Fig. 6 Fig. 8 Results CASE I: Fig. 7 Fig. 9 Full flap reflection was placed from a retromolar pad to the contralateral side (Fig. 6). Measurements from the CT scan were then transferred directly on the flapped mandibular bone before making perforations for the desired bone removal location. Each perforation was connected, and the ridge was smoothed down before making pilot drills (Fig. 7). Atrophic bone was removed in one section (Fig. 8) then implant placement was completed without a surgical guide (Fig. 9). CASE II: Fig. 10 Fig. 12 Fig. 11 Fig. 13 Fig. 14 102 AUGUST 2018 // dentaltown.com A full thickness flap was placed from the retromolar pad to the contralateral side. A bone reduction guide was placed inside the flap, resting on bone (Fig. 10). A surgical Lindemann bur was used to remove bone and teeth simultaneously (Fig. 11), leaving the remaining ridge perfectly flat (Fig. 12). After the root tips were removed, the pilot drill guide was used (Fig. 13) to place the implants in their preplanned positions (Fig. 14). Conclusion The postoperative CT images reveal the accuracy and precision of the procedure following the surgical bone-reduction guide (Fig. 15), especially when compared to the results of the nonguided reduction surgery (Fig. 16). The postoperative panorex of guided implant placement, showing parallelism of the osseointegrated implants (Fig. 17), further accentuates the accuracy of placement for guided surgery versus nonguided (Fig. 18). After placing a full thickness flap, it is often difficult to find hard landmarks on an edentulated ridge. Using a bone reduction guide ensures a faster more predictable reduction without over- or under-reducing the bone. Following up with a pilot drill bone guide provides proper alignment for implant placement. To ensure the guide is fully seated on bone passively, the flap has to be adequate enough to incorporate the thickness of the material under the tissues without pressure from the tissues to disrupt the guide seating. This may require a larger flap or deeper elevation to enable fully seating the guide into place.http://www.dentaltown.com