Bone Supported Surgical Guide

160K+ surgical guides designed & 500K+ implants planned   =   18 years of experience.  Talk to us about your case.

Surgical GuidesUsually used for edentulous patients, this type of guide gains its support from the load bearing areas or the divergence of the alveolar ridge.

A bone supported surgical guide is generally used for full-arch edentulous implant cases. This type of guide derives its support from load bearing areas and/or the natural divergence of the alveolar ridge seen in both maxillary and mandibular arches in a corono-apical direction. Bone supported guides are difficult to fabricate and accurately place intraorally due to the extent of flap reflection needed for access, as well as inaccuracies that can result from the digital workflow. Although the difficulties associated with bone supported guides are well reported, they may be mitigated with proper planning, accurate imaging and operator experience.

Bone supported guides are available for most cases. Simply upload your CBCT scan and provide the information on our on line Rx. If the case is to involve immediate prosthetic, ROE can support you with immediate dentures, trough guides, or upgrade to full surgical guide and integrated prosthetics using CHROME GuidedSMILE.

Bone Supported Surgical Guide

Bone Supported Surgical Guide Workflow Steps

Step Bone Supported - Dentate
1. Inspect guide for proper implant sites placement as well as proper design and sizing for any instrumentation.
2. Extract teeth and flap the gums.

  • If fixation pins are included: firmly hold the guide in position and drill the buccal holes, and place the pins through the guide. If the guide has integrated teeth, as the denture scan appliance, close patient in the bite to set the fixation.
  • Without fixation screws or pins: firmly hold the guide in position
3. Drill the osteotomies to completion following the provided drill report as well as following the Guided Kit and implant company’s protocol.

  • If Fully Guided Kit is utilized, and allows implant placement through the guide, proceed.
  • If Fully Guided Kit is not utilized, remove guide and place implants.
4. Complete bone and tissue desired procedure to finish of the surgery.
Step Bone Supported - Edentulous
1. Inspect guide for proper implant sites placement as well as proper design and sizing for any instrumentation.
2. Flap tissue adequately for guide seating directly on the bone.
3. Seat guide onto the bone surface. Minor bone adjustments may be necessary to fully seat the guide.

  • If fixation pins are included: firmly hold the guide in position and drill the buccal holes, and place the pins through the guide. If the guide has integrated teeth, as the denture scan appliance, close patient in the bite to set the fixation.
  • Without fixation screws or pins: firmly hold the guide in position.
4. Drill the osteotomies to completion following the provided drill report as well as following the Guided Kit and implant company’s protocol.

  • If Fully Guided Kit is utilized, and allows implant placement through the guide, proceed.
  • If Fully Guided Kit is not utilized, remove guide and place implants.
5. Remove the guide.
6. If you have bone reduction, this guide may be used to drill osteotomies and place implant prior to or after bone reduction, depending on the prolongation capabilities of the Guided Kit, and how the guide was requested
Step Bone Supported / Bone Reduction with Facial Drill Channel
1. Inspect guide for proper implant sites placement as well as proper design and sizing for any instrumentation.
2. If patient is dentate, extract teeth and flap gums. If fully edentulous, proceed to flap right away, as the guide sits on the bone.
3. Seat guide onto the bone surface. Minor bone adjustments may be necessary to fully seat the guide.

  • If fixation pins are included: firmly hold the guide in position and drill the buccal holes, and place the pins through the guide. If the guide has integrated teeth, as the denture scan appliance, close patient in the bite to set the fixation.
  • Without fixation screws or pins: firmly hold the guide in position.
4. Drill the osteotomies to completion following the provided drill report as well as following the Guided Kit and implant company’s protocol.

  • If Fully Guided Kit is utilized, and allows implant placement through the guide, proceed.
  • If Fully Guided Kit is not utilized, remove guide and place implants.
5. Pass a #6 round bur through the Facial Drill Channel and score a line into the bone the length of the channel.
6. Remove the guide.
7. This guide may be used to drill osteotomies and place implant prior to or after bone reduction, depending on the prolongation capabilities of the Guided Kit, and how the guide was requested.

4/5 Days

4 days planning
5 days production

Rx’s

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Denture Design Service

Digital Design Services

An increasing number of doctors are purchasing equipment to fabricate dentures, splints, and surgical guides in-office. Simply send ROE your digital or analog records and we will create a ready-to-print file.

RealGUIDE

Review & approve your cases when you want

This simple-to-use planning software will deliver planned cases case for approval. With the Viewer, you can change the implant and abutment position and size, and idealize the plan to your liking.

Videos

Fabricating Custom Surgical Guides

Fabricating Custom Surgical Guides for YOUR Implant System
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What Records Should You Send ROE

What Records Should You Send ROE for Your Surgical Guide Needs?
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Guided Bone Reduction and Implant Placement with Bone Channel Guide

Guided Bone Reduction and Implant Placement with Bone Channel Guide
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Part 1 of 3

Today's Guided Surgery from Simple to Full Arch Rehabilitation (Part 1 of 3)
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Part 2 of 3

Today's Guided Surgery from Simple to Full Arch Rehabilitation (Part 2 of 3)
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Part 3 of 3

Today's Guided Surgery from Simple to Full Arch Rehabilitation (Part 3 of 3)
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Review our Surgical Guide Offerings

Tooth Supported Tissue Supported Bone Supported CombiGuide CHROME GuidedSMILE
Bone Reduction Optional
Application Generally 1+ implants, guiding 1-6 sites Edentulous cases where guide is based on a dual-scan Best for edentulous cases where dual-scan is not an option. Optional open channel for bone leveling Full arch all-metal guide, but limited to bone reduction and implant placement Fully-guided All-on-X surgery & restoration.
No. of Sites 1-6 Any Number Any Number Any Number Any Number
Materials Printed surgical resin, with Ti sleeves or sleeveless Printed surgical resin, with Ti sleeves or sleeveless Printed surgical resin, with Ti sleeves or sleeveless Cobalt-CHROME guides with surgical resin Cobalt-CHROME guides with surgical resin, Lucitone backup denture, PMMA provisional, Zirconia final
Days in Lab 3 days planning
4 days production
4 days planning
4 days production
4 days planning
5 days production
5 days planning
5 days production
5 days planning
10 days production
Guided Kits All All All All All
Price $$ $$ $$$ $$$ $$$$

Surgical Guide ADA Codes

  • D6190 – radiographic/surgical implant index, by report
  • D6010 – Surgical placement of implant body: endosteal implant
  • D6012 – Surgical placement of interim implant body for transitional prosthesis: endosteal implant
  • D5934 – Mandibular resection prosthesis with guide flange
  • D5935 – Mandibular resection prosthesis without guide flange
  • D3432 – Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery
  • D4266 – Guided tissue regeneration, natural teeth – resorbable barrier, per site
  • D6106 – Guided tissue regeneration – resorbable barrier, per implant

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