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Fabrication of Maxillary Denture Guide 10.12.2016 LUF NEW

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Case example of how to fabricate a maxillary denture guide beginning with a duplicated denture & using the Guide Right Surgical Guide System including a diagnostic guide, Invivo5 software analysis to evaluate, correct, refabricate with 2-Piece guide posts & verify the proposed implant placements from the surgical guide. This case entails 5 linear corrections, 1 angular correction, 5 placement Invivo5 cone beams to support Conus abutment prosthesis, one in the Incisive Canal.

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Fabrication of Maxillary Denture Guide 10.12.2016 LUF NEW

  1. 1. Fabrication of MAXILLARY DENTURE GUIDE Featuring: • 2-Piece Guide Posts • Invivo5 Software Analysis • Linear & Angular Corrections • Straumann Implants • Placement of 5 implants to support Conus abutment prosthesis including one in Incisive Canal Guide Right™ Surgical Guide System DéPlaque LUF Treatment plan for this case: Conus abutment supported prosthesis
  2. 2. Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com DéPlaque A Geometric Approach to Guided Surgery Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ re-fabricate ▪ place
  3. 3. Guide Right™ Surgical Guide System DéPlaque ▪ fabricate Diagnostic GUIDE ▪ evaluate ▪ correct ▪ re-fabricate surgical guide ▪ verify ▪ place
  4. 4. Duplicated Denture Oral surface Occlusal surface
  5. 5. Pre-op Cone beam radiograph with denture guide in patient PANOREX VIEW
  6. 6. 2 mm X 20 mm guide posts inserted through guide sleeves in Lab Putty Base & used for registering corrected guide posts for complete denture guide.
  7. 7. Invivo5 Anatomage Cone Beam Analysis PRE-OP Each site must be evaluated
  8. 8.  Measure the angle formed by the 2 intersecting lines  use the angle tool in Invivo5 to measure & correct the angle of the guide post/sleeve When … the long axis of the sleeves & the virtual implants are not parallel.
  9. 9. DéPlaque ▪ fabricate diagnostic guide ▪ evaluate with cone beam images ▪ correct ▪ re-fabricate surgical guide ▪ verify ▪ place Guide Right™ Surgical Guide System
  10. 10. axial cross sectional # 3 Pre-op tangential volumetric HOME POSITION Straumann 3.3 mm BLT
  11. 11. axial cross sectional # 3 Pre-op tangential volumetric LINEAR CORRECTION: 1 mm offset toward buccal
  12. 12. cross sectional magnified # 3 Pre-op LINEAR CORRECTION: 1 mm offset toward buccal
  13. 13. axial cross sectional # 4 Pre-op tangential volumetric HOME POSITION Straumann 3.3 mm BLT
  14. 14. axial cross sectional # 4 Pre-op tangential LINEAR CORRECTION: 2 mm offset toward buccal 17 mm VIRTUAL FIXATION SCREW volumetric
  15. 15. cross sectional # 4 Pre-op LINEAR CORRECTION: 2 mm offset toward buccal 17 mm VIRTUAL FIXATION SCREW
  16. 16. axial cross sectional # 5 Pre-op tangential volumetric HOME POSITION Straumann 3.3 X 8 mm BLT
  17. 17. cross sectional # 5 Pre-op HOME POSITION Straumann 3.3 X 8 mm BLT
  18. 18. axial cross sectional # 7 Pre-op tangential volumetric HOME POSITION: , NO Correction 3.3 X 8 mm Straumann BLT
