2 piece guide post with steps to making a surgical guide featuring invivo5 software

Guide Right™ Surgical Guide System

Use of 2-Piece Guide Post

DéPlaque

Guide Right™

2-Piece Guide Posts

DéPlaque

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.

2-Piece Guide Post

Offset Lower Piece

The Offset Lower Piece is constructed in a series of offsets with 8 flat sides to

allow corrections in 0.5 mm intervals in any direction to change the linear position

of the surgical guide sleeve.

2-Piece Guide Post

Upper Removable Piece

2.7 mm

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.

Angle Corrections:

The lower piece of the straight 2-piece guide post can be altered for angular corrections by bending the 1/16th

shaft up to 35º 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 have 8 sides & are designed for linear corrections that reposition the implant in either bucco-

linqual or mesio-distal plane or two adjacent planes i.e. mesio-buccal with/without changing the angle of the

guide post. The Pythagorean theorem is used to calculate the amount of rotation.

Use with Guide Sleeves

Guide Sleeves made for 2-Piece Guide Posts are designed to match the diameter (0.05 mm larger) of the

upper piece of the 2-piece guide posts & are available in many diameters:2.7 mm id X 5.0 mm or 7.0 mm long • 3.0 mm id X 5 mm or 8.0 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 (straight or offset) can be used with any of the original 3 mm cylindrical guide

sleeves & the 4.5 & 5.3 mm Serial Kits.

When to Use the 2-Piece Guide Post

1. WHEN the path of withdrawal of the guide sleeve & the adjacent teeth are not parallel, the

surgical guide may be mechanically locked on cast

HOW• 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

2. WHEN 2 adjacent guide posts are not parallel the surgical guide will be mechanically locked on cast

HOW• A 2-Piece Guide Post allows the removal of the upper piece of the guide post & the removal of the

completed SURGICAL guide with non-parallel 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

prosthetically planned implant trajectory of the DIAGNOSTIC guide.

Guide Right

2 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.

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 up 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

OPTION 2


Cylindrical Guide Sleeve with the coordinating 2- Piece Guide Post

PURPOSE: • used in areas where access & visibility is not limited

HOW:

• drill access is from the top of the surgical guide

• may require drills with drill stops to determine drill depth of the osteotomy

• 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

• has less chance of error than when using the open guide

REQUIRES: the use of the 2- piece Guide Post to fabricate and correct the guide.

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”


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 with the 1/16” diameter part of the lower post

with clearance for the removal of the larger guide sleeve 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.

Design & Specifications

Lower Piece STRAIGHT

The 2-Piece Guide Post Design is comprised of 2 compatible parts:

Lower Piece & 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

rectangular platform of the lower piece on which various sized upper

removable posts can be placed to hold the SURGICAL guide sleeve.

• Allows fabrication of multiple SURGICAL guides with different diameter guide

sleeves with the same corrected lower piece

SPECIFICATIONS:

• 3/32” outside diameter fits in the 3/32” diameter hole drilled in the cast

• The lower shaft & the platform have 4 or 8 equal flat sides representing mesial,

distal, buccal or lingual surfaces or mesio-distal, mesio-buccal, mesio-lingual or

disto-lingual surfaces.


Lower Piece OFFSET

LOWER PIECE OFFSET guide posts

PURPOSE:

• Offsets are designed for linear corrections that reposition the implant in

either buccal, lingual or mesial or distal or 2 adjacent planes (ie mesio-

buccal) with/without changing the angle for the surgical guide.

SPECIFICATIONS:

3/32” outside diameter to fit in the 3/32” hole in the cast

Lower post has 8 flat sides

Rectangular platform has 4 flat sides & available in various size offsets >

0.5 mm, 1.0 mm 1.5 mm, 2.0 mm, 2.5 mm & 3.0 mm 4.0mm and 5.0mm

UPPER PIECE guide post

PURPOSE:

Compatibility: to fit a variety of guide sleeve id often matching the diameter of the keys

made by implant companies

Benefit: Allows removal of the corrected 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 & matching 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” bendable shaft of the Lower Piece of the

2-piece guide post


◄ Upper Piece

ACESSORIES for 2-Piece Guide Post

Stylusfor 2-Piece Guide Post

PURPOSE: Used with the Guide Right™ Bending Tool to make angle corrections

• to the lower piece of the 2-piece guide post

• the shaft of the magnetic guide post

SPECIFICATIONS:

• Opening► 1/16” ► to fit lower piece of 2-piece guide post

3 mm ► to fit over a magnetic guide post


Start With Precision. Place With Confidence.™

1.800.314.0065 • www.deplaque.com

fabricate ▪ evaluate ▪ correct ▪ verify ▪ place

DéPlaque

Steps to Making a Guide Right™ Surgical Guide

Fabrication & Correction

Diagnostic & Surgical Guides

Immediate Placement Casefeaturing

2-Piece Guide Post • Invivo5

Allen

Surgical Guide


DéPlaque

▪ fabricate diagnostic guide

▪ evaluate

▪ correct

▪ re-fabricate surgical guide

▪ verify

▪ place

A hole was drilled through the cingulum of the existing tooth with a 3/32” drill

and a 3 mm straight guide post was inserted

3 mm DIAGNOSTIC GUIDE sleeve placed on the post

with cleat positioned toward the palatal

After lubricating the cast and blocking out undercuts, clear Triad® gel

has been applied to capture cleat on the guide sleeve & adjacent teeth

to form the DIAGNOSTIC guide.

