The Dual-Guide Technique

The Dual-Guide Technique

By Dr. Nachum Samet
July 26, 2021

nachum-blogUtilizing two guides for efficient implant placement and immediate loading

The patient is a 35-year-old man, suffering from severe medical conditions that contraindicate any open-flap surgery.

In 2014, he fell and badly injured teeth 12-11-21.
At that time, to prevent surgery, root canal treatments were performed in these teeth and they were restored with crowns.
At the end of 2020, he complained that teeth 12-11 were not stable, and felt "funny".
In a radiograph it was obvious that teeth 12-11 suffer from external resorption.

It was clear than that there is no way but to extract teeth 12-11.
Under strict medical supervision, the two teeth were extracted, and he received a temporary partial denture which he did not like, and therefor asked for a fixed solution.


After three months of healing, a CBCT of the area was obtained.
The ridge at the site was slightly resorbed, and the crestal width measured 4-5mm.
Due to his medical condition, and in order to avoid open-flap surgery, Adin's guided surgery was used.
Two Adin Touareg CloseFit™ NP 3.0mm were planned to ensure maximum bone surrounding the implants, A secondary prosthetic guide, with two provisional crowns was also planned, to perform immediate loading at the time o f implant placement.
On follow-up visits it was obrious that the gingival tissues were healed appropriately, restoring form and function of the treated area.



Post accident condition.





Crowns at 6 years follow-up.





External resorption.





CBCT of the area.





A model showing buccal tissue deficiency.





Bone evaluation.





Implant placement plan.





Surgical guide.




n9n10Prosthetic guide.




n11n12n13Guide evaluation and adjustment to ensure correct seating before surgery.




n14n15n16Tissue punch and removal of soft tissue.




n17Pilot drill.




n18Implant drill.




n19Parallel pins.




n20Parallel pins.




n21Implant placement through the guide.




n22Insertion torque assessment to evaluate the ability to perform immediate loading.




n23The two implants in place.




n24Secondary, prosthetic guide evaluation and adjustment to ensure correct seating.




n25Secondary, prosthetic guide In place.




n26Temporary abutments connected to implants.




n27Validation of secondary, prosthetic guide seating with no direct contact with temporary abutments.




n28Application small amount of acrylic resin to the temporary abutments.




n29Application small amount of acrylic resin to the provisional crowns.




n30Seating and holding the secondary, prosthetic guide in place to ensure correct connection to the temporary abutments.




n31Unscrewing of provisional crowns and finilizing acrylic resin apposition around temporary abutments.




n32n33n34Separating provisional crowns from the guide and shape adjustment outside of the mouth.




n35Try-in of provisional crowns in mouth.




n36Adjustments of shape and occlusion in the mouth.





n37Adjustments of shape and occlusion in the mouth ensuring no direct contact with adjacent teeth.




n38Color adjustments.




n39Delivery of provisional, immediate crowns.




n40One week follow-up.
Note gingival healing and that there is no contact between provisional crowns and adjacent teeth.




n413 weeks follow-up.
(Chlorhexidine stains on adjacent teeth)



Dr. Nachum Samet

About the Author:
Dr. Nachum Samet

Dr. Nachum Samet is a multi-awarded Professor at the Harvard School of Dental Medicine, where he acted as the Director of Pre-Doctoral Prosthodontics and also held a degree of Assistant Professor of Restorative Dentistry and Biomaterials. In recognition of his significant contribution, Dr. Samet still holds a part-time position at Harvard, and is a member of the school’s Board. He has been placing and restoring dental implants for over 20 years.

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