Tissue Supported Surgical Guide

Tissue-supported surgical guides derive their primary support and retention from intraoral soft tissues and mucosa, commonly fabricated based on existing removable prostheses to provide familiar patient comfort and established tissue relationships.

While this approach offers the advantage of utilizing proven prosthetic designs and patient-adapted appliances, tissue-supported guides present unique clinical considerations, including potential movement during surgery, variations in tissue thickness and quality, and retention challenges similar to those encountered with complete dentures.

The mucosal support system may introduce directional movement that could affect implant placement accuracy, particularly when combined with flap reflection procedures that add complexity to the surgical protocol.

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The ROE Approach to Tissue-Supported Guides

At ROE, we design tissue-supported guides from existing or new full dentures using a precise dual scan protocol—scanning the appliance intraorally with proper patient bite registration, followed by an extraoral scan of the appliance.

This comprehensive approach, combined with CBCT imaging and detailed prosthetic planning, ensures optimal guide fabrication while acknowledging the inherent limitations of tissue-supported systems.

For complex cases beyond standard full denture applications, our technical team provides personalized consultation to achieve the best possible outcomes.

The primary advantage we see with tissue-supported guides is the reduced risk of damage to vital anatomy through precise surgical planning.

ROE can fabricate these guides in multi-level or "stackable" options to accommodate your specific surgical protocol needs. When your patients present with good-quality mucosa, these guides offer an excellent solution for reducing the number of surgical steps required for implant placement.

Important Clinical Considerations

We want you to understand that tissue-supported guides represent the least accurate option in our surgical guide portfolio.

The pressure exerted during surgery, combined with the natural resilience of the mucosa, may cause guide movement that can affect placement precision.

We work closely with you to optimize design and fit, but this inherent limitation should be considered when selecting the appropriate guide type for your specific case requirements.

	Workflow
1.	Inspect guide for proper implant sites placement as well as proper design and sizing for any instrumentation.
2.	Seat guide intraorally securely onto the tissue surface and verify in a window, if present, of a full seat. If there is a rocking, adjust if possible for full seat. If full seat is not possible, must being with new records. 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.

Fabricating Custom Surgical Guides

What Records Should You Send ROE

Dual Scan for Doctors

Today's Guided Surgery - 1 of 3

Today's Guided Surgery - 2 of 3

Today's Guided Surgery - 3 of 3

	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.

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Tissue Supported Surgical Guide

The ROE Approach to Tissue-Supported Guides

Clinical Guidance for
Tissue Supported Guides