STEPS to creating a Guide Right™ Surgical Guide

STEP 1 Locate the position of the guide post

using one of the following methods:

• a wax set up

• estimate by measuring a tooth and its

position in the contralateral arch


STEP 2 Using a 3/32” drill make a hole in the cast



• a wax set up

• estimate by measuring a tooth and its position in the

contralateral arch




• a wax set up

• estimate by measuring a tooth and its position in the

contralateral arch


STEP 3 Place a 3 mm guide post in the 3/32” hole

• to provide a reference position

• to continually return to the prosthetically

planned position (HOME POSITION)




• a wax set up

• estimate by measuring a tooth and its position in the contralateral arch




• to continually return to the prosthetically planned position (HOME POSITION)

STEP 4 Place a radio-opaque guide sleeve on the guide post

• cleat positioned to the lingual


STEP 5 Add Triad® gel or acrylic resin

• capturing the cleat & the adjacent teeth

to form a DIAGNOSTIC guide



• a wax set up

• Estimate, measuring a tooth and its position in the

contralateral arch




• to continually return to

STEP 4 Place a radio-opaque guide sleeve on the guide post

• cleat positioned to the lingual

To assure accurate implant placement

► free of anatomic obstruction ◄

the following considerations are suggested.

The position of the guide sleeve is an estimated prosthetically planned implant

trajectory & therefore may not be in the best anatomic position

The position of the guide sleeve & the proposed implant position must be

evaluated in relation to the alveolar bone, the nerves and or the location of the

sinus for each patient.


DéPlaque

▪ fabricate diagnostic guide

▪ evaluate ▪ correct

▪ re-fabricate surgical guide

▪ verify

▪ place


STEP 6 Take a cone beam X-ray

• with DIAGNOSTIC guide securely seated in the patient


Step 7 Evaluate the X-ray

• to accurately place within alveolar bone,

• to evaluate proximity to nerves or sinus

Is the planned implant trajectory/angle anatomically acceptable?

Is the planned implant linear position anatomically acceptable?

Must angle or position be changed to become anatomically acceptable?


Use of Invivo5 Software

to

Evaluate, Correct, & Verify planned implant trajectory

prior to drilling the osteotomy

STEP 8

Invivo5 Anatomage

NAVIGATION

used to determine & make corrections

for Guide Right™ Surgical Guides

Invivo5 Software

Navigating the System

For better understanding of

use of Invivo5 software

SEE slide show at

www.deplaque.com

Steps to Making & Correcting a Surgical Guide

Steps to using Invivo5 for Evaluation

Using Invivo5 Software

START from the HOME POSITION ► the AXIAL view

► the view showing a virtual implant aligned with the image

of the DIAGNOSTIC guide sleeve in Invivo5 software.

3 PLANES are viewed in the AXIAL view

(A) the bucco-lingual / cross sectional plane may / may not display as a line intersecting the alveolar

bone/ridge at 90º diagonally

(B) the mesio-distal plane / tangential plane (HOME POSITION)

(C) The IDEAL POSITION shown in the AXIAL PLANE is when the line

intersecting the alveolar bone is 90º indicating the direction of

the bucco-lingual plane being viewed.

STEP by STEP

Evaluation

Home Position

tangential volumetric

AXIAL cross sectional


from the HOME POSITION ►

All angle and linear measurements or corrections

MUST be made… from the HOME POSITION

► THEREFORE return to the HOME POSITION

to initiate a change in the either plane

► After making a correction (angular or linear) in one plane

you must return to the HOME POSITION

to make a change in the other plane.

STEP by STEP

Evaluation

axial cross section

Invivo5 3D Cone Beam X-ray Composite Views



CHANGES in the proposed implant position

Changing the LINEAR POSITION…

… in either mesio-distal plane or bucco-lingual plane is made by

selecting an offset guide post to alter the position of the guide sleeve

Changing the ANGLE of the TRAJECTORY

by measuring the angle of the proposed implant location &

bending the guide post to the corrected angle.

After making a correction (angle or linear) in one plane

YOU MUST RETURN TO THE HOME POSITION

To measure and make the 2nd correction needed in the other plane.

.

