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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
Generation ll Bending Tool
MMEI 2.2013
Fabrication of DIAGNOSTIC guide
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.
DIAGNOSTIC Guide
3 mm
post & sleeve
4 mm
post & sleeve
4 mm X 20
Guide Posta3 mm X 30
Generation ll Guide Post
3 mm X 30
Guide Post
Actual Guide Posts Used
PREview of Pre-op Corrections
# 12
NO CORRECTION
#13
LINEAR CORRECTION
2.1 mm toward the bucal + 2.1 mm toward the distal
accomplished by: 3 mm offset guide post rotated 45° disto-buccally
# 19
LINEAR CORRECTION
2 mm toward the buccal
ANGULAR CORRECTION6.6° toward the lingual
#14
LINEAR CORRECTION
3 mm toward the palatal
PRE-OPERATIVE Evaluation
GALAXIS Cone Beam Images
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.
GALAXIS
#12
tangential view cross sectional view
GALAXIS
Both views indicate #12 to be well aligned
no need to be corrected
# 13 panoramic view
middle implant highlighted in orange
GALAXIS
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.
GALAXIS # 13
Cosine is applied to determine correction data.
* see next 4 slides
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
See additional slide show: for more information
Pythagorean Theorem
COSINE Calculations for Guide Right™ Guides
dis
tal 2
.1
mm
buccal 2.1 mm
A = cosine of 45 X 3 mm offset post
(0.707 X 3 mm = 2.12 mm)
guide post center
45°
What is COSINE? See FAQ www.deplaque.com
Cosine for site #13
dis
tal 1
.8
mm
buccal 1.8 mm
A = cosine of 45 X 2.5 mm offset post
(0.707 X 2.5 mm = 1.8 mm)
guide post center
45°
Cosine EXAMPLE
dis
tal 1
.06
m
m
buccal 1.06 mm
A = cosine of 45 X 1.5 mm offset post
(0.707 X 1.5 mm = 1.06 mm)
guide post center
45°
Cosine EXAMPLE
dis
tal 1
.4
mm
buccal 1.4 mm
A = cosine of 45 X 2 mm offset post
(0.707 X 2 mm = 1.42 mm)
guide post center
45°
Cosine EXAMPLE
# 14 panoramic view
GALAXIS
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.
# 14
GALAXIS
# 19 panoramic view
GALAXIS
tangential view cross sectional view
ANGULAR CORRECTION of 6.6 to the lingual will be needed
and 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.
GALAXIS
# 19
REview of Pre-op Corrections
# 12
NO CORRECTION
#13
LINEAR CORRECTION
2.1 mm toward the bucal + 2.1 mm toward the distal
accomplished 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
Fabrication of SURGICAL guide
magnetic guide posts in cast
• # 12 leave as is
• # 13 move buccally 2 mm.
• # 14 No angle correction is necessary
Magnetic guide posts with open guide sleeves
showing cleats positioned toward the palatal surface.
Triad® Gel applied to open guide sleeve cleats
& adjacent teeth to form the SURGICAL guide.
After the initial 2 mm drill a direction indicator was
placed to check the proximity to the adjacent root.
POST-OPERATIVE Evaluation
GALAXIS Cone Beam Images
# 12 volumetric view
POST OP results
GALAXIS
#13 panoramic view
GALAXIS
tangential view cross sectional view
Alignment of the #12 implant with the SURGICAL guide in place - both views.
POST-op RESULTS#12
GALAXIS
tangential view cross sectional view
Alignment of the #13 implant with open guide sleeve - both views.
POST-op RESULTS#13
GALAXIS
tangential view cross sectional view
Alignment of the #14 implant with guide sleeves – both views.
POST-op RESULTS#14
GALAXIS
Post-op position of the #19 implant
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.
A lateral view of the master cast
with prepared abutments.
Final restorations.
Final restoration.
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
(1) Generation ll Bending Tool & 3mm Stylus
Triad® Gel
► See slide show : Use of Pythagorean Theorem with Guide Right System
1.800.314.0065 • www.deplaque.com
A System of Components for 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
Guide Right™ Surgical Guide System
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
fabricate evaluate correct verify place
DéPlaque
