Figures:
Figure 1: A 2nd clear duplicate was fabricated and proposed sites were outlined on the interior of the maxillary denture with a marker and guide holes were created through the interior maxillary denture with a 3/32” drill, 2 mm guide sleeves were pressed into the holes in the possible implant sites.
Figure 2: Site #3 was noted to have insufficient crestal height to allow implant placement without a crestal sinus lift.
­­­Figure 3: Virtual planning of site #4 with the diagnostic guide intraorally with Invivo5 software during the CBCT scan determined no linear or angle correction would be required at this site.
Figure 4: Site #5 was selected for placement of a stabilization screw for the full arch surgical guide and sufficient bone was present to accommodate the screw. No angle or linear corrections are needed.
Figure 5: Virtual planning of site #6 with the diagnostic guide intraorally during the CBCT scan determined no correction would be required at this site.
Figure 6: Site #8 was planned for use for a fixation screw for the surgical guide and a 1 mm linear distal correction would be needed to avoid the incisive canal.
Figure 7: Virtual planning of site #10 with the diagnostic guide intraorally during the CBCT scan determined 15° buccal angle correction would be required for this site.
Figure 8: Site #12 was planned for placement of a stabilization screw for the surgical guide and no angle or linear corrections were needed.
Figure 9: Virtual planning of site #13 with the diagnostic guide intraorally during the CBCT scan determined no angle or linear correction would be required at this site.
Figure 10: Diagnostic Guide with positions for implants at sites 4, 6, 10 and 13. The putty was pressed into the underside of the denture and 2 mm straight posts were placed through the guide sleeves while the putty was setting.
Figure 11: Corrected 2-Piece straight lower-part guide posts replacing the 2 mm straight guide posts for the planned sites for implants and guide stabilization screws into the guide post sites on the putty model.
Figure 12: Guide Right Bending Tool
Figure 13: A 15° buccal angle correction was required at site #10, this was accomplished with the Guide Right Bending Tool (DePlaque)
Figure 14: Guide sleeves that were 3 mm ID were placed on each of the upper-removable guide posts to accommodate the 3 mm depth stop drills that will be utilized at surgery.
Figure 15: Guide Right™ 3 mm depth stop drills for depths from 6mm to 15mm (DePlaque)
Figure 16: The holes for the guide posts are enlarged in the duplicate denture to accept the corrected positions of the guide posts. Openings are filled in with acrylic (Primotec LC gel). The acrylic gel is cured around the guide posts with UV light to form the final surgical guide to accommodate the 3 mm guide sleeves which are used with 3 mm depth stop drills. The duplicate denture and the openings are filled in with flowable acrylic LC gel (Primotec) to secure the corrected positions of the guide posts and form the final surgical guide . The denture is inserted in the patient and secured with three 2 X 17 mm screws to prepare the osteotomies and place the implants through the guide sleeves.
Figure 17: Panoramic radiograph taken following implant placement.
Figure 18: Milled parallel Conus abutments placed into the integrated maxillary implants (left) and interior of the maxillary overdenture with receptacles for the Conus abutments (right).
Figure 19: Final implant supported prosthesis.