Skip to the main content.
Facebook Instagram Linkedin YouTube

Bone Supported Surgical Guide

 

At ROE, bone supported surgical guides represent our most advanced solution for full-arch edentulous implant cases, designed to derive support from the load-bearing areas and natural divergence of the alveolar ridge in both maxillary and mandibular arches.

While these guides present unique fabrication and placement challenges due to the extensive flap reflection required for proper access and potential inaccuracies inherent in the digital workflow, we've refined our processes to mitigate these difficulties through meticulous planning, advanced imaging protocols, and extensive technical expertise. 
Bone-Supported Surgical Guide Hero@0.25x
Bone-Supported Surgical Guide Overview@0.25x

The most significant clinical considerations for bone supported surgical guides center on the extensive flap reflection required for proper access and seating, which increases surgical complexity and demands considerable operator experience for successful outcomes.

The accuracy of these guides is heavily dependent on the quality of the entire digital workflow—from initial CBCT imaging through planning and fabrication—where cumulative inaccuracies can significantly impact precision.

Additionally, the challenging nature of intraoral placement, combined with the inherent fabrication complexity of these guides, requires meticulous pre-surgical planning and thorough case evaluation to ensure predictable results.

Successful implementation of bone-supported guides requires careful case selection, high-quality imaging protocols, and experienced surgeons skilled in guided surgery techniques. These critical factors enable practitioners to navigate the inherent technical challenges and achieve optimal implant placement outcomes.

Clinical Considerations for Bone Supported Surgical Guides

  • Extensive Flap Reflection Required – Bone supported guides necessitate significant tissue reflection to expose the bone and properly seat the guide, increasing surgical complexity
  • Digital Workflow Accuracy Dependencies – Guide precision relies heavily on the quality of digital scanning, planning, and fabrication processes, with potential for cumulative inaccuracies
  • Challenging Intraoral Placement – Accurate positioning can be difficult due to the extent of access required and limited visual references after flap reflection
  • Operator Experience Critical – Proper placement and utilization require significant surgical experience and expertise for optimal outcomes
  • Fabrication Complexity – These guides are among the most difficult to fabricate accurately compared to tooth or tissue supported alternatives
  • Planning Requirements – Success depends on meticulous pre-surgical planning and high-quality imaging protocols to mitigate inherent challenges
  • Full-Arch Case Applications – Primarily indicated for edentulous patients requiring complete arch reconstruction where other support options are unavailable
  • Support Limitations – Reliance on alveolar ridge contours and load bearing areas may be compromised in cases with significant bone loss or irregular anatomy
  • Surgical Time Considerations – Extended flap reflection and guide placement procedures may increase overall surgical time and patient morbidity

Bone Supported Surgical Guide Workflow Steps

Workflow - 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.
Workflow - 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
Workflow - 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.

Video Resources

Fabricating Custom Surgical Guides

What Records Should You Send ROE

What is the Bone Channel Guide?

Today's Guided Surgery - 1 of 3

Today's Guided Surgery - 2 of 3

Today's Guided Surgery - 3 of 3

Surgical Guide Offerings - Product Comparison

Price Days in Lab Guided Kits No. of Sites Application
Tooth Supported $$ 3 days planning
4 days production 		All 1-6 Printed surgical resin, with Ti sleeves or sleeveless
Tissue Supported $$ 4 days planning
4 days production 		All Any Number

Edentulous cases where guide is based on a dual-scan
Bone Supported $$$ 4 days planning
5 days production 		All Any Number

Best for edentulous cases where dual-scan is not an option. Optional open channel for bone leveling
CombiGuide $$$ 5 days planning
5 days production 		All Any Number

Full arch all-metal guide, but limited to bone reduction and implant placement
CHROME GuidedSMILE $$$$ 5 days planning
10 days production 		All Any Number Fully-guided All-on-X surgery & restoration.

How can we help you today?

Can't find what you're looking for? No problem. Let us help.

 
ROE’s experts are dedicated to elevating your dental practice.
  • Full-service national dental laboratory
  • Comprehensive Certified Dental Laboratory (CDL) services
  • Case planning support from 20+ Certified Dental Technicians
  • Specialists in both fixed, removable, implant and full-arch dentistry
  • Tailored support for all cases, from routine to complex
  • National Association of Dental Laboratories (NADL) member
  • Only FDA-approved materials used
  • All products made in the USA
  • Thousands of free online education materials