  19. 19. axial cross sectional # 7 Pre-op tangential volumetric NO CORRECTION 17 mm VIRTUAL FIXATION SCREW
  20. 20. axial cross sectional tangential volumetric INCISIVE CANAL POTENTIAL SITE Straumann 4.1 X 8 mm BL OUTLINE of VIRTUAL IMPLANT
  21. 21. cross sectional INCISIVE CANAL CROSS SECTION Straumann 4.1 X 8 mm BL OUTLINE of VIRTUAL IMPLANT
  22. 22. axial cross sectional Pre-op tangential volumetric INCISIVE CANAL 4.1 X 8 mm OPAQUE VIRTUAL IMPLANT
  23. 23. axial cross sectional # 10 Pre-op tangential volumetric HOME POSITION 3.3 mm Straumann BLT
  24. 24. axial cross sectional # 10 Pre-op tangential volumetric LINEAR CORRECTION: 1 mm offset palatal 2 X17 mm VIRTUAL FIXATION SCREW
  25. 25. cross sectional # 10 Pre-op LINEAR CORRECTION: 1 mm offset palatal 2 X17 mm VIRTUAL FIXATION SCREW
  26. 26. axial cross sectional # 11 Pre-op tangential volumetric HOME POSITION NO change Straumann 3.3 mm BLT
  27. 27. axial cross sectional # 11 Pre-op tangential volumetric HOME POSITION
  28. 28. axial cross sectional # 13 Pre-op tangential volumetric HOME POSITION Straumann BLT 0.5 mm offset toward buccal
  29. 29. axial cross sectional # 13 Pre-op tangential volumetric LINEAR CORRECTION: 0.5 mm offset toward palatal 2 X17 mm VIRTUAL FIXATION SCREW
  30. 30. # 13 Pre-op LINEAR CORRECTION: 0.5 mm offset toward palatal 2 X17 mm VIRTUAL FIXATION SCREW cross sectional
  31. 31. axial cross sectional # 14 Pre-op tangential volumetric HOME POSITION 3.3 mm Straumann BLT
  32. 32. axial cross sectional # 14 Pre-op tangential volumetric LINEAR CORRECTION: 1 mm offset toward buccal
  33. 33. cross sectional # 14 Pre-op LINEAR CORRECTION: 1 mm offset toward buccal
  34. 34. axial cross sectional # 14 Pre-op tangential volumetric ANGLE CORRECTION: 14° distal to avoid sinus
  35. 35. # 14 Pre-op tangential ANGLE CORRECTION: 14° distal to avoid sinus
  36. 36. X-ray of VIRTUAL FIXATION SCREW in mid-palatal suture Potential site for fixation screw
  37. 37. DéPlaque ▪ fabricate diagnostic guide ▪ evaluate ▪ correct ▪ re-fabricate surgical guide ▪ verify ▪ place Guide Right™ Surgical Guide System
  38. 38. LUF IMPLANT POSITION & SIZE # 3 3.3 X 8 mm BLT ••• ••• ••• Linear Correction: 1 mm offset buccal # 4 17 mm fixation screw ••• ••• ••• Linear Correction: 2 mm offset buccal # 5 3.3 X 8 mm BLT ••• ••• ••• No Correction # 7 17 mm fixation screw ••• ••• ••• No Correction: #10 17 mm fixation screw ••• ••• ••• Linear Correction: 1 mm offset buccal #11 3.3 x 8 mm BLT ••• ••• ••• No Correction: #13 17 mm fixation screw ••• ••• ••• Linear Correction: 0.5 mm offset buccal # 14 3.3 x 8 mm BLT ••• ••• ••• Linear Correction: 1 mm offset buccal Angular Correction: 14° distal Incisive Canal 4.1 X 8 mm BL ••• ••• ••• NOTE: Implant placement in Incisive Canal was added due to the limited surface area of the four other 3.3 mm X 8 mm implants. CORRECTIONS
  39. 39. Flap design outlined on Lab Putty matrix
  40. 40. DéPlaque Guide Right™ Surgical Guide System Offset Guide Posts
  41. 41. LINEAR CORRECTIONS are made with the offset guide post Guide Right™ Offset Guide Posts LINEAR CORRECTION
  42. 42. 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.