STEP by STEP

Evaluation


HOME POSITION WARNING

Measuring or making angle or linear corrections

from any other positions (cross sectional or tangential)

will lead to errors,

& the corrections recorded will not be accurate

BECAUSE

the angle is not measured from the HOME POSITION

STEP by STEP

Evaluation

Invivo5 Anatomage

NAVIGATION

used to make corrections

for Guide Right™ Surgical Guides

Home Position • Cross Sectional View

Center Line of the implant is passing through center of guide sleeve

The line indicating the plane of the cross sectional view should be

rotated to position at 90º tangential to the curvature of the arch

of the alveolar bone in the Axial view

IN HOME POSITION AXIAL VIEW

use of Invivo5 Sofware

90º

Home Position • Tangential View

Indicates

no correction is needed in

the mesio-distal plane.

Evidenced by

the alignment of the axis

of the implant with the

radio-lucent center of the

DIAGNOSTIC guide sleeve

& the long axis of the

existing tooth.

Home Position • Composite View


axial cross sectional


DéPlaque

▪ fabricate [diagnostic guide]

▪ evaluate

▪ correct ▪ re-fabricate [surgical guide]

▪ verify

▪ place

CROSS SECTION VIEW

high magnification

DIAGNOSTIC guide position:

showing apex of implant too close

to the buccal plate (<4 mm)

which should be grafted for best

esthetic results

Capelli M. et alJ Perio vol 84 # 12, 2013

CROSS SECTIONAL Composite View

8º Labial Angle Correction moves osteotomy Palatal


axial cross sectional

CROSS SECTION 8º Labial Angle Correction

INDICATES

8º CORRECTION IS CHOSEN to

avoid the proximity of the implant to

the facial plate as observed in the

buccl-lingual plane.

EVIDENCED BY

THE ANGLE FORMED by the long

axis of the implant with the long axis

of the radio-lucent center of the

DIAGNOSTIC guide sleeve with the

long axis of the existing tooth.

TANGENTIAL VIEW 8º Labial Angle Correction

NOTE: the tangential view

changes because the long axis

of the implant no longer passes

through the radio-lucent center

of the DIAGNOSTIC guide

sleeve

TANGENTIAL

CROSS SECTIONAL

NOTE: the loss of the original shape of the

guide sleeve in tangential view

toward buccal

CROSS SECTION

8º toward buccal Correction moves osteotomy Palatal

REPOSITION GUIDE SLEEVE

ANGULAR CORRECTIONS are made with the

Guide Right™

Bending Tool

Step by step instructions at end of slideshow

Single Bendcorrections in one plane

Guide Right™

Bending Tool

2- piece guide post

LOWER PIECE of 2-piece guide post in the Bending Tool block

BENDING the 1/16 “ lower part of the guide post 8º WITH STYLUS

8º

CLOSE UP

Bending Tool block with guide post bent 8º


DéPlaque


▪ evaluate

▪ correct

▪ re-fabricate [surgical guide]

▪ verify

▪ place

The existing crown is removed sectioned from the cast.

The crown is removed from the cast.

A 3 mm lower piece of 2-piece guide post

corrected 8º toward the buccal & shown placed in the hole

Upper piece is placed on the 8º angle corrected lower piece of the guide post

INCISAL VIEW

3 mm guide sleeve placed on the upper piece of the guide sleeve

PALATAL VIEW

Corrected SURGICAL guide

FACIAL VIEW

corrected SURGICAL guide with 3 mm oval window guide sleeve


DéPlaque


▪ evaluate

▪ correct


▪ verify▪ place

Actual 2-piece guide post bent 8º

placed on printout of cone beam X-ray image

(CROSS SECTIONAL VIEW)

VERIFY ACCURACY


DéPlaque


▪ evaluate

▪ correct


▪ verify

▪ place

A crestal incision is made

The SURGICAL guide with a 3 mm oval open guide sleeve is placed

A 3 mm hybrid drill

used to start the osteotomy

A Straumann 2.2 mm drill

used to drill to the required depth

A Straumann 2.8 mm drill

used to enlarge the diameter of the 2.2 mm drill to final depth.

An optional 2nd SURGICAL guide was made on the same cast

with an 8º corrected guide post for the final 3.75 mm drill

2ND OPTIONAL SURGICAL GUIDE

made with 3.9 mm sleeve & used with final 3.75 mm drill

The alignment of the implant is checked with the 3.9 mm id guide sleeve.

Placement of implant and carrier is used to verify final alignment of implant.

Final Placement

Single Bendcorrections in one plane

Guide Right™

Bending Tool

2- piece guide post

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 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 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 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.

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.

Guide Right™

BENDING TOOL

SINGLE BEND review

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 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 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.

Step 3 The set screw is loosened and the guide post is rotated 90 ° next flat surface.

Step 2 The 1st bend can be made to the right or left direction.

Step 6 The second bend can be made in either direction according to the x-ray.

Guide Right™

BENDING TOOL


1.800.314.0065 • www.deplaque.com

DéPlaque

“Steps to Making & Correcting a Surgical Guide”

featuring

Steps to using Invivo5 for Evaluation

Bending Tool 2 Bends

For more information on use of 2-Piece Guide Post

see

2 piece guide post with steps to making a surgical guide featuring invivo5 software

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Transcript of 2 piece guide post with steps to making a surgical guide featuring invivo5 software