Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

2 piece guide post with steps to making a surgical guide featuring invivo5 software

1,968 views

Published on

Guide Right Surgical Guide System New 2-Piece Guide Post featuring Evaluation of guide using Invivo5 Software.

  • Be the first to comment

  • Be the first to like this

2 piece guide post with steps to making a surgical guide featuring invivo5 software

  1. 1. DéPlaque Guide Right™ Surgical Guide System Use of 2-Piece Guide Post
  2. 2. DéPlaque Guide Right™ 2-Piece Guide Posts
  3. 3. 2-Piece Guide Post Straight Lower Piece with Upper Removable Piece The bottom half of the Straight Lower Pieces of the 2-Piece Guide Post are designed with 4 flat sides corresponding with the mesial, distal, buccal & lingual surfaces of the tooth.
  4. 4. 2-Piece Guide Post Offset Lower Piece The Offset Lower Piece is constructed in a series of offsets with 8 flat sides to allow corrections in 0.5 mm intervals in any direction to change the linear position of the surgical guide sleeve.
  5. 5. 2-Piece Guide Post Upper Removable Piece 2.7 mm
  6. 6. Purpose & Use of the 2-Piece Guide Post The 2-piece guide post is designed to facilitate the correction & removal of surgical guides made with cylindrical guide sleeves even when the 3-D planned implant sights are not parallel. Angle Corrections: The lower piece of the straight 2-piece guide post can be altered for angular corrections by bending the 1/16th shaft up to 35º with the Guide Right Bending Tool. After the bend is made the upper piece/post is selected to coordinate with the guide sleeve dimension and placed over the 1/16” shaft for the fabrication of the surgical guide. Linear Corrections Offset guide posts have 8 sides & are designed for linear corrections that reposition the implant in either buccolinqual or mesio-distal plane or two adjacent planes i.e. mesio-buccal with/without changing the angle of the guide post. The Pythagorean theorem is used to calculate the amount of rotation. Use with Guide Sleeves Guide Sleeves made for 2-Piece Guide Posts are designed to match the diameter (0.05 mm larger) of the upper piece of the 2-piece guide posts & are available in many diameters: 2.7 mm id X 5.0 mm or 7.0 mm long • 3.0 mm id X 5 mm or 8.0 mm long • 4.2 mm id X 5.0 mm long • 5.3 mm id X 5.0 mm long. The 2-Piece 3 mm Guide Post (straight or offset) can be used with any of the original 3 mm cylindrical guide sleeves & the 4.5 & 5.3 mm Serial Kits.
  7. 7. When to Use the 2-Piece Guide Post 1. WHEN the path of withdrawal of the guide sleeve & the adjacent teeth are not parallel, the surgical guide may be mechanically locked on cast HOW • A closed cylindrical sleeve is selected • An angle correction is made by bending the guide post • Triad® gel is added to both the guide sleeve and the adjacent teeth to form the surgical guide 2. WHEN 2 adjacent guide posts are not parallel the surgical guide will be mechanically locked on cast HOW • A 2-Piece Guide Post allows the removal of the upper piece of the guide post & the removal of the completed SURGICAL guide with non-parallel cylindrical guide sleeves from the cast. • The SURGICAL guide is made with the upper piece of the 2-Piece Guide Post which has the axis of the geometrically corrected implant trajectory • The axis of the lower piece of the guide post has the bucco-lingual and mesio-distal axis of the originally prosthetically planned implant trajectory of the DIAGNOSTIC guide.
  8. 8. Guide Right 2 OPTIONS for Fabrication of Surgical Guide with NON-PARALLEL Adjacent Guide Posts OPTIONS 1 Magnetic Guide Post with coordinating Open Guide Sleeve 2 2-Piece Guide Post with Cylindrical Guide Sleeves are selected for the surgical guide.
