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18 maxillary edentulous case

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The Guide Right Surgical Guide System is a system of components for the fabrication and correction of diagnostic and surgical dental implant guides in 1 or 2 dimensions.

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18 maxillary edentulous case

  1. 1. Guide Right™ Edentulous Maxillary Arch  6 implants  magnetic guide post  3 mm open guide sleeves  2 mm guide sleeves Invivo5 GALAXIS Anatomage  software evaluation ▪ comparisonHOO 2.2013
  2. 2. Duplication & Conversion of Complete Denture into DIAGNOSTIC Guide
  3. 3. Duplicate, trim and try the denture in to be sure it still fits etc.
  4. 4. View into the mucosal side of the denture base where 10shallow holes have marked the center of the alveolar ridge.
  5. 5. Holes are drilled through the denture base with a 3/32” drill from the mucosalside of the denture centered in the middle of the concavity of the alveolar ridge.
  6. 6.  3 mm holes are drilled in the denture where the proposed implant sites are possible. 3 mm od X 2 mm id aluminum guide sleeves (0 cleats) Clear Triad® Gel has be added to secure them on the oral side of the denture. 6 to 8 sites will be chosen based on the cone beam X-ray. At this point the patient and denture are ready for the cone beam volumetric X-ray. Several screws (13 - 15 mm) will be placed in 2 or more of the sites to stabilize the denture during the surgery.
  7. 7. Lab putty has been mixed and molded into thedenture base with 3 mm od X 2 mm id guide sleeves guide sleeves in place and removed leaving an indentation in the lab putty.
  8. 8. 2 mm drills have been usedto index the guide sleevesby drilling through theminto the Lab Putty at least10-12 mm
  9. 9. The denture and drills have been removed leaving the registration holesof the long axis of the guide posts in the lab putty.
  10. 10. PREOPERATIVE Evaluation GALAXIS Software Galileos Invivo5 Software Anatomagepanoramic ▪ tangential ▪ cross sectional
  11. 11. Preview of Pre-op Corrections #4 #6 #8NO CORRECTION ANGULAR CORRECTION ANGULAR CORRECTION 28° bend toward the palatal 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal #9 # 13 ANGULAR CORRECTION LINEAR CORRECTION31º bend toward the palatal 1 mm offset toward the buccal
  12. 12. Selecting the Corrective Angle There is not one specific angle that is the absolute angle of placement. The range varies by 20° between the buccal and lingual plates. The position nearest the guide sleeve with the smallest angle should be selected depending on the closest to the opposing restoration. [ In this case position (B) ] A BInvivo5Anatomage
  13. 13. #4 Initial Alignmentaxial cross section Invivo5 Anatomagetangential volumetric
  14. 14. #4 ANGULAR CORRECTION: 12° toward the facial cross section tangentialGALAXIS
  15. 15. #4 ANGULAR CORRECTION: 15° Invivo5 GALAXIS Anatomage cross sectional views
  16. 16. #6 ANGULAR CORRECTION: 28° toward the palatalaxial cross section Invivo5 Anatomagetangential volumetric
  17. 17. # 6 ANGULAR CORRECTION: 28° to 31° to the buccal Invivo5 GALAXIS Anatomage cross sectional view
  18. 18. #8 ANGULAR CORRECTION: 24º indicatedaxial cross section Invivo5 Invivo5 Anatomage Anatomagetangential volumetric
  19. 19. #8 ANGULAR CORRECTION: 24° toward facial Invivo5 GALAXIS Anatomage cross section
  20. 20. # 9 ANGULAR CORRECTION: 31º Indicatedaxial cross section Invivo5 Anatomagetangential volumetric
  21. 21. #9 31º Angle is Measured Invivo5 GALAXIS Anatomage cross sectional view
  22. 22. #11 ANGULAR CORRECTION: 24º indicatedaxial cross section Invivo5 Anatomagetangential volumetric
  23. 23. #11 ANGULAR CORRECTION: 24º to the facial Invivo5 GALAXIS Anatomage
  24. 24. #11 ANGULAR CORRECTION: 28° to 31° software comparisonInvivo5Anatomage cross sectional views
  25. 25. #13 LINEAR CORRECTION: 1 mm offset toward the buccal axial cross section Invivo5 Anatomage tangential volumetric
