This document describes the steps for fabricating a diagnostic surgical guide using the Guide Right system, which includes bending a guide post to correct the planned implant angle based on a cone beam CT evaluation. A diagnostic guide is made using an initial straight guide post. CBCT imaging of the guide reveals the needed angular corrections of 14 degrees mesially and 18 degrees buccally. The guide post is then bent using the Guide Right bending tool to make the compound corrections. A surgical guide is fabricated using the bent guide post to accurately place the implant.

1. COMPOUND BEND
featuring: Guide Right™
Guide Post Bending Tool
Magnetic Guide Post
Open Guide Sleeve
KLEIS 2.2013

2. Fabrication of DIAGNOSTIC Guide

3. An impression is taken and a cast is made, a hole is drilled in the
cast at the #19 site planned for implant placement with a 3/32” drill.

4. A 3 mm guide post is placed in the hole.

5. A 3 mm X 8 mm guide sleeve is placed over the guide post. The angle of the
guide post is not critical as this is for a DIAGNOSTIC guide which will be
evaluated and corrected using information from a cone beam X-Ray.

6. Under cuts are blocked out and petroleum gel is used to lubricate the cast. Triad®
Gel is added to the brackets of the guide sleeve and the adjacent teeth to form the
body of the DIAGNOSTIC guide. The guide is placed in the patient for the Cone
Beam X-ray.

7. PRE-OPERATIVE
GALAXIS Cone Beam Software
Evaluation

8. Preview of Pre-op Corrections
#19
ANGULAR CORRECTION
in 2 dimensions
1st BEND: 14° toward the mesial in the cross sectional plane
2nd BEND: 18° toward the buccal in the tangential plane

9. GALAXIS #19 panoramic view
CBVI X-rays were taken with the Sirona Galileos
The location of the mandibular nerve is mapped out on the panoramic view.
A virtual implant is superimposed in line with the radio-opaque guide sleeve
to evaluate the planned implant trajectory.

10. 14°
mesial
alteration
GALAXIS tangential view
A virtual implant of the size & length planned for placement is superimposed on the
CBVI image. Preference: align the implant parallel to the axis of the adjacent
bicuspid. This requires a change in the angle of the guide sleeve by 14°

11. 18°
lingual
alteration
cross sectional view
The virtual implant is ideally placed in the center of the alveolar ridge.
The angle formed by a line superimposed on the long axis of the virtual implant and the
long axis of the diagnostic guide sleeve and the long axis virtual implant is 18° measured
with the GALAXIS software.

12. making corrections
The guide post used in correcting the The guide post is placed in the bending block
angle has four flat slides representing the attached to the bending tool plate with a 35° scale
mesial, distal, buccal & lingual surfaces. and a set screw.
The set screw is tightened against one of the four flat
An orientation dot is designed to mark sides of the guide post with the orientation dot in view.
the buccal surface. The purpose of the set screw is to prevent rotation
while the guide post is being bent.

13. Close up of stylus over post in bending
block after bend is made.
A guide post with 4 flat surfaces
is placed in the bending tool.
The set screw is tightened with a hex driver.
A stylus is placed over the guide post.
The stylus is moved to the right to the appropriate
degree according to the CBVI.

14. After the 1st bend is complete, the set screw is released and the guide post is rotated
90° counter clockwise until the next flat surface (representing the buccal surface of the
guide post) is aligned with the set screw.
The set screw is retightened.
When rotated the stylus raises up off the plate and points to the 0 degrees.
A stylus support bar is moved down to support the stylus to maintain the angle of the
first bend while the second bend is being made.

15. corrected guide post
viewing
the buccal orientation
The post is placed back in the cast.
The orientation dot is positioned on the buccal surface to maintain the buccal
surface of the guide post to the buccal.
A superimposed line on the cast indicates the angle of the original hole made
with the 3/32” drill.

16. Fabrication of SURGICAL Guide

17. lingual view buccal view
A 4 mm open guide sleeve has been placed back
on the 4 mm corrected magnetic corrected guide post.

18. open guide sleeve
SURGICAL guide
Triad® Gel has been added to the adjacent teeth of the lubricated cast and to the
brackets on the 4 mm open guide sleeve.

19. The SURGICAL guide securely seated in the patient.
The osteotomy was started using a 2 mm pilot drill with drill stop slightly smaller
(3.9 mm) diameter than the inside diameters of the 4 mm guide sleeve.

20. A open guide sleeve of 4 mm diameter was used for the surgery.
The 4 mm open guide sleeve will accommodate drills up to 4 mm diameter.

21. The diameter of the osteotomies were enlarged by visually
centering the increasing size drills in the 4 mm guide sleeve.

22. Final Implant Placement

23. Final Restoration

24. 2 Years Later

25. Guide Right™
Products used in this presentation
1 - 3/32” drill
1 - 3 mm Guide Post
1 - 3 mm X 8 mm Guide Sleeve
1 - 4 mm Magnetic Guide Post
1 - 4 mm Open Guide Sleeve
Triad® Gel
Guide Post Bending Tool
1.800.314.0065 • www.deplaque.com

26. Guide Right™
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.

27. 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 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.

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