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Guide Right™
               Edentulous Maxillary Arch


        6 implants
            magnetic guide post
            3 mm open guide sleeves
            2 mm guide sleeves
                        Invivo5
             GALAXIS   Anatomage
        software evaluation ▪ comparison



HOO 2.2013
Duplication & Conversion of Complete Denture
        into DIAGNOSTIC Guide
Duplicate, trim and try the denture in to be sure it still fits etc.
View into the mucosal side of the denture base where 10
shallow holes have marked the center of the alveolar ridge.
Holes are drilled through the denture base with a 3/32” drill from the mucosal
side of the denture centered in the middle of the concavity of the alveolar ridge.
 3 mm holes are drilled in the denture
  where the proposed implant sites
  are possible.

    3 mm od X 2 mm id aluminum guide sleeves
    (0 cleats)

 Clear Triad® Gel has be added to
  secure them on the oral side of the
  denture.

 6 to 8 sites will be chosen based on the
  cone beam X-ray.

 At this point the patient and denture are
  ready for the cone beam volumetric X-ray.

 Several screws (13 - 15 mm) will be placed
  in 2 or more of the sites to stabilize the
  denture during the surgery.
Lab putty has been mixed and molded into the
denture base with 3 mm od X 2 mm id guide sleeves guide sleeves in place
                 and removed leaving an indentation in the lab putty.
2 mm drills have been used
to index the guide sleeves
by drilling through them
into the Lab Putty at least
10-12 mm
The denture and drills have been removed leaving the registration holes
of the long axis of the guide posts in the lab putty.
PREOPERATIVE
            Evaluation


      GALAXIS Software
        Galileos

       Invivo5        Software
       Anatomage

panoramic ▪ tangential ▪ cross sectional
Preview of Pre-op Corrections

        #4                        #6                            #8
NO CORRECTION          ANGULAR CORRECTION            ANGULAR CORRECTION
                      28° bend toward the palatal    17º bend toward the palatal

                                  # 11
                        ANGULAR CORRECTION
                       33º bend toward the palatal

           #9                                              # 13
 ANGULAR CORRECTION                              LINEAR CORRECTION
31º bend toward the palatal                   1 mm offset toward the buccal
Selecting the Corrective Angle
  There is not one specific angle that is the absolute angle of placement.
  The range varies by 20° between the buccal and lingual plates.

  The position nearest the guide sleeve with the smallest angle should be selected
  depending on the closest to the opposing restoration. [ In this case position (B) ]




                       A                                       B
Invivo5
Anatomage
#4 Initial Alignment

axial                               cross section




                        Invivo5
                        Anatomage




tangential                            volumetric
#4 ANGULAR CORRECTION: 12° toward the facial




          cross section         tangential
GALAXIS
#4 ANGULAR CORRECTION: 15°




        Invivo5                    GALAXIS
        Anatomage



           cross sectional views
#6 ANGULAR CORRECTION: 28° toward the palatal
axial                                 cross section




                        Invivo5
                        Anatomage




tangential                              volumetric
# 6 ANGULAR CORRECTION: 28° to 31° to the buccal




  Invivo5                               GALAXIS
  Anatomage



                 cross sectional view
#8       ANGULAR CORRECTION: 24º indicated

axial                                    cross section




                             Invivo5
                            Invivo5
                             Anatomage
                            Anatomage




tangential                                 volumetric
#8   ANGULAR CORRECTION: 24° toward facial




              Invivo5                 GALAXIS
              Anatomage




                      cross section
# 9 ANGULAR CORRECTION: 31º Indicated

axial                                    cross section




                           Invivo5
                           Anatomage




tangential                                 volumetric
#9   31º Angle is Measured




       Invivo5                  GALAXIS
       Anatomage



         cross sectional view
#11 ANGULAR CORRECTION: 24º indicated

axial                                    cross section




                           Invivo5
                           Anatomage




tangential                                 volumetric
#11   ANGULAR CORRECTION: 24º to the facial




