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9 maxillary posterior 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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9 maxillary posterior case

  1. 1. Maxillary Posterior Case 4 Implants: #12 ▪ #13 ▪ #14 #19 *guide not shown in presentation Ceramic & Open Stainless Guide Sleeves Magnetic & Offset Open Guide Posts 3D Cone Beam Imaging Utilizing Cosine Rule Guide Post Bending ToolMMEI 2.2013
  2. 2. Fabrication of DIAGNOSTIC guide
  3. 3. DIAGNOSTIC Guide 3 mm post & sleeve 4 mm post & sleeve Holes are drilled in the cast in the planned positions of the bicuspids and first molar. Two 3 mm guide posts and a 4 mm guide post were placed in the holes in the cast. Three ceramic guide sleeves were used to make the initial DIAGNOSTIC guide.
  4. 4. Actual Guide Posts Used 3 mm X 30 3 mm X 30 4 mm X 20Generation ll Guide Post Guide Post Guide Posta
  5. 5. PREview of Pre-op Corrections # 12 NO CORRECTION #13 LINEAR CORRECTION 2.1 mm toward the bucal + 2.1 mm toward the distalaccomplished by: 3 mm offset guide post rotated 45° disto-buccally # 19 LINEAR CORRECTION 2 mm toward the buccal ANGULAR CORRECTION 6.6° toward the lingual #14 LINEAR CORRECTION 3 mm toward the palatal
  6. 6. PRE-OPERATIVE EvaluationGALAXIS Cone Beam Images
  7. 7. #12 GALAXIS A cone beam X-ray was taken and the images are viewed for each individual site to verify or correct the position of the guide sleeve. Panoramic views in the GALAXIS (Sirona) software are not very accurate. Therefore, tangential & cross sectional views are used to verify the sites in next slides.
  8. 8. GALAXIS tangential view cross sectional view Both views indicate #12 to be well aligned no need to be corrected
  9. 9. GALAXIS # 13 panoramic view middle implant highlighted in orange
  10. 10. GALAXIS # 13 tangential view cross sectional view Both views indicate the 3 mm ceramic guide sleeve should be moved to the buccal & distal to correct the position of the proposed osteotomy.This means: a LINEAR CORRECTION of 2.1 mm bucally and 2.1 mm distally made by using a 3 mm offset guide post rotated 45° disto-buccally.The angle of the guide sleeve is correct. Therefore , NO ANGULAR CORRECTION. Cosine is applied to determine correction data. * see next 4 slides
  11. 11. DéPlaque Pythagorean TheoremCOSINE Calculations for Guide Right™ Guides The cosine of 45° is recommended for Guide Right corrections BECAUSE rotating the offset guide post half way between 2 adjacent planes (90° apart) is 45°. See additional slide show: for more information Pythagorean Theorem COSINE Calculations for Guide Right™ Guides
  12. 12. Cosine for site #13 A = cosine of 45° X 3 mm offset post (0.707 X 3 mm = 2.12 mm) distal 2.1 mm 45° buccal 2.1 mmguide post center What is COSINE? See FAQ www.deplaque.com
  13. 13. Cosine EXAMPLE A = cosine of 45° X 2.5 mm offset post (0.707 X 2.5 mm = 1.8 mm) distal 1.8 mm 45° buccal 1.8 mmguide post center
  14. 14. Cosine EXAMPLE A = cosine of 45° X 1.5 mm offset post (0.707 X 1.5 mm = 1.06 mm) distal 1.06 mm 45° buccal 1.06 mmguide post center
  15. 15. Cosine EXAMPLE A = cosine of 45°X 2 mm offset post (0.707 X 2 mm = 1.42 mm) distal 1.4 mm 45° buccal 1.4 mmguide post center
  16. 16. GALAXIS # 14 panoramic view
  17. 17. GALAXIS # 14 A 5 X 9 mm virtual implant is placed on the cone beam image and indicates  LINEAR CORRECTION: the guide post will need to be moved 3 mm palatally  by using a 3 mm offset post with no change in the angle of the guide post.
  18. 18. GALAXIS # 19 panoramic view
  19. 19. # 19 GALAXIS tangential view cross sectional viewANGULAR CORRECTION of 6.6° to the lingual will be neededand a LINEAR CORRECTION of the guide post >2 mm to the buccal using a 2 mm offset guide post to avoid perforation of the lingual plate.The green line indicates the acceptable angle of the guide sleeve in the bucco-lingual plane.
  20. 20. REview of Pre-op Corrections # 12 NO CORRECTION #13 LINEAR CORRECTION 2.1 mm toward the bucal + 2.1 mm toward the distalaccomplished by: 3 mm offset guide post rotated 45° disto-buccally #14 LINEAR CORRECTION 3 mm toward the palatal # 19 *guide not shown in presentation LINEAR CORRECTION 2 mm toward the buccal ANGULAR CORRECTION 6.6° toward the lingual
  21. 21. Fabrication of SURGICAL guide
  22. 22. magnetic guide posts in cast• # 12 leave as is• # 13 move buccally 2 mm.• # 14 No angle correction is necessary
  23. 23. Magnetic guide posts with open guide sleevesshowing cleats positioned toward the palatal surface.
  24. 24. Triad® Gel applied to open guide sleeve cleats& adjacent teeth to form the SURGICAL guide.
  25. 25. After the initial 2 mm drill a direction indicator wasplaced to check the proximity to the adjacent root.
  26. 26. POST-OPERATIVE EvaluationGALAXIS Cone Beam Images
  27. 27. GALAXIS # 12 volumetric view POST OP results
  28. 28. GALAXIS #13 panoramic view
  29. 29. #12 POST-op RESULTSGALAXIS tangential view cross sectional viewAlignment of the #12 implant with the SURGICAL guide in place - both views.
  30. 30. #13 POST-op RESULTSGALAXIS tangential view cross sectional view Alignment of the #13 implant with open guide sleeve - both views.
  31. 31. #14 POST-op RESULTSGALAXIS tangential view cross sectional view Alignment of the #14 implant with guide sleeves – both views.
  32. 32. Post-op position of the #19 implant
  33. 33. Impressions were made at the time of the surgery and an X-ray was taken of the impression copings for #12 ▪ #13 ▪ #14 to be sure they were completely seated.
  34. 34. A lateral view of the master cast with prepared abutments.
  35. 35. Final restorations.
  36. 36. Final restoration.
  37. 37. Guide Right™ Products Used in this Presentation (1) 3/32” drill (2) 3 mm & (1) 4 mm Straight Guide Posts for the DIAGNOSTIC guide (2) 3 mm & (1) 4 mm Ceramic Guide Sleeve for the DIAGNOSTIC guide (2) 3 mm & (1) 4 mm Open Guide Sleeve for the SURGICAL guide (1) 3 mm Straight Magnetic Guide Post (1) 3 mm x 3 mm Offset Magnetic Guide Post (1) 4 mm x 3 mm Offset Magnetic Guide Post Guide Post Bending Tool & 3mm Stylus Triad® Gel ► See slide show : Use of Pythagorean Theorem with Guide Right System1.800.314.0065 • www.deplaque.com
  38. 38. A System of Componentsfor the fabrication and correction of diagnostic & surgical guides in one or two dimensions  In-office or lab fabrication  Evaluate with 2D & 3D imaging  Allows linear and angular correction  Enables precision implant placement  Cost effective 1.800.314.0065 • www.deplaque.com
  39. 39. 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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