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

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4/23/2014
1
Guide Right™ Surgical Guide System
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
fabricate ▪ evaluate ▪ correct ▪ verify ▪ place
DéPlaque
In-office 3D Surgical Guides for 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
Application of In-office Guide Right™ Surgical Guide System
for Accurately Placing Short Implants
In-office 3D Surgical Guides for Placing Short Implants
Part 1
4/23/2014
2
Introduction to Guide Right™ Surgical Guide System
Is There a Need for Short Implants?
Need for Guided Implant Surgery for Short Implants
description of guide components: purpose & use
use of the Guide Right™ guide system:
fabrication, evaluation, correction & placement using surgical guide for short implants
Case Examples
speaker discussion
fully guided vs partially guided surgery
speaker discussion
Is There a Need for Short Implants?
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.
4/23/2014
3
Study to compare the preservation of marginal bone when using
4 mm diameter implants
6 mm with 11 mm implant length
Conclusive evidence indicates that treatment with short implants
had no negative effect on maintaining marginal bone levels when
compared to standard length implants.
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
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
Rise in injury to inferior alveolar nerve
“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;
Current Use of and need for Guided Surgery
4/23/2014
4
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.
4/23/2014
5
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.
oWider implants have greater surface area
Restoration of Short Implants
Need for Guided Implant Surgery for Short Implants
fully guided
vs
partially guided surgery
4/23/2014
6
Guide Right™ Surgical Guide System
Start With Precision. Place With Confidence.™
Comparison with ▪ without guide used in implant placement planning
DéPlaque
#19 #30
#29
#21
implants placed WITHOUT a guide implants placed WITH a guide
Introduction to Guide Right™ Surgical Guide System
description of guide components, purpose & use
A Geometric approach to guided implant placement
In-office or lab fabrication
Evaluate with 3D imaging
Allows linear and angular correction
Enables precision implant placement
Cost effective
A System of Components
for the fabrication & correction of diagnostic & surgical guides
in three dimensions
Guide Right™ Surgical Guide System
4/23/2014
7
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: cylindrical · open
Pilot Drills
Pin-vice
Guide Post Bending Tool
Standard Guide Posts
for fabricating diagnostic guide
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.
Straight
4/23/2014
8
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
4/23/2014
9
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
3/32”
5/64” drill
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.
4/23/2014
10
Correctable Magnetic Offset Guide Post
3.0 X 0.5 mm offset (up to 5 mm offset)
used with open guide sleeves
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.
4/23/2014
11
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.
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 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 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 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.
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.
Guide Right™
GUIDE POST BENDING TOOL
SINGLE BEND review
4/23/2014
12
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 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 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.
Step 3 The set screw is loosened and the guide post is rotated 90 ° next flat surface.
Step 2 The 1st bend can be made to the right or left direction.
Step 6 The second bend can be made in either direction according to the x-ray.
Guide Right™
BENDING TOOL
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
4/23/2014
13
Short Implant
site # 3
•Fabrication DIAGNOSTIC guide
•Evaluate using invivio5 software
•No correction necessary
•Fabricate SURGICAL guide
Case 1
•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
Surgical Guide
Diagnostic Guide
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate diagnostic guide
▪ evaluate
▪ correct
▪ re-fabricate surgical guide
▪ verify
▪ place
4/23/2014
14
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
4/23/2014
15
Guide Right™ Surgical Guide System
DéPlaque
▪ 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 cross section
tangential volumetric
of virtual planned
implant position
Invivo5
4/23/2014
16
Axial view
# 3
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
Cross Section view
# 3
Angular Correction
•not needed
Implant
•5 X 6 mm
Invivo5
Tangential view
# 3
Angle Correction
•not needed
Linear Correction
•0.5 mm offset
mesial
Invivo5
4/23/2014
17
Guide Right™ Surgical Guide System
DéPlaque
▪ 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
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
4/23/2014
18
tangential cross section
Verify
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
4/23/2014
19
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
4/23/2014
20
5 mm trephine drill inserted in guide sleeve
SURGICAL guide
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
Occlusal view of clinical site prior to the procedure
4/23/2014
21
Mirror shot with SURGICAL guide in place
Guide in place with implant & carrier in placed
Cover screw in place
Palatal incision with flap reflected toward the buccal surface
4/23/2014
22
Final implant placement
(avoiding a sinus elevation)
