new 2-piece guide post with steps to making a surgical guide featuring invivo5 software 4.23.17

Guide Right™ Surgical Guide System

DéPlaque

A Geometric Approach to Guided Surgery

with

Use of 2-Piece Guide Post

DéPlaque


2-Piece Guide Post

Straight Lower Piece with Upper Removable Piece

The bottom half of the Straight Lower Piece of the 2-Piece Guide Post is designed with 4 flat sides allowing corrections in 4 directions: corresponding with the mesial, distal, buccal & lingual surfaces of the tooth.,

Advantage of the 2-Piece Guide Post: All diameter guide sleeves can be used by changing the coordinating diameter of the upper piece of the guide post which are available in sizes including 3.0, 3.9, 4.5, 4.8, 5.5, 6.0 mm (slightly smaller o.d. than the guide sleeve i.d.) to fit the keys made for many of the implant manufactures.

* * If you have previously purchased original offset guide posts (without the smaller post diameter below the rectangular offset platform) we suggest that you arrange to exchange them at no cost by calling DePlaque 800.314.0065.

2-Piece Guide Post

Offset Lower Piece

The OFFSET Lower Piece is constructed in a series of offsets with 8 flat sides allowing corrections in 0.5 mm intervals in 8 directions to change the linear position of the surgical guide sleeve.

2-Piece Guide Post Lower Offset Piece Parts

8 flat sides allows corrections in 8 directions:

mesial mesio-buccal buccal mesio-lingual distal disto-lingual lingualmesio-lingual

8 FLAT SIDES

OFFSET

UPPER-PORTION

LOWER-BENDING PORTION

LOWER-PORTION

PLATFORM

2-Piece Guide Post

Upper Removable Piece

2.7 mm2.0 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.

Linear Corrections with Offset Guide Posts:

Offset guide posts have 8 sides & are designed for linear corrections that reposition the implant in either buccal, linqual, mesial or distal plane or any of the four adjacent planes i.e. mesio-buccal with or without changing the angle of the guide post. The Pythagorean theorem is used to calculate the amount of rotation.

Angle Corrections:

•Single Angle Correction: Guide post angle corrections/bends are made below the post platform in a single bend to accommodate/allow a linear adjustment in any direction.

The lower piece of the straight 2-piece guide post can also 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 removable piece/post is selected to coordinate with the guide sleeve dimension & placed over the 1/16” shaft for the fabrication of the surgical guide.

Multiple Corrections:

•Linear Correction plus Angle Corrections in any or combined directions

•Two Angle Corrections to the same offset post:

Make 1st correction below the post platform Make 2nd correction above the post platform

Use of the 2-Piece Guide Post with Guide Sleeves

Use with Guide Sleeves

The 2-piece guide post can be used with any diameter cylindrical guide sleeves by selecting the appropriate diameter upper part slightly smaller than the diameter of the guide sleeve.

Guide Sleeve Diameters Available2.7 mm • 3.0 mm • 3.8 mm • 4.0 mm • 4.2 mm • 4.5 mm • 5.0 mm • 5.26 mm • 5.3 mm • 6.0 mm. 2.0 mm • Custom sizes available on request.

When to Use the 2-Piece Guide Post

WHEN the path of withdrawal of the surgical guide & the adjacent teeth are not parallel most of the time, the SURGICAL guide may be mechanically locked on the cast.

HOW•A cylindrical sleeve is selected.

•An angle correction is made by bending the guide post.

•Triad® gel is added to both the guide sleeve & the adjacent teeth of a lubricated cast to form the SURGICAL guide.

WHEN 2 adjacent guide posts are not absolutely parallel, which is most of the time,the SURGICAL guide will be mechanically locked on the 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. 2-Piece Guide Post with Cylindrical Guide Sleeves are selected for the SURGICAL guide.

2. Magnetic Guide Post with coordinating Open Guide Sleeve ** For the more advanced user because there is a greater for error if you drill outside of the open guide sleeve

OPTION 1 for Non-parallel Adjacent Guide Posts

Magnetic Guide Post with the coordinating Open Guide Sleeve

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 size to fabricate the guide

OPTION 2 for Non-parallel Adjacent Guide Posts

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: use of the 2-Piece Guide Post to fabricate & correct the guide.

Why the 2-Piece Guide Post is OPTION OF CHOICE

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”

for Non-parallel Adjacent Guide Posts

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 has 4 equal flat sides representing mesial, distal, buccal or 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

Caution: if the angle of the lower piece is changed several times it will break

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

Guide Right™ Bending Tool StylusUsed to make angle corrections with the Guide Right™ Bending Tool

1/16” opening to fit lower-piece of 2-piece guide post

FLAT-END

3 mm opening to fit over a magnetic guide post

OPEN-END

1/16” opening to make 2nd bend of compound bend

CONE-END

“Steps to Making a Guide Right™ Surgical Guide” follows this slide...

