19 fibular graft case
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Transcript of 19 fibular graft case
# 29 and #30
3 mm Guide Posts
3 mm Diagnostic Guide Sleeves
3 mm Magnetic Guide Posts
3.3 and 4 mm Open Guide Sleeves
Generation ll / Guide Post Bending Tool
Software Evaluation
Guide Right™
Fibular Graft Case
Invivo5 Anatomage
Featuring:
KARLS
This patient had a section of the mandible removed & grafted
with a vascular fibular graft 2 years prior to implant placement.
Fabrication of DIAGNOSTIC Guide
3/32” holes were drilled in the cast in the positions of the 2nd bicuspid and 1st molar.
The cast was lubricated with petroleum jelly.
Two straight 3 mm guide posts were placed in the openings.
3 mm cylindrical guide sleeves were placed on the guide posts
with cleats positioned toward the lingual surface.
Triad® Gel was added & cured to capture the cleats& form the DIAGNOSTIC
guide which was placed in the patient and a cone beam X-ray was taken.
Invivo5
Software Evaluation
Pre-op
Anatomage
The DIAGNAOSTIC guide sleeves viewed in the cone beam images were evaluated.
[ axial, tangential and cross sectional views ]
axial cross sectional
tangential volumetric
Invivo5 Anatomage
# 29
Initial Alignment
# 29
8° angular correction to the mesial is necessary
axial cross sectional
tangential volumetric
Invivo5 Anatomage
# 29
▪ close-up showing 8° bend toward the mesial needed ▪
tangential
Invivo5 Anatomage
axial cross sectional
tangential volumetric
# 29
ANGULAR CORRECTION: 5 ° toward the lingual
LINEAR CORRECTION: 1 mm offset
Invivo5 Anatomage
5° angular correction 1 mm offset linear correction
cross section tangential # 29
Invivo5 Anatomage
axial cross sectional
tangential volumetric
# 30
Initial Alignment
Invivo5 Anatomage
Invivo5 Anatomage
cross sectional
# 30
Shows initial alignment is NOT GOOD
Invivo5 Anatomage
cross sectional view
axial cross sectional
tangential volumetric
# 30
4.8 mm X 10 mm Straumann Implant (virtual image)
1 mm offset guide post > 15° bend toward lingual
Invivo5 Anatomage
cross sectional
shows a 15° angular correction is necessary for the
guide sleeve to line up with the position of the virtual implant
Invivo5 Anatomage
tangential view
# 30
Guide Right™
Generation ll ▪ Guide Post Bending Tool
For more information on use of the bending tool go to
www.deplaque.com ▪ Guide Right™ Generation ll Bending Tool
10 ° example
Preview of Pre-op Corrections
#30
LINEAR CORRECTION
1 mm offset
ANGULAR CORRECTION
1 BEND: 15° toward lingual
#29
LINEAR CORRECTION
1 mm offset
ANGULAR CORRECTION
1ST BEND: 8° toward the mesial
2nd BEND: 5° toward the lingual
Cosine is applied to determine correction data.
* see next 3 slide
Guide post positioned in the bending tool
with offset positioned forward.
# 29
BEND
8° toward the mesial
# 29
The 1 mm offset guide post with an 8 mm correction is rotated 90°
and placed back in the bending tool for the second 5° bend toward lingual.
# 29 5° correction
stylus over 1 mm offset guide post bent 15° toward lingual
# 30
# 29 1 mm offset
5 ° bend
# 29
8° lingual bend
tangential view cross sectional view
Offset magnetic guide posts in cast
Buccal view of magnetic guide post with open guide sleeve
Fabrication of SURGICAL Guide
Triad® Gel added to open guide sleeves to form the SURGICAL guide.
SURGICAL Guide
Ramus plate must be avoided
Invivo5
Software Verification
Post-op
Anatomage
axial cross sectional
tangential volumetric
#29
Note: implant placement
with virtual implants positioned over actual implants
Invivo5 Anatomage
axial cross sectional
tangential volumetric
#30
Post-op Implant Placement
Invivo5 Anatomage
Custom impression coping due to the depth of the fixture
Peri-apical X-ray to confirm seating of impression coping.
Custom Atlantis Abutments
Final restoration in master cast
Restoration on master cast
Atlantis Abutments in place
Final restoration
Magnetic Offset Guide Posts
Straight
3.0 mm od
Offset
3.0 od X 0.5 mm os
3.0 od X 1.0 mm os
3.0 od X 1.5 mm os
3.0 od X 2.0 mm os
3.0 od X 2.5 mm os
3.0 od X 3.0 mm os
Guide Right™
Products shown in this case
3/32” Drill
3 mm Guide Posts
3 mm Diagnostic Guide Sleeves
3 mm Magnetic guide posts
3.3 mm Open Guide sleeves
4 mm Open Guide Sleeves
1.0 mm Offset Magnetic Guide Sleeve
Triad® Gel
1.800.314.0065 • www.deplaque.com
Guide Right™ Surgical Guide System
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
fabricate ▪ evaluate ▪ correct ▪ verify ▪ place
DéPlaque