo5 Software to Evaluate, Correct, & Verify Prosthetically planned implant trajectory prior to drilling the osteotomy “Home Position” #3 axial of virtual planned implant position cross section Invivo5 tangential volumetric 15 4/23/2014 #3 Axial view The line indicating the plane of the cross sectional view should be rotated to position at 90º tangential to the curvature of the arch of the alveolar bone in the Axial view #3 Cross Section view Angular Correction • not needed Implant • 5 X 6 mm Invivo5 #3 Tangential view Angle Correction • not needed Linear Correction • 0.5 mm offset mesial Invivo5 16 4/23/2014 DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place 0.5 mm offset lower piece of 2-piece guide post with no angle correction DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place 17 4/23/2014 Verify tangential cross section A 5.2 mm upper piece guide post & 5.3 mm cylindrical guide sleeve were used because the 6 mm Megagen implant requires a 5 mm trephine drill to prepare the initial osteotomy. 5.3 mm cylindrical guide sleeve is positioned with cleats palatally 18 4/23/2014 Triad® gel is added to the lubricated cast to form the SURGICAL guide Occlusal view of SURGICAL guide with upper piece 5.3 mm guide post removed SURGICAL guide with 5.3 mm guide sleeve 19 4/23/2014 SURGICAL guide 5 mm trephine drill inserted in guide sleeve DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place Occlusal view of clinical site prior to the procedure 20 4/23/2014 Mirror shot with SURGICAL guide in place Guide in place with implant & carrier in placed Palatal incision with flap reflected toward the buccal surface Cover screw in place 21 4/23/2014 Final implant placement (avoiding a sinus elevation) Verification of accurate placement with SURGICAL guide in place Case 2 Short Implant 5.5 X 7 mm site # 3, • • • • Fabrication DIAGNOSTIC guide Evaluate using invivio5 software No correction necessary Fabricate SURGICAL guide • mm guide post 5.25 • mm guide sleeve 5.3 22 4/23/2014 Single Implant Case featuring 2-Piece Guide Post • Invivo5 Evaluation #3 Diagnostic Guide Surgical Guide DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate diagnostic guide ▪ ▪ ▪ ▪ ▪ evaluate correct re-fabricate surgical guide verify place 3/32” drill positioned in 3/32” hole drilled in cast 23 4/23/2014 Standard Guide Posts Short Guide Post 18 mm x 9 mm x 3/32 in. Straight Guide Post 30 mm x 2.9 mm x 3/32 in. 3 mm guide post positioned in proposed implant site 3 mm guide post with 3 mm guide sleeve positioned in proposed implant site 24 4/23/2014 Triad® gel added to capture cleat of 3 mm guide sleeve to form DIAGNOSTIC guide DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate diagnostic guide ▪ evaluate ▪ ▪ ▪ ▪ correct re-fabricate surgical guide verify place Creating a Guide Right™ Surgical Guide Use of Invivo5 Software to Evaluate, Correct, & Verify Prosthetically planned implant trajectory prior to drilling the osteotomy 25 4/23/2014 # 3 Home Position axial cross section Invivo5 tangential #3 volumetric Angular Corrections • 24˚ 6 x 6 mm adjusted with hard sharpened filter axial cross section Invivo5 tangential volumetric Angular Correction • 24˚ palatally Invivo5 #3 tangential cross section 26 4/23/2014 #3 Angular Corrections • Range 15˚- 24˚ Invivo5 Guide Right™ Guide Post Bending Tool 15˚ Illustrating 15˚ bend DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place Lower piece of 2-piece guide post (no offset) 27 4/23/2014 2-Piece Guide Post Straight Lower Piece with Upper Removable Piece The bottom half of all Lower Pieces of the 2-Piece Guide Post are designed with 4 flat sides corresponding with the mesial, distal, buccal & lingual surfaces of the tooth. Upper piece of 2-piece 4.9 mm guide added to lower piece Triad® gel added to capture cleats 3.9 mm guide sleeve on 3.8 mm post 5.1 mm guide sleeve on 4.9 mm post NOTE: Two different SURGICAL guides were fabricated & used in this case to accommodate the initial 3.8 mm hybrid drill & 5 mm diameter drill 28 4/23/2014 Occlusal view Buccal view SURGICAL guide 5.1 mm guide sleeve over 4.9 mm upper post over lower post Occlusal view of SURGICAL guide with upper post removed to view the centered lower post with in the 5.1 mm guide sleeve Buccal view SURGICAL guide 2 mm hybrid drill with 3.8 mm shaft in 5.1 mm guide sleeve 29 4/23/2014 DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place Verification of correction Original path of 3/32” drill DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place 30 4/23/2014 fractured tooth Implant placement 3.9 mm guide sleeve stage 2 surgery How Corrections are Made in 2 Planes ( bucco-lingual & mesio-distal ) Compound Bends Guide Right™ Guide Post Bending Tool 20˚ 1st BEND The 1st correction is made 31 4/23/2014 stylus support bar thumb screws set screw PREPARATION for 2nd Bend • • • After 1st correction the set screw is released with hex driver. Stylus & post are rotated back to the 0˚ position. Support bar is placed on the bending plate against the stylus & thumb screws are re-tightened against the flat side guide post to maintain the angle of the 1st correction while the 2nd correction is made with the support bar in place. 