D I G I TA L I M P L A N T O L O G Y Then a 3D surgical guide was designed. We used the distal abutment teeth and a guide pin in the anterior mandible to create trapezoidal stability of the surgical guide in the mouth during surgery. Stability of the guide is extremely important in immediate extraction of full arch cases. Placing the guide pin/osteotomy in immediate extraction cases can sometimes be less accurate as the guide can rock on the soft tissue area where the extractions just took place. To avoid this from occurring, a simple 3D guide was designed to place the guide pin osteotomy when the teeth where still present. Hence, once the teeth were extracted, the implant surgical guide was easily referenced and fitted without any loss of accuracy. This was achieved by using the distal implant prosthesis and the anterior guide pin osteotomy that was already placed with the 1st guide pin 3D guide. This is easily accomplished with 3Shape Implant Studio. The problem with immediate extractions and guided surgery is that there are no reference points for the surgical guide to sit after the extractions. Using soft tissue and opposing occlusions is less than ideal and not as accurate as it should be. The beauty of having a guide-pin surgical guide is we were able to place the guide pin osteotomy prior to extraction of the teeth. Hence this guide was using the hard tissue of the existing teeth prior to extractions occurring. Having the guide holes, we were able to accurately locate our second implant surgical guide once all the extractions and full clearance had occurred. Orders 1 3 0 0 6 5 8 8 2 2 23