Guide Right™ CASE FOR ANGLED IMPLANTS # 10 & # 6 Vacuform Shell Offset Guide Posts Open Guide Sleeves Evaluation using Software Lineal Corrections Angular Corrections Featuring: Invivo5 ZHEN 2.2013

Fabrication of DIAGNOSTIC guide Vacuform 3 mm guide posts 3 mm guide sleeves Fabrication of DIAGNOSTIC guide

Cast of the patient as he presented at initial exam.

Temporary partial denture

Impression and cast with partial denture in place.

Vacuform shell on cast marked to indicate the planned axis holes for the implants.

Holes are drilled through the plastic shell into the incisal edge with 3/32” drills.

Vacuform shell on cast with holes drilled indicating the proposed axis holes for the implants.

The vacuform shell removed.

The drills are removed and replaced with two short 3 mm straight guide posts.

3 mm diagnostic guide sleeves (with 1 cleat) are placed on the guide posts with cleats positioned on the palatal surface.

Triad® Gel is applied capturing the cleats on the guide posts and adjacent teeth to form the DIAGNOSTIC guide which is used for the cone beam imaging.

# 6 PREOPERATIVE Software Evaluation Invivo5 Anatomage

Initial Alignment of guide sleeve with implant # 6 Initial Alignment of guide sleeve with implant axial cross sectional Invivo5 Anatomage tangential view volumetric

Utilizing 12º Angled Southern Implant ▪ # 6 Utilizing 12º Angled Southern Implant ▪ axial cross sectional Invivo5 Anatomage tangential view volumetric Cone beam image showing alignment of the guide sleeve in the # 6 position. A 12 º bend is required for this site.

Southern Implant & Guide Right™ Guide Sleeve in Place ▪ 12º facial correction needed to place implant ▪ #6 cross sectional view Invivo5 Anatomge

Initial Alignment of guide sleeve with implant # 6 Initial Alignment of guide sleeve with implant axial cross sectional Invivo5 Anatomage tangential view volumetric

# 6 Invivo5 Anatomage tangential view The guide sleeve is in line with the virtual implant, but close to root of #5. So a 1.5 mm offset post will be used to move the position of the guide sleeve to the mesial.

# 10 PREOPERATIVE Software Evaluation Invivo5 Anatomage

Showing virtual implant and the guide sleeve in two planes. ▪ Initial Alignment ▪ Invivo5 Anatomage #10 Showing virtual implant and the guide sleeve in two planes. occlusal cross sectional Invivo5 Anatomage tangential view volumetric

Angular Correction for guide sleeve: 12º toward the facial #10 A Southern 12° Co-axis Implant will be used, Angular Correction for guide sleeve: 12º toward the facial cross sectional Invivo5 Anatomage

▪ Southern Implant 12º co-axis virtual image ▪ Linear Correction: 1 mm offset guide post > moving closer to root of # 11 Invivo5 Anatomage # 10 Invivo5 Anatomage tangential view

Fabrication of SURGICAL guide Magnetic Guide Posts Open Guide Sleeves

Fabrication of SURGICAL Guide Magnetic Guide Posts Open Guide Sleeves

Corrected magnetic offset guide posts in place: # 6 > 1.5 mm offset guide post to move mesially, away from # 5 #10 > 1.0 mm offset guide post to move distally, closer to # 11

3.3 mm open guide sleeves positioned over the magnetic guide posts with cleats positioned toward the palatal surface.

Triad® Gel is added to form the completed SURGICAL guide.

POST-OPERATIVE Final X-rays

Final X-rays of implant placement # 6 # 10 Final X-rays of implant placement

RESTORATION

Axis indicator (3 mm guide posts) in place

Posts indicating the long axis of the abutments

Atlantis abutments

Final restoration

Final restoration

Atlantis Abutment

Final Restoration

Final Restoration

Guide Right™ 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™ 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™ 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

Close up of Offset Guide Posts in bending block Guide Right™ Guide Post Bending Tool

Magnetic Guide Posts 3.0 mm od Offset 3.0 od X 0.5 mm os 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 2 - 3/32” Drill 2 - 3 mm Straight Guide Posts (short) 2 - 3 mm Guide Sleeves 1 - 3 mm X 1.0 mm Offset Magnetic Guide Post 1 - 3 mm X 1.5 mm Offset Magnetic Guide Post 2 - 3 mm Open Guide Sleeve Guide Post Bending Tool Triad® Gel

A System of Components for the fabrication and correction of DIAGNOSTIC & SURGICAL guides 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 fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com