  43. 43. # 3 2-Piece offset lower guide post aligned in order they will be placed
  44. 44. Puddy cast with palatal guide post, corrected lower part offset guide posts positioned in sites with corresponding upper guide post
  45. 45. corrected 2-Piece upper guide posts with guide sleeves
  46. 46. 2-Piece upper guide sleeves positioned on guide posts with cleats toward the palatal surface palatal guide post
  47. 47. DéPlaque ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place Guide Right™ Surgical Guide System
  48. 48. Triad® gel applied to form the corrected DENTURE GUIDE
  49. 49. Additional Triad® gel applied
  50. 50. Guide Posts removed from DENTURE GUIDE
  51. 51. Access view left Access view right
  52. 52. If necessary???, palatal fixation screw: 3.5 x 8 mm
  53. 53. Trimmed DENTURE GUIDE
  54. 54. Guide Right™ Surgical Guide System DéPlaque ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place Guide Right™ Surgical Guide System
  55. 55. Invivo5 Anatomage Cone Beam Analysis POST-OP
  56. 56. # Incisive Canal Post-op axial cross sectional tangential volumetric 4.1 X 8 mm Straumann
  57. 57. # 3 Post-op axial cross sectional tangential volumetric Straumann 3.3 X 8 mm Implant Bone has been spread with Densah drills
  58. 58. # 7 Post-op axial cross sectional tangential volumetric Straumann 3.3 X 8 mm Implant bone has been spread with Densah drills
  59. 59. # 11 Post-op axial cross sectional tangential volumetric Straumann 3.3 X 8 mm Implant bone has been spread using Densah drills
  60. 60. # 14 Post-op axial cross sectional tangential volumetric Straumann 3.3 X 8 mm Implant
  61. 61. view Guide Right™ View VIDEO L for actual site preparation & implant placement www.deplaque.com
  62. 62. For more in-depth instruction & understanding of Guide Right Surgical Guide System view SLIDE SHOWS at www.deplaque.com “INTRODUCTION to GUIDE RIGHT COMPONENTS with SINGLE IMPLANT” “2-PIECE GUIDE POST with STEPS to MAKING a SURGICAL GUIDE FEATURING: INVIVO5 SOFTWARE”
  63. 63. Guide Right™ GUIDE POST BENDING TOOL Steps to SINGLE BEND Step 1 Place bending tool plate on a secure flat surface with the degree increments at the top & the stainless steel bar at the bottom. Step 2 Locate the two 3/32” holes in the top of the stainless steel bar. The hole closest to the plate is used for all guide posts up to 3.0 mm offsets. The front hole is used for offsets 3.5 mm or larger. Place the bottom half of the guide post to be bent into the hole. Position the offset guide post in the hole determined by the planned direction of the correction. Tighten the set screw. Step 3 Select the appropriate stylus to fit over the top half of the guide post. Step 4 Fit the stylus over the guide post securely with the point directed at 0° & the bottom of the stylus in contact with the platform of 2-piece guide post or if no platform on post, in contact with 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 Remove the stylus. Loosen screw to remove the guide post bent to the desired angle.
  64. 64. Guide Right™ GUIDE POST BENDING TOOL Steps to COMPOUND BEND Step1 Position a straight or offset guide post in the bending plate, tightening the set screw against one of the 8 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 & the guide post is rotated 90° next flat surface. Step 4 The 2nd bend in the 2nd plane is made after rotating the guide post up away from the surface of the bending plate to register the stylus point back at 0º. Step 5 Slide the stylus support bar down under the stylus until it supports the stylus. Tighten the side screws before making the 2nd bend. Step 6 The 2nd 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 with a felt tip pen facing the buccal or lingual surface. Be sure the post is in the correct position. If necessary, Linear Corrections, using an Offset Guide Post, must be determined & made before Angle Corrections. Offset 2-Piece Guide Posts available in the 3 mm guide post: 0.5,1, 1.5, 2.0, 2.5 & 3.0 mm.
  65. 65. Versah Densah Drill Kit used to prepare & widen the osteotomy
  66. 66. Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com DéPlaque A Geometric Approach to Guided Surgery Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ re-fabricate ▪ place

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