  9. 9. OPTION 1 for Non-parallel Adjacent Guide Posts Open Guide Sleeve with the coordinating Magnetic Guide Post PURPOSE: used in posterior areas where access is limited HOW: • • • • • facilitates access from the open side of the guide sleeve allows viewing the drill depth markings accommodates drill sizes equal up to guide sleeve id indexed to adjacent teeth of edentulous area registered to the occlusal & lingual surface of the adjacent teeth with light-cured resin REQUIRES: coordinating magnetic guide post to fabricate the guide
  10. 10. OPTION 2 for Non-parallel Adjacent Guide Posts Cylindrical Guide Sleeve with the coordinating 2- Piece Guide Post PURPOSE: • used in areas where access & visibility is not limited HOW: • • • • • • drill access is from the top of the surgical guide may require drills with drill stops to determine drill depth of the osteotomy accommodate surgical drill sizes which fit inserts of serial guide sleeves indexed to adjacent teeth of edentulous area with light-cured resin used in the anterior or posterior areas has less chance of error than when using the open guide REQUIRES: the use of the 2- piece Guide Post to fabricate and correct the guide.
  11. 11. Why the 2-Piece Guide Post is a Better Option When an angle correction is made by bending the guide post, light cured resin is added to the guide sleeve & the adjacent teeth to form the surgical guide as a result… The surgical guide may be mechanically locked on the cast IF the path of withdrawal of the guide sleeve & the adjacent teeth are not parallel, OR IF there are 2 adjacent guide posts that are not parallel. “a must use” for Non-parallel Adjacent Guide Posts
  12. 12. OPTION 2 (continued) 2-Piece Guide Post HOW Use of the 2-piece guide post allows easy removal of the surgical guide when the upper piece of the guide post is removed leaving the lower piece with the 1/16” diameter part of the lower post with clearance for the removal of the larger guide sleeve in the cast. WHY The cylindrical guide sleeve & the corrected SURGICAL guide are made with the upper piece of the 2-piece guide post which has the axis of the geometrically corrected implant trajectory. The axis of the lower piece of the guide post has the axis of the originally prosthetically planned implant trajectory of the DIAGNOSTIC guide sleeve which is based on the original 3/32” hole drilled in the cast.
  13. 13. Design & Specifications Lower Piece STRAIGHT The 2-Piece Guide Post Design is comprised of 2 compatible parts: Lower Piece & Upper Piece which can be removed one from the other LOWER PIECE STRAIGHT guide post PURPOSE: • Configured with 1/16” od X 5.0 mm length shaft extending up from the rectangular platform of the lower piece on which various sized upper removable posts can be placed to hold the SURGICAL guide sleeve. • Allows fabrication of multiple SURGICAL guides with different diameter guide sleeves with the same corrected lower piece SPECIFICATIONS: • 3/32” outside diameter fits in the 3/32” diameter hole drilled in the cast • The lower shaft & the platform have 4 or 8 equal flat sides representing mesial, distal, buccal or lingual surfaces or mesio-distal, mesio-buccal, mesio-lingual or disto-lingual surfaces.
  14. 14. Design & Specifications Lower Piece OFFSET LOWER PIECE OFFSET guide posts PURPOSE: • Offsets are designed for linear corrections that reposition the implant in either buccal, lingual or mesial or distal or 2 adjacent planes (ie mesiobuccal) with/without changing the angle for the surgical guide. SPECIFICATIONS:    3/32” outside diameter to fit in the 3/32” hole in the cast Lower post has 8 flat sides Rectangular platform has 4 flat sides & available in various size offsets > 0.5 mm, 1.0 mm 1.5 mm, 2.0 mm, 2.5 mm & 3.0 mm 4.0mm and 5.0mm
  15. 15. Design & Specifications ◄ Upper Piece UPPER PIECE guide post PURPOSE:    Compatibility: to fit a variety of guide sleeve id often matching the diameter of the keys made by implant companies Benefit: Allows removal of the corrected SURGICAL guide from the cast even when multiple posts for multiple implants sites are not parallel. More than one SURGICAL guide can be made with a larger or smaller diameter upper piece & matching larger or smaller diameter guide sleeves. SPECIFICATIONS:    Length: 10 mm Options > od: 2.7 mm, 3.0 mm, 4.2 mm, 5.3 mm & others with 1/16 inch hole in shaft. Hole size: 1/16” hole id which fits over the 1/16” bendable shaft of the Lower Piece of the 2-piece guide post
