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Guide Right™
                   Fibular Graft Case


    Featuring:
   # 29 and #30
   3 mm Guide Posts
   3 mm Diagnostic Guide Sleeves
   3 mm Magnetic Guide Posts
   3.3 and 4 mm Open Guide Sleeves
   Generation ll / Guide Post Bending Tool
   Invivo5 Software Evaluation
    Anatomage




KARLS
This patient had a section of the mandible removed & grafted
with a vascular fibular graft 2 years prior to implant placement.
Fabrication of DIAGNOSTIC Guide
 3/32” holes were drilled in the cast in the positions of the 2nd bicuspid and 1st molar.
 The cast was lubricated with petroleum jelly.
 Two straight 3 mm guide posts were placed in the openings.
3 mm cylindrical guide sleeves were placed on the guide posts
with cleats positioned toward the lingual surface.
Triad® Gel was added & cured to capture the cleats& form the DIAGNOSTIC
guide which was placed in the patient and a cone beam X-ray was taken.
Pre-op
    Invivo5
    Anatomage

Software Evaluation
# 29
                               Initial Alignment
           axial                                                  cross sectional




                                                 Invivo5
                                                Anatomage




           tangential                                                  volumetric

The DIAGNAOSTIC guide sleeves viewed in the cone beam images were evaluated.
                        [ axial, tangential and cross sectional views ]
# 29
8° angular correction to the mesial is necessary

 axial                              cross sectional




                         Invivo5
                        Anatomage




 tangential                              volumetric
# 29
▪ close-up showing 8° bend toward the mesial needed ▪




                       tangential


 Invivo5
Anatomage
# 29
        ANGULAR CORRECTION: 5 ° toward the lingual
          LINEAR CORRECTION: 1 mm offset

axial                                 cross sectional




                           Invivo5
                          Anatomage




tangential                                 volumetric
# 29         cross section
            tangential


   5° angular correction          1 mm offset linear correction

 Invivo5
Anatomage
# 30
             Initial Alignment
axial                             cross sectional




                      Invivo5
                        Invivo5
                     Anatomage
                      Anatomage




tangential                            volumetric
# 30
            Shows initial alignment is NOT cross sectional
                                           GOOD




                           cross sectional view
 Invivo5
Anatomage
# 30
4.8 mm X 10 mm Straumann Implant (virtual image)
1 mm offset guide post > 15° bend toward lingual


axial                                 cross sectional




                         Invivo5
                        Anatomage




tangential                                 volumetric
# 30   shows a 15° angular correction is necessary for the
   guide sleeve to line up with the position of thecross sectional
                                                     virtual implant




                             tangential view
 Invivo5
Anatomage
Guide Right™
       Generation ll ▪ Guide Post Bending Tool


                                               10 ° example




  For more information on use of the bending tool go to
www.deplaque.com ▪ Guide Right™ Generation ll Bending Tool
Preview of Pre-op Corrections

               #29                                    #30

   LINEAR CORRECTION                        LINEAR CORRECTION
            1 mm offset                          1 mm offset

  ANGULAR CORRECTION                      ANGULAR CORRECTION
1ST BEND:    8° toward the mesial        1 BEND: 15° toward lingual
2nd BEND:    5° toward the lingual


            Cosine is applied to determine correction data.
                           * see next 3 slide
# 29




       Guide post positioned in the bending tool
            with offset positioned forward.
# 29




             BEND
       8° toward the mesial
The 1 mm offset guide post with an 8 mm correction is rotated 90°
and placed back in the bending tool for the second 5° bend toward lingual.
# 29   5° correction
# 30




 stylus over 1 mm offset guide post bent 15° toward lingual
tangential view   cross sectional view

      # 29                # 29
8° lingual bend       1 mm offset
                        5 ° bend
Offset magnetic guide posts in cast
Buccal view of magnetic guide post with open guide sleeve
Fabrication of SURGICAL Guide
Triad® Gel added to open guide sleeves to form the SURGICAL guide.
SURGICAL Guide
Ramus plate must be avoided
Post-op
   Invivo5
   Anatomage

Software Verification
#29
               Note: implant placement
with virtual implants positioned over actual implants

   axial                               cross sectional




                            Invivo5
                           Anatomage




   tangential                               volumetric
#30
             Post-op Implant Placement

axial                                 cross sectional




                           Invivo5
                          Anatomage




tangential                                 volumetric
Custom impression coping due to the depth of the fixture
Peri-apical X-ray to confirm seating of impression coping.
Custom Atlantis Abutments
Final restoration in master cast
Restoration on master cast
Atlantis Abutments in place
Final restoration
Magnetic Offset 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
 3.0 od X 2.5 mm os
 3.0 od X 3.0 mm os
Guide Right™
Products shown in this case

 3/32” Drill
   3 mm Guide Posts
   3 mm Diagnostic Guide Sleeves
   3 mm Magnetic guide posts
   3.3 mm Open Guide sleeves
   4 mm Open Guide Sleeves
   1.0 mm Offset Magnetic Guide Sleeve
 Triad® Gel