HOW TO ORDER:•All 2-Piece Guide Post pieces are sold individually.•Order one upper removable piece for each lower removable piece of the 2-piece guide post.

o The removable upper piece can be reused for multiple cases. o Example: a three-implant case will require three removable

posts for three 2-piece guide post pieces which can all be used in future cases

o SPECIAL ORDERS available on request. 800.314.0065

1.800.314.0065 • www.deplaque.com


Start With Precision. Place With Confidence.™


fabricate ▪ evaluate ▪ correct ▪ verify ▪ place

DéPlaque

A Geometric Approach to Guided Surgery

Steps to Making a Guide Right™ Surgical Guide

Fabrication & Correction Diagnostic & Surgical GuidesImmediate Placement Case

featuring

2-Piece Guide Post • Invivo5

Allen

Surgical Guide

STEPS to creating a Guide Right™ Surgical Guide


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

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


DéPlaque

▪ fabricate diagnostic guide

▪ evaluate ▪ correct ▪ re-fabricate surgical guide▪ verify▪ place


STEP 4 Place a radio-opaque guide sleeve on the guide post• cleat positioned to the lingual

3 mm DIAGNOSTIC GUIDE sleeve placed on the post with cleat positioned toward the palatal


STEP 5 Add Triad® gel or acrylic resin • capturing the cleat & the adjacent teeth to form a

DIAGNOSTIC guide

After lubricating the cast & blocking out undercuts, clear Triad® gel has been applied to capture cleat on the guide sleeve & adjacent teeth to form the DIAGNOSTIC guide.

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?

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.

Use of Invivo5 Softwareto

Evaluate, Correct, & Verify planned implant trajectory

prior to drilling the osteotomy

STEP 8


Invivo5 Software

Navigating the System

For a 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.

(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

Use of Invivo5 Software

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

corr

ect

incorre

ct

tangential

SOFTWARE GRID

each square: 5 X 5 mm

each side of the square: 5 mm

center mark is 2.5 mm

Understanding Grid Measurements

2.5 mm

5 mm

Invivo5

5 X 5 mm

LINEAR CORRECTION

Home Position • Composite View




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 Angle to Palatal



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 SECTION8º 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 BendSingle Bendcorrections in one plane

Guide Right™

Bending Tool

2-Piece Straight Guide Post in Bending Tool Block

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

8º

8º

CLOSE UP ILLUSTRATION

Bending Tool Block with 2-Piece Offset Guide Post bent below the platform


DéPlaque


▪ evaluate ▪ correct

▪ re-fabricate [surgical guide]▪ verify▪ place

The existing crown is sectioned to remove from the cast.

The crown is removed from the cast.

lower piece of 2-piece guide post corrected 8º toward the buccal is shown placed in the hole

3 mm 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 2-piece guide post

PALATAL VIEW Corrected SURGICAL guide

FACIAL VIEW 8º corrected SURGICAL guide with 3 mm oval window guide sleeve


DéPlaque



▪ re-fabricate [surgical guide]

▪ verify▪ place

Actual 2-piece guide post bent 8º placed on printout of cone beam X-ray image

(CROSS SECTIONAL VIEW)

VERIFY ACCURACY


DéPlaque



▪ re-fabricate [surgical guide]▪ 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

Closure

Temporary Restoration

• 3 mm straight guide post• 3 mm diagnostic guide sleeve

DIAGNOSTIC GUIDE

SURGICAL GUIDE • Lower piece straight 2-piece guide post

• 3 mm upper piece 2-Piece guide post • 3 mm guide sleeve

Guide Right™ Components Used in this Case

ANGLE CORRECTION:

• 8º toward labial

Guide Right™ BENDING TOOL

SINGLE BEND review

Step 1 Place bending tool plate on a secure flat surface with the degree increments at the top & the stainless steel bar at the bottom.

Step 2 Locate the two 3/32” holes in the top of the stainless steel bar. The hole closest to the plate is used for all guide posts up to 3.0 mm offsets. The front hole is used for offsets 3.5 mm or larger. Place the bottom half of the guide post to be bent into the hole. Position the offset guide post in the hole determined by the planned direction of the correction. Tighten the set screw.

Step 3 Select the appropriate stylus to fit over the top half of the guide post.

Step 4 Fit the stylus over the guide post securely with the point directed at zero degrees & the bottom of the stylus in contact with the platform of 2-piece guide post or if no platform on post, in contact with block.

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 Remove the stylus. Loosen screw to remove the guide post bent to the desired angle.

COMPOUND BEND overview

Guide Right™ BENDING TOOL

Step1 Position a straight or offset guide post in the bending plate, tightening the set screw against one of the 8 flat surfaces on the lower half of the guide post.

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

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

Step 4 The 2nd bend in the 2nd plane is made after rotating the guide post up away from the surface of the bending plate to register the stylus point back at 0º.

Step 5 Slide the stylus support bar down under the stylus until it supports the stylus. Tighten the side screws before making the 2nd bend.

Step 6 The 2nd bend can be made in either direction according to the X-ray.

Step 7 Remove the stylus and place the guide post back in the cast with the appropriate side indicated by a mark with a felt tip pen facing the buccal or lingual surface. Be sure the post is in the correct position.

If necessary,Linear Corrections, using an offset guide post, must be determined & made before Angle

Corrections.

Offset 2-Piece Guide Posts available in the 3 mm guide post: 0.5,1, 1.5, 2.0, 2.5 & 3.0 mm.



DéPlaque

HOW TO ORDER:•All 2-Piece Guide Post pieces are sold individually.•Order one upper removable piece for each lower removable piece of the 2-piece guide post.

o The removable upper piece can be reused for multiple cases. o Example: a three-implant case will require three removable

posts for three 2-piece guide post pieces which can all be used in future cases

o SPECIAL ORDERS available on request. 800.314.0065



DéPlaque

“Steps to Making & Correcting a Surgical Guide”featuring

Steps to using Invivo5 for EvaluationBending Tool 2 Corrections

For more information on use of 2-Piece Guide Post

see

new 2-piece guide post with steps to making a surgical guide featuring invivo5 software 4.23.17

Health & Medicine