              Invivo5                  GALAXIS
              Anatomage
#11 ANGULAR CORRECTION: 28° to 31°
                software comparison




Invivo5
Anatomage



                       cross sectional views
#13 LINEAR CORRECTION: 1 mm offset toward the buccal

  axial                                   cross section




                           Invivo5
                           Anatomage




   tangential                             volumetric
#13 LINEAR CORRECTION: 1.5 mm toward the buccal




               Invivo5                   GALAXIS
               Anatomage


                      cross section
#13 LINEAR CORRECTION: 1.5 mm toward the buccal
             Software Comparison




               Invivo5                    GALAXIS
               Anatomage
Review of Pre-op Corrections

        #4                        #6                            #8
NO CORRECTION          ANGULAR CORRECTION            ANGULAR CORRECTION
                      28° bend toward the palatal    17º bend toward the palatal

                                  # 11
                        ANGULAR CORRECTION
                       33º bend toward the palatal

           #9                                              # 13
 ANGULAR CORRECTION                              LINEAR CORRECTION
31º bend toward the palatal                   1 mm offset toward the buccal
Guide Right™
                        GUIDE POST BENDING TOOL
    If the angle needs to be corrected a guide post is bent in the Guide Right™ Bending Tool.


 A guide post is placed in the bending tool
  and a set screw tightened.
 The bending stylus is placed over the
  guide post and the post is bent in the first
  plane.
 If a second bend is indicated by a scan the
  bent post in loosened and rotated 90
  degrees and the set screw retightened.
 The slide support bar is moved down in
  contact with the stylus and the second
  bend is made in the second plane.                      Bending tool step by step
                                                         guide at end of this slideshow.
Fabrication of SURGICAL Guide
• 3 mm magnetic guide posts with smaller diameter 3/32” lower half
  have been inserted into the 2 mm holes in the Lab Putty.

• They have not been corrected yet with the information from the volumetric
  scan.
• After bending the posts to the correct angles, according to the cone beam X-ray,
  the posts are marked on the facial surface to orient them to be placed back in the
  Lab Putty.
• Posts should also be marked sequentially (1-6) to keep them in order.
 Open guide sleeves are used for the
    best visibility during surgery .


 The acrylic sides of the denture have been
    removed with acrylic burrs to form slots
    where the guide sleeves have been
    removed for the placement of the angle
    corrected open guide sleeves on the
    magnetic guide posts


   Note the offset guide post in the right most distal #13
    site used to correct the linear position of the implant.
Open guide sleeves have been added to the magnetic guide posts with the
cleats positioned on the palatal surface without interference from the acrylic
of the duplicated denture.
Triad® Gel is added to the remaining denture base
to capture the open guide sleeves and the cleats.
After incorporating the open guide sleeves two additional 3 mm holes
              are used in the #7 and #10 positions
             to accommodate 2 mm guide sleeves
    for 2 mm x 15 mm screws (Salvin) to stabilize the denture.
2 mm X 15 mm screws will be used to stabilize the
Denture while the osteotomies are being prepared.
Open guide sleeves allow visibility of drill depth markings.
A milled bar with locator
attachments is made to
support the prosthesis
Final Prosthesis
Milled bar with locator attachments
Intraoral view of attached bar
Insertion of milled bar.
Intraoral view of final prosthesis.
Final Prosthesis
Guide Right™
       Products shown in this Presentation

   (2) 3/32” drill
   (10) 3 mm od X 2 mm id guide sleeves (0 cleats) special phone order
   (6) 2 mm Drills
   (5) 3 mm Magnetic Guide Posts
   (1) 1 mm Offset Magnetic Guide Posts
   (6) 3 mm Open Guide Sleeves
   (1) Guide Post /Generation ll Bending Tool & 3mm Stylus
    Acrylic Burrs
    Triad® Gel from your dental products supplier


