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 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.

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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 Anatomag

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# 29

Initial Alignment

# 29 8° angular correction to the mesial is necessary

axial cross sectional

tangential volumetric

Invivo5 Anatomag

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# 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 Anatomag

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cross sectional

# 30 Shows initial alignment is NOT GOOD

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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 Bending Tool

For more information on use of the bending tool go towww.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 mesial2nd 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

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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