  16. 16. ACESSORIES for 2-Piece Guide Post
  17. 17. Stylus for 2-Piece Guide Post PURPOSE: Used with the Guide Right™ Bending Tool to make angle corrections • to the lower piece of the 2-piece guide post • the shaft of the magnetic guide post SPECIFICATIONS: • Opening► 1/16” ► to fit lower piece of 2-piece guide post 3 mm ► to fit over a magnetic guide post
  18. 18. DéPlaque Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com
  19. 19. Steps to Making a Guide Right™ Surgical Guide
  20. 20. Fabrication & Correction Diagnostic & Surgical Guides Immediate Placement Case featuring 2-Piece Guide Post • Invivo5 Surgical Guide Allen
  21. 21. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate diagnostic guide ▪ ▪ ▪ ▪ ▪ evaluate correct re-fabricate surgical guide verify place
  22. 22. A hole was drilled through the cingulum of the existing tooth with a 3/32” drill and a 3 mm straight guide post was inserted
  23. 23. 3 mm DIAGNOSTIC GUIDE sleeve placed on the post with cleat positioned toward the palatal
  24. 24. After lubricating the cast and blocking out undercuts, clear Triad® gel has been applied to capture cleat on the guide sleeve & adjacent teeth to form the DIAGNOSTIC guide.
  25. 25. STEPS to creating a Guide Right™ Surgical Guide STEP 1 Locate the position of the guide post using one of the following methods: • a wax set up • estimate by measuring a tooth and its position in the contralateral arch
  26. 26. STEPS to creating a Guide Right™ Surgical Guide STEP 1 Locate the position of the guide post using one of the following methods: • a wax set up • estimate by measuring a tooth and its position in the contralateral arch STEP 2 Using a 3/32” drill make a hole in the cast
  27. 27. STEPS to creating a Guide Right™ Surgical Guide STEP 1 Locate the position of the guide post using one of the following methods: • a wax set up • estimate by measuring a tooth and its position in the contralateral arch STEP 2 Using a 3/32” drill make a hole in the cast STEP 3 Place a 3 mm guide post in the 3/32” hole • to provide a reference position • to continually return to the prosthetically planned position (HOME POSITION)
  28. 28. STEPS to creating a Guide Right™ Surgical Guide STEP 1 Locate the position of the guide post using one of the following methods: • a wax set up • estimate by measuring a tooth and its position in the contralateral arch STEP 2 Using a 3/32” drill make a hole in the cast STEP 3 Place a 3 mm guide post in the 3/32” hole • to provide a reference position • to continually return to the prosthetically planned position (HOME POSITION) STEP 4 Place a radio-opaque guide sleeve on the guide post • cleat positioned to the lingual
  29. 29. STEPS to creating a Guide Right™ Surgical Guide STEP 1 Locate the position of the guide post using one of the following methods: • a wax set up • Estimate, measuring a tooth and its position in the contralateral arch STEP 2 Using a 3/32” drill make a hole in the cast STEP 3 Place a 3 mm guide post in the 3/32” hole • to provide a reference position • to continually return to STEP 4 Place a radio-opaque guide sleeve on the guide post • cleat positioned to the lingual STEP 5 Add Triad® gel or acrylic resin • capturing the cleat & the adjacent teeth to form a DIAGNOSTIC guide
  30. 30. To assure accurate implant placement ► free of anatomic obstruction ◄ the following considerations are suggested.  The position of the guide sleeve is an estimated prosthetically planned implant trajectory & therefore may not be in the best anatomic position  The position of the guide sleeve & the proposed implant position must be evaluated in relation to the alveolar bone, the nerves and or the location of the sinus for each patient.