                      1.800.314.0065 •    www.deplaque.com
Guide Right™
    GENERATION II / 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.
Guide Right™
   GENERATION II / GUIDE POST 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.
DéPlaque


Guide Right™ Surgical Guide System
 fabricate ▪ evaluate ▪ correct ▪ verify ▪ place




Start With Precision. Place With Confidence.™

      1.800.314.0065 •     www.deplaque.com

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18 maxillary edentulous case

  • 1. Guide Right™ Edentulous Maxillary Arch  6 implants  magnetic guide post  3 mm open guide sleeves  2 mm guide sleeves Invivo5 GALAXIS Anatomage  software evaluation ▪ comparison HOO 2.2013
  • 2. Duplication & Conversion of Complete Denture into DIAGNOSTIC Guide
  • 3. Duplicate, trim and try the denture in to be sure it still fits etc.
  • 4. View into the mucosal side of the denture base where 10 shallow holes have marked the center of the alveolar ridge.
  • 5. Holes are drilled through the denture base with a 3/32” drill from the mucosal side of the denture centered in the middle of the concavity of the alveolar ridge.
  • 6.  3 mm holes are drilled in the denture where the proposed implant sites are possible.  3 mm od X 2 mm id aluminum guide sleeves (0 cleats)  Clear Triad® Gel has be added to secure them on the oral side of the denture.  6 to 8 sites will be chosen based on the cone beam X-ray.  At this point the patient and denture are ready for the cone beam volumetric X-ray.  Several screws (13 - 15 mm) will be placed in 2 or more of the sites to stabilize the denture during the surgery.
  • 7. Lab putty has been mixed and molded into the denture base with 3 mm od X 2 mm id guide sleeves guide sleeves in place and removed leaving an indentation in the lab putty.
  • 8. 2 mm drills have been used to index the guide sleeves by drilling through them into the Lab Putty at least 10-12 mm
  • 9. The denture and drills have been removed leaving the registration holes of the long axis of the guide posts in the lab putty.
  • 10. PREOPERATIVE Evaluation GALAXIS Software Galileos Invivo5 Software Anatomage panoramic ▪ tangential ▪ cross sectional
  • 11. Preview of Pre-op Corrections #4 #6 #8 NO CORRECTION ANGULAR CORRECTION ANGULAR CORRECTION 28° bend toward the palatal 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal #9 # 13 ANGULAR CORRECTION LINEAR CORRECTION 31º bend toward the palatal 1 mm offset toward the buccal
  • 12. Selecting the Corrective Angle There is not one specific angle that is the absolute angle of placement. The range varies by 20° between the buccal and lingual plates. The position nearest the guide sleeve with the smallest angle should be selected depending on the closest to the opposing restoration. [ In this case position (B) ] A B Invivo5 Anatomage
  • 13. #4 Initial Alignment axial cross section Invivo5 Anatomage tangential volumetric
  • 14. #4 ANGULAR CORRECTION: 12° toward the facial cross section tangential GALAXIS
  • 15. #4 ANGULAR CORRECTION: 15° Invivo5 GALAXIS Anatomage cross sectional views
  • 16. #6 ANGULAR CORRECTION: 28° toward the palatal axial cross section Invivo5 Anatomage tangential volumetric
  • 17. # 6 ANGULAR CORRECTION: 28° to 31° to the buccal Invivo5 GALAXIS Anatomage cross sectional view
  • 18. #8 ANGULAR CORRECTION: 24º indicated axial cross section Invivo5 Invivo5 Anatomage Anatomage tangential volumetric
  • 19. #8 ANGULAR CORRECTION: 24° toward facial Invivo5 GALAXIS Anatomage cross section
  • 20. # 9 ANGULAR CORRECTION: 31º Indicated axial cross section Invivo5 Anatomage tangential volumetric
  • 21. #9 31º Angle is Measured Invivo5 GALAXIS Anatomage cross sectional view
  • 22. #11 ANGULAR CORRECTION: 24º indicated axial cross section Invivo5 Anatomage tangential volumetric
