# 23 SINGLE IMPLANT CASE Osteotomy Progression in Open Guide Sleeve Featuring 3 x1.0 mm Magnetic Offset Guide Post Open Guide Sleeve Utilizing Cosine Rule Generation ll Bending Tool GALAXIS Software Evaluation Invivo5 Software Evaluation Drill series in SURGICAL Guide TUIT 2013

Fabrication of DIAGNOSTIC Guide

A 3/32” hole is drilled in the cast

Buccal view

Generation ll straight guide post showing 4 flat sides & marker dot. 2 mm guide post 2 mm guide sleeve

A 2 mm guide post with 2 mm guide sleeve (used in narrow spaces) is placed in the hole.

Triad® Gel was added to capture the cleat of the guide sleeve to form the DIAGNOSTIC guide

GALAXIS Cone Beam Images PRE-operative Evaluation

#23 Panoramic view GALAXIS

cross sectional view indications Close up NOTE: distance between yellow & green lines = angular correction of 20° cs view shows that the virtual implant should be repositioned 1 mm toward the lingual plus the axis bent toward the lingual position the implant in the center of the bone (blow up section between yellow and green lines) 1st angle correction must be deleted before 2nd correction can be made. GALAXIS necessary to correctly place implant virtual implant should be repositioned 1 mm toward the lingual & positioned in the center of the bone axis should be bent toward the lingual # 23

Tangential View Indications: # 23 Tangential View Indications: Implant could be repositioned 6° Angle bent toward the mesial (left) Implant centered between the roots of the adjacent teeth 6° angular correction is necessary to correctly place implant Tangential view suggests the implant could be repositioned 6° angled toward the mesial (left) to be center between the roots of the adjacent teeth GALAXIS 1st angle correction must be deleted before 2nd angle correction can be made.

Preview of Corrections Invivo5 Anatomage ANGULAR CORRECTION #23 LINEAR CORRECTION 1 mm offset toward the lingual 1st BEND: 20° toward the lingual 2nd BEND: 6° toward the mesial

ALIGNMENT of guide sleeve with long axis of implant FIRST BEND: 20° correction to the lingual # 23 cross sectional (bucco-lingual) axial Invivo5 Anatomage tangential (mesio-distal) volumetric

Evaluation Plane : yellow line which should be (is) a bucco-lingual / cross sectional orientation # 23 Invivo5 Anatomage axial view

Axial view should always be adjusted to the 90° cross sectional plane of the alveolar ridge. # 23 Each time a change is made in the Invivo5 software go back to the initial line up view and calculate the angle in the 2nd plane. When the correction of the angle of a Guide Right guide sleeve is made with the Invivo5 software rotation tool in one plane (tangential, for example) the other plane (cross sectional plane) is no longer visible after about a 10° rotation. Therefore, it is necessary to go back to the initial alignment view (implant screen) and make changes in the other plane. axial view evaluation plane

ALIGNMENT (bucco-lingual) Indication: 20° Angular Correction to the Lingual is needed Invivo5 Anatomage FIRST BEND An angle is measured where the line passing thru the long axis of the implant and the long axis of the guide sleeve intersect. In this case: 20° cross sectional view

3 mm magnetic guide post with 1 3 mm magnetic guide post with 1.0 mm offset in bending block to be bent 20°

Initially, the stylus over the unbent offset guide post should point to zero.

FIRST BEND: 20º

ALIGNMENT of guide sleeve with long axis of implant SECOND BEND: 6° Angular Correction toward the mesial # 23 axial cross sectional Invivo5 Anatomage tangential volumetric image

# 23 PRE-OP initial ALIGNMENT Indication: 6° Angular Correction Necessary Invivo5 Anatomage axial view

Indication: 6° Correction toward mesial is needed # 23 Pre-op SECOND BEND Invivo5 Anatomage tangential view

INITIAL ALIGNMENT: guide post with virtual implant # 23 INITIAL ALIGNMENT: guide post with virtual implant Invivo5 Anatomage cross sectional view

ALIGNMENT (bucco-lingual) Indication: 20° Angular Correction to the Lingual is needed Invivo5 Anatomage For FIRST BEND An angle is measured by intersection of the line passing thru the long axis of the implant and the long axis of the guide sleeve. In this case, 20° cross sectional view

SECOND BEND: 6°

Generation ll (4 sided lower portion of post) 3 mm X 1 mm offset Magnetic Offset Guide Post with 20º bend toward the lingual 6º bend toward the mesial

3 mm X 1 mm offset magnetic guide post Corrected 3 mm X 1 mm offset magnetic guide post with open guide sleeve

Fabrication of Surgical Guide

Bent 1 mm offset guide post in cast

3 mm open guide sleeve positioned over 3 mm x 1 mm offset post with cleats to the lingual.

with corrected offset magnetic guide post SURGICAL Guide with corrected offset magnetic guide post

SURGICAL guide in place with initial 2 mm drill

with DIAGNOSTIC guide post to check the placement. Periapical X-ray with DIAGNOSTIC guide post to check the placement.

2 mm drill

2.5 mm drill

Implant carrier

Cover screw

Final placement

Guide Right™ Products shown in this case 1 - 3/32” drill 1 - 2 mm Guide Post 1 - 2 mm Guide Sleeve 1 - 3 mm X 1 mm offset Magnetic Offset Guide Post 1 - 3 mm Open Guide Sleeve Generation ll Bending Tool Triad® Gel 1.800.314.0065 • www.deplaque.com

Guide Right™ Generation ii Bending Tool SINGLE BEND review 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™ Generation ii 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 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.

A System of Components for the fabrication and correction of diagnostic & surgical guide in one or two dimensions In-office or lab fabrication Evaluate with 2D & 3D imaging Allows linear and angular correction Enables precision implant placement Cost effective 1.800.314.0065 • www.deplaque.com

Guide Right™ Surgical Guide System DéPlaque Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com