The surgical guide will help the surgeon place the implant in a position favorable in relation to the planed final restoration. Surgical guides can be made in a wide variety and depend on the surgeons preference and extent of the final restoration.

Vacuum form

The simplest way to make a surgical guide is to make a vacuum form over the duplicated diagnostic wax up and drill a hole through the occlusal surface of the vacuum form in the proposed implant site. This type of guide will leave the surgeon the greatest freedom how to angle the osteotomy drill. A variant would be to fill the edentulous area of the vacuum form with clear acrylic and drill the guide hole from the occlusal all the way to the tissue area ( a metal guide tube can be embedded in the acrylic). The aforementioned guide leaves no room for the surgeon to adjust the angle of the osteotomy during surgery.

Depending on the number of implants and extent of the final restoration, a existing denture can be duplicated in clear acrylic and fashioned in to a surgical guide by removing the lingual portion of the teeth in the acrylic guide, leaving only a thin shell on the buccal or labial portion. This will give the surgeon maximum freedom while still being able to visualize the position of the future restoration in relation to the implant position.

Model based

One step closer to a truly high-tech guided surgical guide is the model based surgical guide. First a vacuum form is made over the study model without a prior diagnostic wax up. Extending the vacuum form over the buccal and lingual flanges in the proposed implant site and drill three or four small holes on each side (buccal and lingual) in the long axis of the future implant.

The dentist then will probe and record with a perioprobe the tissue thickness through each hole. Once the vacuum form and the data sheet are returned to the laboratory. the technician will remove the appropriate thickness of stone from the model, according to the measured tissue thickness. A implant analog is placed in ideal position in the stone model, representing the future implant position. Implant manufacturer specific distancing pieces and bushings are incorporated in to a surgical guide. Nobel Biocare published a complete manual for the model-base planning.