  31. 31. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate diagnostic guide ▪ evaluate ▪ ▪ ▪ ▪ correct re-fabricate surgical guide verify place
  32. 32. STEPS to creating a Guide Right™ Surgical Guide STEP 6 Take a cone beam X-ray • with DIAGNOSTIC guide securely seated in the patient
  33. 33. STEPS to creating a Guide Right™ Surgical Guide Step 7 Evaluate the X-ray • to accurately place within alveolar bone, • to evaluate proximity to nerves or sinus Is the planned implant trajectory/angle anatomically acceptable? Is the planned implant linear position anatomically acceptable? Must angle or position be changed to become anatomically acceptable?
  34. 34. STEPS to creating a Guide Right™ Surgical Guide STEP 8 Use of Invivo5 Software to Evaluate, Correct, & Verify planned implant trajectory prior to drilling the osteotomy
  35. 35. Invivo5 Anatomage NAVIGATION used to determine & make corrections for Guide Right™ Surgical Guides
  36. 36. Invivo5 Software Navigating the System For better understanding of use of Invivo5 software SEE slide show at www.deplaque.com Steps to Making & Correcting a Surgical Guide Steps to using Invivo5 for Evaluation
  37. 37. STEP by STEP Evaluation Using Invivo5 Software START from the HOME POSITION ► the AXIAL view ► the view showing a virtual implant aligned with the image of the DIAGNOSTIC guide sleeve in Invivo5 software. 3 PLANES are viewed in the AXIAL view (A) the bucco-lingual / cross sectional plane may / may not display as a line intersecting the alveolar bone/ridge at 90º diagonally (B) the mesio-distal plane / tangential plane (HOME POSITION) (C) The IDEAL POSITION shown in the AXIAL PLANE is when the line intersecting the alveolar bone is 90º indicating the direction of the bucco-lingual plane being viewed.
  38. 38. Home Position AXIAL tangential cross sectional volumetric
  39. 39. STEP by STEP Evaluation Use of Invivo5 Software from the HOME POSITION ► All angle and linear measurements or corrections MUST be made… from the HOME POSITION ► THEREFORE return to the HOME POSITION to initiate a change in the either plane ► After making a correction (angular or linear) in one plane you must return to the HOME POSITION to make a change in the other plane.
  40. 40. Invivo5 3D Cone Beam X-ray Composite Views axial tangential cross section volumetric
  41. 41. STEP by STEP Evaluation Use of Invivo5 Software CHANGES in the proposed implant position Changing the LINEAR POSITION… … in either mesio-distal plane or bucco-lingual plane is made by selecting an offset guide post to alter the position of the guide sleeve Changing the ANGLE of the TRAJECTORY by measuring the angle of the proposed implant location & bending the guide post to the corrected angle. After making a correction (angle or linear) in one plane YOU MUST RETURN TO THE HOME POSITION To measure and make the 2nd correction needed in the other plane. .
  42. 42. STEP by STEP Evaluation Use of Invivo5 Software HOME POSITION WARNING Measuring or making angle or linear corrections from any other positions (cross sectional or tangential) will lead to errors, & the corrections recorded will not be accurate BECAUSE the angle is not measured from the HOME POSITION
  43. 43. Invivo5 Anatomage NAVIGATION used to make corrections for Guide Right™ Surgical Guides
  44. 44. Home Position • Cross Sectional View Center Line of the implant is passing through center of guide sleeve
  45. 45. use of Invivo5 Sofware IN HOME POSITION AXIAL VIEW 90º The line indicating the plane of the cross sectional view should be rotated to position at 90º tangential to the curvature of the arch of the alveolar bone in the Axial view
  46. 46. Home Position • Tangential View Indicates no correction is needed in the mesio-distal plane. Evidenced by the alignment of the axis of the implant with the radio-lucent center of the DIAGNOSTIC guide sleeve & the long axis of the existing tooth.
