Abstract:
A prefabricated dental implant surgical guide. The implant surgical guide comprises a tooth shaped contour which simulates a natural tooth and the final prosthesis. The tooth shaped contours can be shaped to match any tooth found in the mouth. The system further comprises apical posts which protrude from the apical aspect of the tooth contour of the surgical guide. These apical posts are capable of marking an initial osteotomy site. The apical posts are further able to be placed in to an initial and developing osteotomy site to verify proper implant location, angulation and rotational position prior to implant placement. Significantly the apical post can be attached to the surgical guide and of a fixed length. The apical post can also be adjustable allowing continuous osteotomy site verification and removable allowing an implant surgical drill to pass thru it thereby allowing continuous osteotomy site development and verification. The system further comprises a coronal post aspect to position the surgical guide. The posts can be removed, the tooth contour aspect of the guide hollowed out and then relined and secured to the abutment aspect of an implant thereby functioning as a provisional crown or crowns. The prefabricated dental implant surgical guide can be used to place single implants or multiple side by side implants in a continuous fashion allowing verification of implant location, angulation and rotational position prior to implant placement leading to a more esthetic, functional and stable prosthesis.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application claims priority under 35 U.S.C. §119(e) from provisional application No. 60/737,789 filed Nov. 17, 2005. The Ser. No. 60/737,789 application is incorporated by reference herein, in its entirety, for all purposes. 
     
    
     BACKGROUND  
       [0002]     This application relates generally to oral implant surgery. More particularly the present invention relates to a surgical guide to be used during dental implant surgery which is used to effect correct placement of a dental implant.  
         [0003]     In the healthy non-diseased mouth with natural teeth present, there exists a biologic relationship between the root of a tooth, the crown of a tooth, the bone surrounding the root and the gingiva (soft tissue) surrounding the bone, root and crown of a tooth. In nature, the shape and contour that the gingiva or soft tissue assumes and follows is dictated by the underlying presence and shape of bone. The bone contours around a natural tooth are actually scalloped, with the bone more apical on the facial and lingual aspects of the tooth and more coronal in the inter-proximal area (between the teeth). In a healthy mouth, this scalloping effect is dictated by the cemento-enamel junction (CEJ) of the tooth which itself is also scalloped. It is this scalloping of the bony architecture which lends itself to the formation and maintenance of proper gingival contours including the inter-dental papilla (the small triangular flesh portion adjacent the gum line and located between the teeth).  
         [0004]     However, despite best efforts of a person, or because of lack of proper dental care, it may become necessary to replace teeth completely. In these cases, dental implant procedures have proven to be an effective method of restoring both form and function in patients having missing teeth. Implants provide a structure upon which a prosthetic tooth or teeth can be attached and secured in an otherwise edentulous (non-tooth) area. In contrast to using dentures or other tooth born fixed or removable dental bridge systems, implants have the advantage of maintaining bone and not being subject to decay.  
         [0005]     Bone support is necessary for proper placement, securement and maintenance of a dental implant. Proper bone support around an implant is also necessary for the development and maintenance of healthy gingival contours, including papilla. Bone growth around an implant follows the shape of the bone-integrating part of the implant. A primary concern in implant dentistry is the precise placement of an implant in its proper location, with appropriate and accurate angulation and rotational position at the time of implant placement surgery. Even the slightest error in implant placement can result in significant complications and or compromises in the stability of the implant, the maintenance of bone, the contours of the gingival tissues, placement of the final prosthesis, stability of the final prosthesis and the overall appearance of the patient&#39;s mouth.  
         [0006]     Accordingly, it is desirable to provide a prefabricated dental implant surgical guide which ensures the proper placement of a dental implant or implants and its corresponding prosthesis (crown or crowns). One exemplary embodiment of the present invention allows it to be converted from a surgical guide to a dental provisional crown which can then be used to help maintain the hard (bone) and soft (gingival) tissue architecture of the mouth during the healing phase of treatment, with the end result being a final prosthesis that is stable, functional, natural looking and aesthetically pleasing in the patient&#39;s mouth.  
         [0007]     For such applications, the prefabricated dental implant surgical guide of the present invention may be configured as a surgical guide with a tooth-shaped configuration with a post affixed to its apical end, or with a post as an integral part of the entire guide. This embodiment of a dental implant surgical guide is placed into an initial osteotomy site (a surgical procedure in which bone is cut or prepared for the placement of a dental implant) at the time of dental implant placement surgery, but prior to final implant body placement, to ensure and or to correct proper location, angulation, and rotational position of an implant body prior to it&#39;s placement.  
         [0008]     The present invention in various embodiments is a prefabricated dental implant placement surgical guide which, in one exemplary embodiment, has a post affixed to the apical end of an anatomically correct tooth form. This tooth form can be made to represent any tooth in the mouth in order to have accurate implant placement regarding the tooth to be replaced.  
         [0009]     At the time of initial osteotomy site preparation, a small hole is prepared into the jaw bone using conventional dental implant surgical drills. The apical post of the surgical implant guide is inserted into the osteotomy site allowing verification of proper implant placement in location, angulation, and rotational position prior to implant body placement. This is accomplished by viewing the surgical guide in place, then comparing the tooth-contoured part of the surgical guide with some facial and/or intra-oral guideline such as the adjacent teeth, gingiva, shape of the arch and lips etc. This allows for proper implant location and ultimately placement to be verified or corrected prior to implant body placement lending to a more stable, functional and esthetic prosthetic outcome. The apical post of the surgical guide can repeatedly be inserted into the osteotomy site, as the site is further developed and deepened to continuously verify proper position and location of the implant body prior to its placement. This process of trying in the surgical guide with further osteotomy site preparation is repeated until the appropriate final depth of the osteotomy site is achieved. Thus the process of the present invention provides for a verified correct position, location and angulation of the osteotomy site, all prior to final implant body placement. If improper alignment is detected during this verification process, the osteotomy site location, angulation and position can be corrected with minimal damage to the bone.  
         [0010]     In another embodiment of the present invention, the prefabricated dental implant surgical guide can be converted into a provisional crown, a plurality of crowns, or a bridge. This is accomplished by removing the finger grip and apical post, or guide post, hollowing out the tooth contour aspect of the guide, and relining the tooth contour aspect of the surgical guide, then reversibly fastening via screw or cement, the tooth contour aspect of the surgical guide to the abutment of an implant body.  
         [0011]     In yet another embodiment, the surgical guide comprises a set of anatomically correct tooth forms each having an apical post and finger grip. The apical posts are graduated in length thus constituting a set of surgical guides that are sequentially used as an osteotomy site is created and deepened. In this way the surgical guide set can sequentially provide guidance that the osteotomy site is being correctly prepared.  
         [0012]     In yet another exemplary embodiment, the prefabricated dental implant surgical guide comprises an anatomically correct tooth form having a bore through the tooth form into which an adjustable and removable post is placed or threaded. The apical end of the post protrudes through the tooth form and can be lengthened by pushing or screwing the post through the bore. In this way the apical end is lengthened and can be placed into the gradually deepening osteotomy site to insure that the site is correctly prepared. The post can also be removed and an osteotomy drill passed thru the bore to allow for further preparation of the osteotomy site with the guide in place. In another embodiment of the present invention, a bottom face of the apical end of the movable post comprises a marking agent. In this embodiment, the surgical guide is placed in a desired position on the jaw bone at a proposed osteotomy site. Once the correct position of the surgical guide is established, the movable post is pressed downward to engage the bottom face of the apical end with the jaw bone thereby marking the location of the osteotomy site.  
         [0013]     In still another exemplary embodiment, the prefabricated dental implant surgical guide comprises a number of anatomically correct tooth forms as a unitary surgical guide. In this case, for example and without limitation, a number of tooth forms can be connected and tried into a series of side by side osteotomy sites as a unit. This allows multiple dental implants to be placed side by side with verification of proper location, angulation, and rotational position.  
         [0014]     Thus various embodiments improve the dental implant placement process and allow for proper placement of a dental implant subsequent to osteotomy site preparation. Embodiments act as a prefabricated surgical guide and improve the placement of a dental implant. Embodiments further allow sequential placement of individual prefabricated implant surgical guides to develop sequential osteotomy sites for subsequent multiple side by side implant placement during dental implant placement surgery. Additional embodiments use unitary multi-tooth prefabricated implant surgical guides during dental implant placement surgery where more than one tooth is to be replaced with a dental implant. Other embodiments use a prefabricated dental implant surgical guide having adjustable apical posts for use with deepening osteotomy sites.  
         [0015]     These and other embodiments will be come apparent to those skilled in the art upon review of the detailed description that follows. 
     