     1.800.314.0065    •   www.deplaque.com
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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19 fibular graft case

  • 1. Guide Right™ Fibular Graft Case Featuring:  # 29 and #30  3 mm Guide Posts  3 mm Diagnostic Guide Sleeves  3 mm Magnetic Guide Posts  3.3 and 4 mm Open Guide Sleeves  Generation ll / Guide Post Bending Tool  Invivo5 Software Evaluation Anatomage KARLS
  • 2. This patient had a section of the mandible removed & grafted with a vascular fibular graft 2 years prior to implant placement.
  • 4.  3/32” holes were drilled in the cast in the positions of the 2nd bicuspid and 1st molar.  The cast was lubricated with petroleum jelly.  Two straight 3 mm guide posts were placed in the openings.
  • 5. 3 mm cylindrical guide sleeves were placed on the guide posts with cleats positioned toward the lingual surface.
  • 6. Triad® Gel was added & cured to capture the cleats& form the DIAGNOSTIC guide which was placed in the patient and a cone beam X-ray was taken.
  • 7. Pre-op Invivo5 Anatomage Software Evaluation
  • 8. # 29 Initial Alignment axial cross sectional Invivo5 Anatomage tangential volumetric The DIAGNAOSTIC guide sleeves viewed in the cone beam images were evaluated. [ axial, tangential and cross sectional views ]
  • 9. # 29 8° angular correction to the mesial is necessary axial cross sectional Invivo5 Anatomage tangential volumetric
  • 10. # 29 ▪ close-up showing 8° bend toward the mesial needed ▪ tangential Invivo5 Anatomage
  • 11. # 29 ANGULAR CORRECTION: 5 ° toward the lingual LINEAR CORRECTION: 1 mm offset axial cross sectional Invivo5 Anatomage tangential volumetric
  • 12. # 29 cross section tangential 5° angular correction 1 mm offset linear correction Invivo5 Anatomage
  • 13. # 30 Initial Alignment axial cross sectional Invivo5 Invivo5 Anatomage Anatomage tangential volumetric
  • 14. # 30 Shows initial alignment is NOT cross sectional GOOD cross sectional view Invivo5 Anatomage
  • 15. # 30 4.8 mm X 10 mm Straumann Implant (virtual image) 1 mm offset guide post > 15° bend toward lingual axial cross sectional Invivo5 Anatomage tangential volumetric
  • 16. # 30 shows a 15° angular correction is necessary for the guide sleeve to line up with the position of thecross sectional virtual implant tangential view Invivo5 Anatomage
  • 17. Guide Right™ Generation ll ▪ Guide Post Bending Tool 10 ° example For more information on use of the bending tool go to www.deplaque.com ▪ Guide Right™ Generation ll Bending Tool
  • 18. Preview of Pre-op Corrections #29 #30 LINEAR CORRECTION LINEAR CORRECTION 1 mm offset 1 mm offset ANGULAR CORRECTION ANGULAR CORRECTION 1ST BEND: 8° toward the mesial 1 BEND: 15° toward lingual 2nd BEND: 5° toward the lingual Cosine is applied to determine correction data. * see next 3 slide
  • 19. # 29 Guide post positioned in the bending tool with offset positioned forward.
  • 20. # 29 BEND 8° toward the mesial
  • 21. The 1 mm offset guide post with an 8 mm correction is rotated 90° and placed back in the bending tool for the second 5° bend toward lingual.
  • 22. # 29 5° correction
  • 23. # 30 stylus over 1 mm offset guide post bent 15° toward lingual
  • 24. tangential view cross sectional view # 29 # 29 8° lingual bend 1 mm offset 5 ° bend
  • 25. Offset magnetic guide posts in cast
  • 26. Buccal view of magnetic guide post with open guide sleeve
  • 28. Triad® Gel added to open guide sleeves to form the SURGICAL guide.
  • 30. Ramus plate must be avoided
  • 31. Post-op Invivo5 Anatomage Software Verification
  • 32. #29 Note: implant placement with virtual implants positioned over actual implants axial cross sectional Invivo5 Anatomage tangential volumetric
  • 33. #30 Post-op Implant Placement axial cross sectional Invivo5 Anatomage tangential volumetric
  • 34. Custom impression coping due to the depth of the fixture
  • 35. Peri-apical X-ray to confirm seating of impression coping.
  • 37. Final restoration in master cast
  • 41. Magnetic Offset 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  3.0 od X 2.5 mm os  3.0 od X 3.0 mm os
  • 42. Guide Right™ Products shown in this case  3/32” Drill  3 mm Guide Posts  3 mm Diagnostic Guide Sleeves  3 mm Magnetic guide posts  3.3 mm Open Guide sleeves  4 mm Open Guide Sleeves  1.0 mm Offset Magnetic Guide Sleeve  Triad® Gel 1.800.314.0065 • www.deplaque.com
  • 43. DéPlaque Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com