Verification of accurate placement with SURGICAL guide in place
Short Implant 5.5 X 7 mm
site # 3,
•Fabrication DIAGNOSTIC guide
•Evaluate using invivio5 software
•No correction necessary
•Fabricate SURGICAL guide
Case 2
•mm guide post 5.25
•mm guide sleeve 5.3
4/23/2014
23
Single Implant Case
featuring
2-Piece Guide Post • Invivo5 Evaluation
Surgical Guide Diagnostic Guide
# 3
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate diagnostic guide
▪ evaluate
▪ correct
▪ re-fabricate surgical guide
▪ verify
▪ place
3/32” drill positioned in 3/32” hole drilled in cast
4/23/2014
24
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
4/23/2014
25
Triad® gel added to capture cleat of 3 mm guide sleeve
to form DIAGNOSTIC guide
Guide Right™ Surgical Guide System
DéPlaque
▪ 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
4/23/2014
26
Home Position
# 3
axial cross section
tangential volumetric
Invivo5
Angular Corrections • 24˚
6 x 6 mm adjusted with hard sharpened filter
# 3
axial cross section
tangential volumetric
Invivo5
Angular Correction • 24˚ palatally
# 3
cross section
tangential
Invivo5
4/23/2014
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Angular Corrections • Range 15˚- 24˚
# 3
Invivo5
Guide Right™
Guide Post Bending Tool
Illustrating 15˚ bend
15˚
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
Lower piece of 2-piece guide post (no offset)
4/23/2014
28
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
5.1 mm guide sleeve on 4.9 mm post 3.9 mm guide sleeve on 3.8 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
4/23/2014
29
Buccal view
SURGICAL guide
5.1 mm guide sleeve over 4.9 mm upper post over lower post
Occlusal view
Occlusal view of SURGICAL guide with upper post removed
to view the centered lower post with in the 5.1 mm guide sleeve
2 mm hybrid drill with 3.8 mm shaft in 5.1 mm guide sleeve
Buccal view SURGICAL guide
4/23/2014
30
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
Original path of 3/32” drill
Verification of correction
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
4/23/2014
31
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
The 1st correction is made
20˚
1st BEND
4/23/2014
32
•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.
set screw
thumb screws
stylus
support bar
PREPARATION for 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.
2nd BEND
The guide post is corrected in the 2nd plane 15˚
while the support bar maintains the 1st correction at 20˚
RESULT of 2nd BEND
4/23/2014
33
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 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 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.
Step 3 The set screw is loosened and the guide post is rotated 90 ° next flat surface.
Step 2 The 1st bend can be made to the right or left direction.
Step 6 The second bend can be made in either direction according to the x-ray.
Guide Right™
BENDING TOOL
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
Case 3
Implant Case
featuring
2-Piece Guide Post • Invivo5 Evaluation
Diagnostic Guide Surgical Guide
4/23/2014
34
3 mm guide posts positioned in 3/32” holes drilled in cast
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.
Lingual view
3 mm diagnostic guide sleeves with cleats positioned
toward the palatal surface on 3 mm straight guide posts
Buccal view
4/23/2014
35
Creating a Guide Right™ Surgical Guide
Use of Invivo5 Software
to
Evaluate, Correct, & Verify
prosthetically planned implant trajectory
prior to drilling the osteotomy
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate diagnostic guide
▪ evaluate
▪ correct
▪ re-fabricate surgical guide
▪ verify
▪ place
tangential volumetric
axial cross sectional
Invivo5
Because of the super-eruption of #15 the position of #18 position will not be used.
#19 Home Position
4/23/2014
36
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.
#19
Invivo5
Tangential View
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
#19
Invivo5
#20 Home Position
4.5 X 7 mm implant
tangential volumetric
axial cross sectional
Invivo5
4/23/2014
37
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.
#20
Invivo5
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.
# 20
Invivo5
# 21 Home Position
3.5 x10 mm implant • anterior to the mental formen
tangential volumetric
axial cross sectional
Invivo5
4/23/2014
38
Cross Sectional View
The vertical red line
indicates the need for a
2.5 mm offset correction
to the lingual
#21
Invivo5
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 .
#21
Invivo5
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place
4/23/2014
39
SEE
Guide Right™ Bending Tool Instructions in this presentation
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
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.
4/23/2014
40
2.5 mm offset posts in sites # 20 & 21
1.5 mm offset post toward the buccal in site # 19
Side view
2-piece 3.8 mm upper piece positioned on lower piece offset posts
3.8 mm
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
4/23/2014
41
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
SURGICAL guide 3 mm upper posterior guide post removed &
ready for Betadyne in ultra sonic cleaner.
occlusal view of centered offsets posts in guide sleeves
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.
4/23/2014
42
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.
Final SURGICAL guide
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide]
▪ evaluate
▪ correct
▪ re-fabricate [surgical guide]
▪ verify
▪ place implants
Resulting implant placement
4/23/2014
43
Guide Right™ Surgical Guide System
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
fabricate ▪ evaluate ▪ correct ▪ verify ▪ place
DéPlaque

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