  47. 47. Home Position • Composite View axial tangential cross sectional volumetric
  48. 48. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  49. 49. CROSS SECTION VIEW high magnification DIAGNOSTIC guide position: showing apex of implant too close to the buccal plate (<4 mm) which should be grafted for best esthetic results Capelli M. et al J Perio vol 84 # 12, 2013
  50. 50. CROSS SECTIONAL Composite View 8º Labial Angle Correction moves osteotomy Palatal axial tangential cross sectional volumetric
  51. 51. CROSS SECTION INDICATES 8º CORRECTION IS CHOSEN to avoid the proximity of the implant to the facial plate as observed in the buccl-lingual plane. EVIDENCED BY THE ANGLE FORMED by the long axis of the implant with the long axis of the radio-lucent center of the DIAGNOSTIC guide sleeve with the long axis of the existing tooth. 8º Labial Angle Correction
  52. 52. TANGENTIAL VIEW 8º Labial Angle Correction CROSS SECTIONAL TANGENTIAL NOTE: the loss of the original shape of the guide sleeve in tangential view NOTE: the tangential view changes because the long axis of the implant no longer passes through the radio-lucent center of the DIAGNOSTIC guide sleeve
  53. 53. CROSS SECTION 8º toward buccal Correction moves osteotomy Palatal REPOSITION GUIDE SLEEVE toward buccal
  54. 54. ANGULAR CORRECTIONS are made with the Guide Right™ Bending Tool Step by step instructions at end of slideshow
  55. 55. Single Bend corrections in one plane Guide Right™ Bending Tool 2- piece guide post
  56. 56. LOWER PIECE of 2-piece guide post in the Bending Tool block
  57. 57. 8º BENDING the 1/16 “ lower part of the guide post 8º WITH STYLUS
  58. 58. CLOSE UP Bending Tool block with guide post bent 8º
  59. 59. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  60. 60. The existing crown is removed sectioned from the cast.
  61. 61. The crown is removed from the cast.
  62. 62. A 3 mm lower piece of 2-piece guide post corrected 8º toward the buccal & shown placed in the hole
  63. 63. Upper piece is placed on the 8º angle corrected lower piece of the guide post
  64. 64. INCISAL VIEW 3 mm guide sleeve placed on the upper piece of the guide sleeve
  65. 65. PALATAL VIEW Corrected SURGICAL guide
  66. 66. FACIAL VIEW corrected SURGICAL guide with 3 mm oval window guide sleeve
  67. 67. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  68. 68. VERIFY ACCURACY Actual 2-piece guide post bent 8º placed on printout of cone beam X-ray image (CROSS SECTIONAL VIEW)
  69. 69. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  70. 70. A crestal incision is made
  71. 71. The SURGICAL guide with a 3 mm oval open guide sleeve is placed
  72. 72. A 3 mm hybrid drill used to start the osteotomy
  73. 73. A Straumann 2.2 mm drill used to drill to the required depth
  74. 74. A Straumann 2.8 mm drill used to enlarge the diameter of the 2.2 mm drill to final depth.
  75. 75. An optional 2nd SURGICAL guide was made on the same cast with an 8º corrected guide post for the final 3.75 mm drill
  76. 76. 2ND OPTIONAL SURGICAL GUIDE made with 3.9 mm sleeve & used with final 3.75 mm drill
  77. 77. The alignment of the implant is checked with the 3.9 mm id guide sleeve.
  78. 78. Placement of implant and carrier is used to verify final alignment of implant.
  79. 79. Final Placement
  80. 80. Single Bend corrections in one plane Guide Right™ Bending Tool 2- piece guide post
  81. 81. Guide Right™ 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.
  82. 82. Guide Right™ 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.
  83. 83. DéPlaque Guide Right™ Surgical Guide System For more information on use of 2-Piece Guide Post see “Steps to Making & Correcting a Surgical Guide” featuring Steps to using Invivo5 for Evaluation Bending Tool 2 Bends 1.800.314.0065 • www.deplaque.com

×