13 mandibular implant case correcting divergent angled diagnostic guide sleeves

CALHO 2.2013

Featuring:

Magnetic Offset Guide Posts

Open Guide Sleeves

Diagnostic Guide Sleeves [to increase diameter of guide sleeve]

GALAXIS Cone Beam Software Evaluation

Generation ll ▪ Guide Post Bending Tool

Correcting Divergent Angled Diagnostic Guide Sleeves

Mandibular Posterior Case

Magnetic 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

Magnetic Guide Post & Open Guide Sleeve Set

3.0 mm Open Guide Sleeve

3.3 mm Open Guide Sleeve

3.7 mm Open Guide Sleeve

4.0 mm Open Guide Sleeve

3.0 mm Straight Magnetic Guide Posts

3.0 mm Offset Magnetic Guide Post

2.0 mm Pilot Drills (to start the osteotomy)

Other Drill Sizes Available on Request

Fabrication of DIAGNOSTIC Guide

Holes are drilled deliberately accentuating inaccurately initially

planned long axis of the implant positions with a 3/32” drill.

Straight 3 mm guide posts are placed in the questionable

holes drilled in the positions of #19 and #20.

View of 3 mm straight guide posts in place showing the divergent angles.

3 mm guide sleeves are positioned on the guide post with the cleat facing the

lingual. The cast is lubricated & Triad® Gel added to the guide sleeves

capturing the cleats including lingual & incisal surfaces of several of the

adjacent teeth. After curing the DIAGNOSTIC guide & securely seating

it in the patient, a cone beam X-ray is taken.

PRE-OPERATIVE Evaluation

GALAXIS Cone Beam

Preview of Pre-op Corrections

#20

7° Bend rotated toward the lingual

ANGULAR CORRECTIONS

#19

9° Bend toward the buccal

Cosine is applied to determine correction data.

* see next 3 slide

Pythagorean Theorem

COSINE 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°.

DéPlaque

Correction based on the calculations

from the Pythagorean Theorem

To move the position of the guide sleeve 1.4 mm both mesially & buccally:

► use a 3 mm X 1.5 mm offset guide post

► and direct the offset 45º facially and buccally.

Cosine: 1.5 mm X 0.71 = 1.06 mm

see slideshow > Use of Pythagorean Theorem in 9 Single Implant Case

A= cosine of 45º X 1.5

(0.707 X 1.5 mm = 1.06 mm

Panoramic view #19 highlighted

The mandibular nerve is drawn in with the GALAXIS software.

GALAXIS

tangential cross sectional

# 19 viewed with GALAXIS software

GALAXIS

tangential

B L

9 °

cross sectional

# 19 evaluated in GALAXIS software and 9° corrected angle drawn in.

GALAXIS

#19 tangential

B L

9 °

#19 cross sectional

A cone beam X-ray is taken with the DIAGNOSIC guide in place.

The images are evaluated with the software.

The cross sectional image on the right will be corrected 9°

rotated toward the buccal surface.

GALAXIS

Panoramic view #20 highlighted

GALAXIS

#20 tangential #20 cross sectional

B L

9°

The image of the mesial implant will be rotated 7° toward the lingual

GALAXIS

#20 tangential #20 cross sectional

B L

7°

The image of the mesial implant will be rotated 7 ° toward the lingual

#20 tangential #20 cross sectional GALAXIS

POST-OPERATIVE verification

GALAXIS Cone Beam Images

9° bend

# 19

7° bend rotated toward the buccal

# 20

7°

Angle corrected 3 mm guide posts in holes

Buccal view

Angle corrected 3 mm guide posts in holes

Buccal view

3 mm guide posts with (3 x 2 mm id) diagnostic guide sleeves (1 cleat)

serving to increase the diameter of the 3 mm guide sleeve

for use with 4 mm open guide sleeve

3 mm guide post with 2 mm id diagnostic guide sleeve (1 cleat)

serving to increase the diameter of the 3 mm guide sleeve

for use with 4mm open guide sleeve

occlusal view

3 mm diagnostic guide sleeves - 3 mm magnetic guide posts

with 4 mm open guide sleeves added

Triad® Gel added & cured to form the SURGICAL guide

Panoramic view # 19

Post-op cone beam shows virtual implant

superimposed over placed implant

and aligned with the open guide sleeve.

GALAXIS

tangential view cross sectional view

#19 Post-Operative Cone Beam

GALAXIS

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™

GENERATION II ▪ GUIDE POST 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™

GENERATION II ▪ Guide Post BENDING TOOL

Guide Right™

Products used in this presentation

1.800.314.0065 • www.deplaque.com

1 - 3/32” drill

2 - 3 mm Guide Post

2 - 3 mm Guide Sleeve

2 - 3 mm x 2 mm id Diagnostic Guide Sleeve [1 cleat]

2 - 4.0 mm Open Guide Sleeve (short)

1 - 2.0 mm x 5.0 mm Pilot Drill

1 - 2.0 mm x 10.0 mm Pilot Drill

Triad® Gel

Generation ll ▪ Guide Post Bending Tool

In-office or lab fabrication Evaluate with 2D & 3D imaging Allows linear and angular correction Enables precision implant placement Cost effective

A System of Components

for the fabrication and correction of diagnostic & surgical guides

in one or two dimensions

Guide Right™ Surgical Guide System

Start With Precision. Place With Confidence.™

1.800.314.0065 • www.deplaque.com

fabricate ▪ evaluate ▪ correct ▪ verify ▪ place