  26. 26. #13 LINEAR CORRECTION: 1.5 mm toward the buccal Invivo5 GALAXIS Anatomage cross section
  27. 27. #13 LINEAR CORRECTION: 1.5 mm toward the buccal Software Comparison Invivo5 GALAXIS Anatomage
  28. 28. Review of Pre-op Corrections #4 #6 #8NO CORRECTION ANGULAR CORRECTION ANGULAR CORRECTION 28° bend toward the palatal 17º bend toward the palatal # 11 ANGULAR CORRECTION 33º bend toward the palatal #9 # 13 ANGULAR CORRECTION LINEAR CORRECTION31º bend toward the palatal 1 mm offset toward the buccal
  29. 29. Guide Right™ GUIDE POST BENDING TOOL If the angle needs to be corrected a guide post is bent in the Guide Right™ Bending Tool. A guide post is placed in the bending tool and a set screw tightened. The bending stylus is placed over the guide post and the post is bent in the first plane. If a second bend is indicated by a scan the bent post in loosened and rotated 90 degrees and the set screw retightened. The slide support bar is moved down in contact with the stylus and the second bend is made in the second plane. Bending tool step by step guide at end of this slideshow.
  30. 30. Fabrication of SURGICAL Guide
  31. 31. • 3 mm magnetic guide posts with smaller diameter 3/32” lower half have been inserted into the 2 mm holes in the Lab Putty.• They have not been corrected yet with the information from the volumetric scan.
  32. 32. • After bending the posts to the correct angles, according to the cone beam X-ray, the posts are marked on the facial surface to orient them to be placed back in the Lab Putty.• Posts should also be marked sequentially (1-6) to keep them in order.
  33. 33.  Open guide sleeves are used for the best visibility during surgery . The acrylic sides of the denture have been removed with acrylic burrs to form slots where the guide sleeves have been removed for the placement of the angle corrected open guide sleeves on the magnetic guide posts Note the offset guide post in the right most distal #13 site used to correct the linear position of the implant.
  34. 34. Open guide sleeves have been added to the magnetic guide posts with thecleats positioned on the palatal surface without interference from the acrylicof the duplicated denture.
  35. 35. Triad® Gel is added to the remaining denture baseto capture the open guide sleeves and the cleats.
  36. 36. After incorporating the open guide sleeves two additional 3 mm holes are used in the #7 and #10 positions to accommodate 2 mm guide sleeves for 2 mm x 15 mm screws (Salvin) to stabilize the denture.
  37. 37. 2 mm X 15 mm screws will be used to stabilize theDenture while the osteotomies are being prepared.
  38. 38. Open guide sleeves allow visibility of drill depth markings.
  39. 39. A milled bar with locatorattachments is made tosupport the prosthesis
  40. 40. Final Prosthesis
  41. 41. Milled bar with locator attachments
  42. 42. Intraoral view of attached bar
  43. 43. Insertion of milled bar.
  44. 44. Intraoral view of final prosthesis.
  45. 45. Final Prosthesis
  46. 46. Guide Right™ Products shown in this Presentation (2) 3/32” drill (10) 3 mm od X 2 mm id guide sleeves (0 cleats) special phone order (6) 2 mm Drills (5) 3 mm Magnetic Guide Posts (1) 1 mm Offset Magnetic Guide Posts (6) 3 mm Open Guide Sleeves (1) Guide Post /Generation ll Bending Tool & 3mm Stylus Acrylic Burrs Triad® Gel from your dental products supplier 1.800.314.0065 • www.deplaque.com
  47. 47. Guide Right™ GENERATION II / GUIDE POST BENDING TOOL SINGLE BEND reviewStep 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.
  48. 48. Guide Right™ GENERATION II / GUIDE POST BENDING TOOL COMPOUND BEND overviewStep 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.
  49. 49. DéPlaqueGuide Right™ Surgical Guide System fabricate ▪ evaluate ▪ correct ▪ verify ▪ placeStart With Precision. Place With Confidence.™ 1.800.314.0065 • www.deplaque.com

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