fabrication of maxillary denture guide 10.12.2016 luf new
TRANSCRIPT
Fabrication of
MAXILLARY DENTURE GUIDE
Featuring:
• 2-Piece Guide Posts • Invivo5 Software Analysis• Linear & Angular Corrections• Straumann Implants• Placement of 5 implants to
support Conus abutment prosthesis including one in Incisive Canal
Guide Right™ Surgical Guide System
DéPlaque
LUF
Treatment plan for this case: Conus abutment supported prosthesis
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
DéPlaque
A Geometric Approach to Guided Surgery
Guide Right™ Surgical Guide Systemfabricate ▪ evaluate ▪ correct ▪ verify ▪ re-fabricate ▪ place
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate Diagnostic GUIDE ▪ evaluate ▪ correct ▪ re-fabricate surgical guide▪ verify▪ place
Duplicated Denture
Oral surface
Occlusal surface
Pre-op Cone beam radiograph with denture guide in patient
PANOREX VIEW
2 mm X 20 mm guide posts inserted through guide sleeves in Lab Putty Base & used for registering corrected guide posts for complete denture guide.
Invivo5 Anatomage
Cone Beam Analysis
PRE-OP
Each site must be evaluated
Measure the angle formed by the 2 intersecting lines
use the angle tool in Invivo5 to measure & correct the angle
of the guide post/sleeve
When … the long axis of the sleeves & the virtual implants are not parallel.
DéPlaque
▪ fabricate diagnostic guide ▪ evaluate with cone beam images ▪ correct ▪ re-fabricate surgical guide▪ verify▪ place
Guide Right™ Surgical Guide System
axial cross sectional
# 3 Pre-op
tangential volumetric
HOME POSITION
Straumann 3.3 mm BLT
axial cross sectional
# 3 Pre-op
tangential volumetric
LINEAR CORRECTION: 1 mm offset toward buccal
cross sectional magnified
# 3 Pre-op
LINEAR CORRECTION: 1 mm offset toward buccal
axial cross sectional
# 4 Pre-op
tangential volumetric
HOME POSITION
Straumann 3.3 mm BLT
axial cross sectional
# 4 Pre-op
tangential
LINEAR CORRECTION: 2 mm offset toward buccal
17 mm VIRTUAL FIXATION SCREW
volumetric
cross sectional
# 4 Pre-op
LINEAR CORRECTION: 2 mm offset toward buccal
17 mm VIRTUAL FIXATION SCREW
axial cross sectional
# 5 Pre-op
tangential volumetric
HOME POSITION
Straumann 3.3 X 8 mm BLT
cross sectional
# 5 Pre-op
HOME POSITION
Straumann 3.3 X 8 mm BLT
axial cross sectional
# 7 Pre-op
tangential volumetric
HOME POSITION: , NO Correction
3.3 X 8 mm Straumann BLT
axial cross sectional
# 7 Pre-op
tangential volumetric
NO CORRECTION
17 mm VIRTUAL FIXATION SCREW
axial cross sectional
tangential volumetric
INCISIVE CANAL POTENTIAL SITE
Straumann 4.1 X 8 mm BL OUTLINE of VIRTUAL IMPLANT
cross sectional
INCISIVE CANAL CROSS SECTION
Straumann 4.1 X 8 mm BL OUTLINE of VIRTUAL IMPLANT
axial cross sectional
Pre-op
tangential volumetric
INCISIVE CANAL
4.1 X 8 mm OPAQUE VIRTUAL IMPLANT
axial cross sectional
# 10 Pre-op
tangential volumetric
HOME POSITION
3.3 mm Straumann BLT
axial cross sectional
# 10 Pre-op
tangential volumetric
LINEAR CORRECTION: 1 mm offset palatal
2 X17 mm VIRTUAL FIXATION SCREW
cross sectional
# 10 Pre-op
LINEAR CORRECTION: 1 mm offset palatal
2 X17 mm VIRTUAL FIXATION SCREW
axial cross sectional
# 11 Pre-op
tangential volumetric
HOME POSITION NO change
Straumann 3.3 mm BLT
axial cross sectional
# 11 Pre-op
tangential volumetric
HOME POSITION
axial cross sectional
# 13 Pre-op
tangential volumetric
HOME POSITION
Straumann BLT 0.5 mm offset toward buccal
axial cross sectional
# 13 Pre-op
tangential volumetric
LINEAR CORRECTION: 0.5 mm offset toward palatal
2 X17 mm VIRTUAL FIXATION SCREW
# 13 Pre-op
LINEAR CORRECTION: 0.5 mm offset toward palatal
2 X17 mm VIRTUAL FIXATION SCREW
cross sectional
axial cross sectional
# 14 Pre-op
tangential volumetric
HOME POSITION
3.3 mm Straumann BLT
axial cross sectional
# 14 Pre-op
tangential volumetric
LINEAR CORRECTION: 1 mm offset toward buccal
cross sectional
# 14 Pre-op
LINEAR CORRECTION: 1 mm offset toward buccal