  • 23. #11 ANGULAR CORRECTION: 24º to the facial Invivo5 GALAXIS Anatomage
  • 24. #11 ANGULAR CORRECTION: 28° to 31° software comparison Invivo5 Anatomage cross sectional views
  • 25. #13 LINEAR CORRECTION: 1 mm offset toward the buccal axial cross section Invivo5 Anatomage tangential volumetric
  • 26. #13 LINEAR CORRECTION: 1.5 mm toward the buccal Invivo5 GALAXIS Anatomage cross section
  • 27. #13 LINEAR CORRECTION: 1.5 mm toward the buccal Software Comparison Invivo5 GALAXIS Anatomage
  • 28. Review of Pre-op Corrections #4 #6 #8 NO CORRECTION ANGULAR CORRECTION ANGULAR CORRECTION 28° bend toward the palatal 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal #9 # 13 ANGULAR CORRECTION LINEAR CORRECTION 31º bend toward the palatal 1 mm offset toward the buccal
  • 29. Guide Right™ GUIDE POST BENDING TOOL If the angle needs to be corrected a guide post is bent in the Guide Right™ Bending Tool.  A guide post is placed in the bending tool and a set screw tightened.  The bending stylus is placed over the guide post and the post is bent in the first plane.  If a second bend is indicated by a scan the bent post in loosened and rotated 90 degrees and the set screw retightened.  The slide support bar is moved down in contact with the stylus and the second bend is made in the second plane. Bending tool step by step guide at end of this slideshow.
  • 31. • 3 mm magnetic guide posts with smaller diameter 3/32” lower half have been inserted into the 2 mm holes in the Lab Putty. • They have not been corrected yet with the information from the volumetric scan.
  • 32. • After bending the posts to the correct angles, according to the cone beam X-ray, the posts are marked on the facial surface to orient them to be placed back in the Lab Putty. • Posts should also be marked sequentially (1-6) to keep them in order.
  • 33.  Open guide sleeves are used for the best visibility during surgery .  The acrylic sides of the denture have been removed with acrylic burrs to form slots where the guide sleeves have been removed for the placement of the angle corrected open guide sleeves on the magnetic guide posts  Note the offset guide post in the right most distal #13 site used to correct the linear position of the implant.
  • 34. Open guide sleeves have been added to the magnetic guide posts with the cleats positioned on the palatal surface without interference from the acrylic of the duplicated denture.
  • 35. Triad® Gel is added to the remaining denture base to capture the open guide sleeves and the cleats.
  • 36. After incorporating the open guide sleeves two additional 3 mm holes are used in the #7 and #10 positions to accommodate 2 mm guide sleeves for 2 mm x 15 mm screws (Salvin) to stabilize the denture.
  • 37. 2 mm X 15 mm screws will be used to stabilize the Denture while the osteotomies are being prepared.
  • 38. Open guide sleeves allow visibility of drill depth markings.
  • 39. A milled bar with locator attachments is made to support the prosthesis
  • 41. Milled bar with locator attachments
  • 42. Intraoral view of attached bar
  • 44. Intraoral view of final prosthesis.
  • 46. Guide Right™ Products shown in this Presentation  (2) 3/32” drill  (10) 3 mm od X 2 mm id guide sleeves (0 cleats) special phone order  (6) 2 mm Drills  (5) 3 mm Magnetic Guide Posts  (1) 1 mm Offset Magnetic Guide Posts  (6) 3 mm Open Guide Sleeves  (1) Guide Post /Generation ll Bending Tool & 3mm Stylus  Acrylic Burrs  Triad® Gel from your dental products supplier 1.800.314.0065 • www.deplaque.com
  • 47. Guide Right™ GENERATION II / 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.
  • 48. Guide Right™ GENERATION II / GUIDE POST 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.
  • 49. DéPlaque Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com