A whole upper jaw with a limited amount of bone.

Type of guide: bone guide.

Predictability as a keyword.

The virtual surgery and prosthetic planning before the operation allow us to visualize the intended result and present it to the patient. The surgeries were performed using surgical guides, titanium abutments, and a cemented bridge. The bridge in the maxilla could, of course, also have been screw-retained. Predictability is one of our key principles in treatment planning and patient care.

Here is a direct installation case. We have been doing similar cases for a long time with good results, but now we are trying to raise the statistics and level here as well. As you know, the availability of palatal bone and the possibility of preparing in the palatal part of the maxilla is crucial for successful results and that the first drilling in the sloping part of the bone is correct immediately, difficult to
readjust if you get too high or low.

Gentle extraction without damaging the buccal bone, we see that the drill goes perfectly into the palatal bone at the right level. This moment is crucial for the best results.

Fixture installation by guide to achieve the same positioning of the fixture as in the virtual surgery, 1.5 mm subcrestal in this case.

Screw-retained provisional crown directly after surgery without contacts to neighboring teeth, not included in occlusion and articulation.

Nice stability of the fixture and very nice for the patient not to have to wear a temporary prosthesis for a long time even though the temporary crown does not have the same aesthetics as a permanent ceramic crown.

Patient cases with about 1 mm to the nerve and some lingual invagination where it is not possible to place the fix directly behind the 44.

Our surgical virtual plane is 1 mm from the nerve and 1 mm from the lingual
compact. Similar surgeries are of course done with full flap ffa to get full insight lingually as that part must be inspected during surgery when we work with small margins. You can see the post-op evaluation where the 37 is 0.14 mm above plane and the 36 0.15 mm below plane. We then chose to do two titanium abutments and a cemented bridge. With this we want to show the very small deviation we can now offer with a tooth-supported guide. Contact us for more information.

Patient who has had a bridge in the third quadrant and now wishes to replace the missing teeth with implants. The patient wants the construction to be as smooth as the old bridge. Our experience with similar cases is that the prosthetic plan is allowed to guide as far as possible.

In the virtual therapy planning, we see that we will achieve the best results if we replace 42 with a hanging joint and then the fixtures.

Also important to plan for the screw holes if that type of KBF is to be made, see photo.

We know that the stability of the guide is important for results so we chose to stabilize with a vertical retention in this case. This guide is not so common with mucosal retention and flap, similar operations we usually do with a guide that is on teeth and then directly on the bone. We perform and evaluate all types of guides ourselves in order to be your knowledge center in guide surgery.

In collaboration with Dentist Mikael Palm we present an evaluation, whole jaw UK with Straumann TL implants.

The most important thing we want to convey here is to keep the remaining teeth to stabilize the guide during surgery. Here Mikael has chosen to operate flapless. The operation is performed with the Straumann guide surgery kit. It is important to point out here that the drilling is done with a guide but the implants are placed without a guide. It is not possible to insert Straumann TL implants through the guide because the collar is wider than the sleeve in the guide. However, we can conclude that the evaluation is very good and the deviation is small. The stability of the guide increases significantly if retained teeth are used. In a similar case, it can otherwise be difficult to find the right position for a mucosa-only guide and flapless surgery is not recommended, an alternative may be a full flap guide.