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Immediate Placement Using Guide Right 2-Piece Guide Post

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2-piece guide post, immediate load, Guide Right
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Immediate Placement Using Guide Right 2-Piece Guide Post

  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 all 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 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. Angular Corrections: The lower piece of the 2-piece guide post can be altered for angular corrections by bending the 1/16th shaft up to 35º to the desired degree 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 are designed for linear corrections that reposition the implant in either bucco-linqual or mesio-distal plane with or without necessarily changing the angle of the guide post. Use with Guide Sleeves Guide Sleeves made for 2-Piece Guide Posts are designed to match the diameter (0.05 mm or larger) of the upper piece of the 2-piece guide posts and are available in many dimensions: 2.7 mm id X 5.0 mm long • 3.0 mm id X 5.0 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 can be used with any of the original 3 mm cylindrical guide sleeves plus 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, SOLUTION • 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 • The path of withdrawal of the guide sleeve and the adjacent teeth are not parallel, 2. WHEN 2 adjacent guide posts are not parallel the surgical guide will be mechanically locked on the cast. SOLUTION: A two piece guide post, allows the removal of the upper piece of the guide post & the removal of the completed surgical guide with 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 prostheticly planned implant trajectory of the diagnostic guide.
  8. 8. Guide Right 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 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 are limited HOW: • • • • • • facilitates access from the top of the SURGICAL guide may require drills with drill stops to determine drill depth. 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 more accurate than the open guide sleeve / less chance of error. 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 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 & the 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 platform of the lower piece on which various sized upper removable posts can be placed to hold the SURGICAL guide sleeve. Allows multiple SURGICAL guides with different diameter guide sleeves SPECIFICATIONS: • 3/32” outside diameter fits in the 3/32” diameter hole drilled in the cast • The lower shaft has 4 equal flat sides representing mesial, distal buccal or 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 bucco-lingual or mesio-distal planes with / without changing the angle for the surgical guide. SPECIFICATIONS:    3/32” outside diameter The lower post has 8 flat sides and the platform having 4 flat sides rectangular platform with various size offsets > 0.5 mm, 1.0 mm 1.5 mm, 2.0 mm, 2.5 mm & 3.0 mm
  15. 15. Design & Specifications Upper Piece UPPER PIECE guide post PURPOSE:   Compatibility: to fit the keys of other implant companies Benefit: Allows removal of the 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 & 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” 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 anglular corrections • to the lower piece of the 2-piece guide post • the shaft of the magnetic guide post  Opening: 1/16” or 3 mm to fit over a guide post
  18. 18. Fabrication & Correction of a SURGICAL Guide Immediate Placement Using the 2-Piece Guide Post jensen
  19. 19. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate diagnostic guide ▪ ▪ ▪ ▪ ▪ evaluate correct re-fabricate surgical guide verify place
  20. 20. The maxillary right lateral incisor will be removed and an implant placed.
  21. 21. 3/32” Drill is used to drill the initial hole through the singulum of # 7 into the base of the cast.
  22. 22. 3 mm guide post with DIAGNOSTIC sleeve positioned in the hole of # 7 on the cast
  23. 23. Clear Triad® gel has been applied to the guide sleeve & adjacent teeth after lubricating the cast and blocking our undercuts to form the DIAGNOSTIC guide.
  24. 24. After the cone beam X-ray is taken the tooth is removed from the cast.
  25. 25. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate diagnostic guide ▪ evaluate ▪ ▪ ▪ ▪ correct re-fabricate surgical guide verify place
  26. 26. Invivo5 Anatomage Cone beam Analysis
  27. 27. A cone beam X-ray provides the correction information to assure guide sleeve was placed at a 4º angle toward the buccal axial cross section Invivo5 Anatomage tangential volumetric
  28. 28. Home position slide step by step…. axial cross section Invivo5 Anatomage tangential volumetric
  29. 29. cross section view Invivo5 Anatomage Indicates guide sleeve is placed at a 4º angle toward the buccal & is the preferred position to place the virtual implant away from the buccal wall.
  30. 30. Invivo5 Anatomage tangential view Indicates no correction is needed in the mesio-distal plane. Evidenced by the alignment of the axis of the implant with the radiolucent center of the DIAGNOSTIC guide sleeve.
  31. 31. Axial View Indicates the plane of the slice being evaluated in the cross sectional view is (& should always be) 90º to the mesio-distal plane. Invivo5 Anatomage
  32. 32. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  33. 33. ANGULAR CORRECTIONS are made with the Guide Right™ Generation ll Bending Tool Step by step instructions at end of slideshow
  34. 34. Single Bend corrections in one plane Guide Right™ Generation ll Bending Tool
  35. 35. Lower piece of guide post in the Bending Tool block
  36. 36. Bending tool with stylus moved 4º to make angular correction to the guide post
  37. 37. Close up view: bending tool block with guide post bent 4º
  38. 38. The 4º angular correction of the guide post is made with the Bending Tool
  39. 39. Lower Piece of 2-piece guide post in site where tooth is removed
  40. 40. Palatal view: lower piece of guide post with 4º correction is placed in the cast
  41. 41. Buccal flat of the offset portion of the lower piece was marked with black magic marker to assure placement with bend toward the buccal.
  42. 42. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  43. 43. 3 mm diameter Upper Piece of post added to the corrected lower piece
  44. 44. Buccal view corrected lower piece with the upper piece in position
  45. 45. A 3 mm upper post placed on corrected lower piece ready for the 3 mm guide sleeve to be placed over it.
  46. 46. A 3 mm guide sleeve placed on the upper piece will be be used with a 2.3 mm hybrid drill.
  47. 47. 3 mm open guide sleeve
  48. 48. 3.80 mm guide post with 3.85 mm guide sleeve is used for the final larger diameter drill to place 4.1 mm implant.
  49. 49. Triad® Gel applied to capture cleats of the 3.9 mm guide sleeve & adjacent teeth to form the DIAGNOSTIC guide
  50. 50. The upper piece of the post has been removed. NOW the SURGICAL guide can be removed, placed in cold sterilization & place in patient for surgery.
  51. 51. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  52. 52. Post-op Verification of accurate implant placement Invivo5 Anatomage
  53. 53. DéPlaque Guide Right™ Surgical Guide System ▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide] ▪ verify ▪ place
  54. 54. Final X-ray with implant in place to verify accurate position.
  55. 55. 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.
  56. 56. 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.
  57. 57. Guide Right™ Bending Tool Close up of Offset Guide Posts in bending block
  58. 58. DéPlaque Guide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ place Start With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com

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