Guide Right™ Edentulous Maxillary Arch 6 implants magnetic guide post 3 mm open guide sleeves 2 mm guide sleeves Invivo5 Anatomage GALAXIS 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.

panoramic ▪ tangential ▪ cross sectional PREOPERATIVE Evaluation GALAXIS Galileos panoramic ▪ tangential ▪ cross sectional Software Invivo5 Anatomage Software

Preview of Pre-op Corrections # 4 NO CORRECTION # 6 ANGULAR CORRECTION 28° bend toward the palatal #8 ANGULAR CORRECTION 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal # 9 ANGULAR CORRECTION 31º bend toward the palatal # 13 LINEAR CORRECTION 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 tangential volumetric Invivo5 Anatomage tangential volumetric

#4 ANGULAR CORRECTION: 12° toward the facial cross section tangential GALAXIS

#4 ANGULAR CORRECTION: 15° GALAXIS Invivo5 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 Anatomage GALAXIS cross sectional view

# 8 ANGULAR CORRECTION: 24º indicated axial cross section Invivo5 Anatomage Invivo5 Anatomage tangential volumetric

# 8 ANGULAR CORRECTION: 24° toward facial Invivo5 Anatomage GALAXIS cross section

# 9 ANGULAR CORRECTION: 31º Indicated axial cross section Invivo5 Anatomage volumetric tangential

# 9 31º Angle is Measured cross sectional view GALAXIS Invivo5 Anatomage GALAXIS cross sectional view

#11 ANGULAR CORRECTION: 24º indicated axial cross section Invivo5 Anatomage Invivo5 Anatomage volumetric tangential

#11 ANGULAR CORRECTION: 24º to the facial GALAXIS Invivo5 Anatomage

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

#13 LINEAR CORRECTION: 1 mm offset toward the buccal axial cross section Invivo5 Anatomage Invivo5 Anatomage tangential volumetric

#13 LINEAR CORRECTION: 1.5 mm toward the buccal Invivo5 Anatomage GALAXIS cross section

#13 LINEAR CORRECTION: 1.5 mm toward the buccal Software Comparison Invivo5 Anatomage GALAXIS

Review of Pre-op Corrections # 4 NO CORRECTION # 6 ANGULAR CORRECTION 28° bend toward the palatal #8 ANGULAR CORRECTION 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal # 9 ANGULAR CORRECTION 31º bend toward the palatal # 13 LINEAR CORRECTION 1 mm offset toward the buccal

GUIDE POST BENDING TOOL 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 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 / 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 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™ 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