axial cross sectional
# 14 Pre-op
tangential volumetric
ANGLE CORRECTION: 14° distal to avoid sinus
# 14 Pre-op
tangential
ANGLE CORRECTION: 14° distal to avoid sinus
X-ray of VIRTUAL FIXATION SCREW in mid-palatal suturePotential site for fixation screw
DéPlaque
▪ fabricate diagnostic guide ▪ evaluate▪ correct ▪ re-fabricate surgical guide▪ verify▪ place
Guide Right™ Surgical Guide System
LUF
IMPLANT POSITION & SIZE
# 3 3.3 X 8 mm BLT ••• ••• ••• Linear Correction: 1 mm offset buccal
# 4 17 mm fixation screw ••• ••• ••• Linear Correction: 2 mm offset buccal
# 5 3.3 X 8 mm BLT ••• ••• ••• No Correction
# 7 17 mm fixation screw ••• ••• ••• No Correction:
#10 17 mm fixation screw ••• ••• ••• Linear Correction: 1 mm offset buccal
#11 3.3 x 8 mm BLT ••• ••• ••• No Correction:
#13 17 mm fixation screw ••• ••• ••• Linear Correction: 0.5 mm offset buccal
# 14 3.3 x 8 mm BLT ••• ••• ••• Linear Correction: 1 mm offset buccal Angular Correction: 14° distal
Incisive Canal 4.1 X 8 mm BL ••• ••• •••
NOTE: Implant placement in Incisive Canal was added due to the limited surface area of the four other 3.3 mm X 8 mm implants.
CORRECTIONS
Flap design outlined on Lab Putty matrix
DéPlaque
Guide Right™ Surgical Guide System
Offset Guide Posts
LINEAR CORRECTIONS are made with the
offset guide post
Guide Right™ Offset Guide Posts
LINEAR CORRECTION
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.
# 7
# 5
# 4
# 3
# 10
# 11
# 13
# 14
2-Piece offset lower guide post aligned in order they will be placed
Puddy cast with palatal guide post,
corrected lower part offset guide posts positioned in sites with corresponding upper guide post
corrected 2-Piece upper guide posts with guide sleeves
2-Piece upper guide sleeves positioned on guide posts with cleats toward the palatal surface
palatal guide post
DéPlaque
▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide]▪ verify▪ place
Guide Right™ Surgical Guide System
Triad® gel applied to form the corrected DENTURE GUIDE
Additional Triad® gel applied
Guide Posts removed from DENTURE GUIDE
Access view left Access view right
If necessary???, palatal fixation screw: 3.5 x 8 mm
Trimmed DENTURE GUIDE
Guide Right™ Surgical Guide System
DéPlaque
▪ fabricate [diagnostic guide] ▪ evaluate ▪ correct ▪ re-fabricate [surgical guide]▪ verify▪ place
Guide Right™ Surgical Guide System
Invivo5 Anatomage
Cone Beam Analysis
POST-OP
# Incisive Canal Post-op
axial cross sectional
tangential volumetric
4.1 X 8 mm Straumann
# 3 Post-op
axial cross sectional
tangential volumetric
Straumann 3.3 X 8 mm Implant Bone has been spread with Densah drills
# 7 Post-op
axial cross sectional
tangential volumetric
Straumann 3.3 X 8 mm Implant bone has been spread with Densah drills
# 11 Post-op
axial cross sectional
tangential volumetric
Straumann 3.3 X 8 mm Implantbone has been spread using Densah drills
# 14 Post-op
axial cross sectional
tangential volumetric
Straumann 3.3 X 8 mm Implant
view
Guide Right™
View VIDEO Lfor actual site preparation & implant placement
www.deplaque.com
For more in-depth instruction & understanding of Guide Right Surgical Guide System view SLIDE SHOWS at www.deplaque.com
“INTRODUCTION to GUIDE RIGHT COMPONENTS with SINGLE IMPLANT”
“2-PIECE GUIDE POST with STEPS to MAKING a SURGICAL GUIDE FEATURING: INVIVO5 SOFTWARE”
Guide Right™
GUIDE POST BENDING TOOL
Steps to SINGLE BENDStep 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 0° & 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.
Guide Right™
GUIDE POST BENDING TOOL
Steps to COMPOUND BEND 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.
Versah Densah Drill Kit used to prepare & widen the osteotomy
Start With Precision. Place With Confidence.™
1.800.314.0065 • www.deplaque.com
DéPlaque
A Geometric Approach to Guided Surgery
Guide Right™ Surgical Guide Systemfabricate ▪ evaluate ▪ correct ▪ verify ▪ re-fabricate ▪ place