2nd BEND • The set screw is loosened & stylus with guide post are rotated 90˚ up off the bending plate. • The set screw is retightened. • The 2nd correction is now made 90˚ to the 1st bend. RESULT of 2nd BEND The guide post is corrected in the 2nd plane 15˚ while the support bar maintains the 1st correction at 20˚ 32 4/23/2014 Guide Right™ BENDING TOOL COMPOUND BEND overview Step 1 Position a straight or offset guide post in the bending plate, tightening the set screw against one of the flat surfaces on the lower half of the guide post. Step 2 The 1st bend can be made to the right or left direction. Step 3 The set screw is loosened and the guide post is rotated 90 ° next flat surface. Step 4 The 2nd bend in the second plane is made after rotating the guide post up away from the surface of the bending plate to register the stylus point back at 0 degrees. Step 5 Slide the stylus support bar down under the stylus until it supports the stylus. Tighten the side screws before making the second bend. Step 6 The second bend can be made in either direction according to the x-ray. Step 7 Remove the stylus and place the guide post back in the cast with the appropriate side indicated by a mark facing the buccal or lingual surface. Be sure the post is in the correct position. If the post needs to be corrected by a linear movement an offset guide post can be used. Off sets available in the 3 mm guide post: 0.5,1,1.5, 2.0, 2.5 , 3.0, 4.0 or 5 mm. Case 3 Short Implants Sites #19 ► 4.5 x 7 mm • #20 ► 4.5 x 7 • #21 ► 3.5 X 10 • Fabrication DIAGNOSTIC guide • Evaluate using invivio5 software • Corrections: • # 19 1.5 mm offset buccal • # 20 2.5 mm offset to the lingual • # 21 2.5 mm offset to the lingual • Fabricate SURGICAL guide Implant Case featuring 2-Piece Guide Post • Invivo5 Evaluation Diagnostic Guide Surgical Guide 33 4/23/2014 3 mm guide posts positioned in 3/32” holes drilled in cast Lingual view After lubricating the cast and blocking out undercuts, clear Triad® gel has been applied to capture cleat on the guide sleeve & adjacent teeth to form the DIAGNOSTIC guide. Buccal view 3 mm diagnostic guide sleeves with cleats positioned toward the palatal surface on 3 mm straight guide posts 34 4/23/2014 Creating a Guide Right™ Surgical Guide Use of Invivo5 Software to Evaluate, Correct, & Verify prosthetically planned implant trajectory prior to drilling the osteotomy DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate diagnostic guide ▪ evaluate ▪ ▪ ▪ ▪ correct re-fabricate surgical guide verify place #19 Home Position Because of the super-eruption of #15 the position of #18 position will not be used. axial cross sectional Invivo5 tangential volumetric 35 4/23/2014 #19 Cross Sectional View • 1.5 offset buccal The virtual implant is a 4.5 X 7 mm implant. The line A – B indicates the level of the slice seen in the axial view The position of the implant will be corrected 1.5 mm offset toward the buccal surface. Invivo5 Tangential View #19 The virtual implant can be seen in the tangential view Below the guide sleeve. If the line indicating the long axis of the virtual implant passes through the radio-lucent center of the DIAGNOSTIC guide sleeve. No correction is needed Invivo5 #20 Home Position 4.5 X 7 mm implant axial cross sectional Invivo5 tangential volumetric 36 4/23/2014 #20 Cross Sectional View • 2.5 mm offset lingual The line passing through The center of the guide sleeve is offset 2.5 mm from the center of the virtual implant. Linear Correction A 2.5 mm offset post will be used to move the sleeve toward the lingual. Invivo5 # 20 Tangential View The line indicating the long axis of the virtual implant passing through the radio-lucent center of the DIAGNOSTIC guide sleeve in the tangential view indicates NO need for a angle or linear correction mesial or distal. Invivo5 # 21 Home Position 3.5 x10 mm implant • anterior to the mental formen axial cross sectional Invivo5 tangential volumetric 37 4/23/2014 #21 Cross Sectional View The vertical red line indicates the need for a 2.5 mm offset correction to the lingual Invivo5 #21 Tangential View The yellow line is passing through the guide sleeve at an angle because the position of the sleeve is now at an angle to the virtual implant . Invivo5 DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place 38 4/23/2014 Linear Corrections made in this case LINEAR Corrections # 19 1.5 mm offset toward the buccal # 20 2.5 mm offset toward the lingual # 21 2.5 mm offset toward the lingual SEE Guide Right™ Bending Tool Instructions in this presentation 2-piece offset lower piece guide posts are used to make offset corrections 2.5 mm offset posts in sites # 20 & 21 1.5 mm offset post toward the buccal in site # 19. 39 4/23/2014 2.5 mm offset posts in sites # 20 & 21 1.5 mm offset post toward the buccal in site # 19 3.8 mm Side view 2-piece 3.8 mm upper piece positioned on lower piece offset posts It is important that the drill trajectory continue to be maintained while the osteotomy is enlarged. THEREFORE multiple guides with appropriate guide sleeve sizes were be used. 2 SURGICAL guides were made & used in this case • initial SURGICAL guide ( 3 mm guide sleeves ) • 2nd SURGICAL guide to accommodate larger drills 40 4/23/2014 Initial SURGICAL guide for 3 mm drill 3 mm upper piece posts & 3 mm posterior angle cut guide sleeves will be used to prepare the initial osteotomy occlusal view of centered offsets posts in guide sleeves SURGICAL guide 3 mm upper posterior guide post removed & ready for Betadyne in ultra sonic cleaner. A 2nd SURGICAL guide made with 3.8 mm upper guide post & 3.9 mm sleeves. Triad® gel has been added to form body of the template. 41 4/23/2014 Final SURGICAL guide View of 3.9 mm guide sleeves with 3.8 mm upper posts allow the use of drills up to 3.8 mm in diameter. Triad® gel is extended to # 29 to increase stability. DéPlaque Guide Right ™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place implants Resulting implant placement 42 4/23/2014 DéPlaque Guide Right ™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com 43
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