    
     DESCRIPTION OF THE FIGURES  
       [0016]      FIGS. 1   a,    1   b,  and  1   c  illustrate a prefabricated dental implant surgical guide configured as a tooth with a static post.  
         [0017]      FIGS. 2   a  and  2   b  illustrate another embodiment of a prefabricated dental implant surgical guide converted to and also used as an interim crown with posts that are removable.  
         [0018]      FIGS. 3   a,    3   b,    3   c  and  3   d  illustrate a prefabricated dental implant surgical guide as a series of tooth shapes having graduated post lengths.  
         [0019]      FIG. 4   a,    4   b  and  4   c  and  4   d  illustrate another embodiment as a prefabricated dental implant surgical guide having a central bore with an adjustable, removable post.  
         [0020]      FIG. 5  illustrates an embodiment, as illustrated in  FIGS. 1   a - c,    2   a - b,    3   a - d  and  4   a - d  being used in a multiple side by side format.  
         [0021]      FIG. 6  illustrates another embodiment as a one piece multiple unit surgical guide.  
         [0022]      FIGS. 7   a - c  illustrates an embodiment for the purpose of marking and identifying an osteotomy site.  
         [0023]      FIGS. 8   a - c  illustrates another embodiment for the purpose of marking and identifying an osteotomy site.  
         [0024]      FIG. 9   a - c  illustrates another embodiment for the purpose of marking and identifying an osteotomy site.  
         [0025]      FIGS. 10   a - c  illustrates another embodiment for the purpose of marking and identifying an osteotomy site.  
         [0026]      FIGS. 11   a - c  illustrates another embodiment for the purpose of marking and identifying an osteotomy site. 
     
    
     DETAILED DESCRIPTION  
       [0027]     As noted above, the present invention comprises a method and apparatus for insuring correct placement of dental implants during the surgical placement process. Referring now to  FIGS. 1   a,    1   b,  and  1   c,  the prefabricated dental implant surgical guide configured as a surgical guide with a tooth-shaped configuration with a post affixed to its apical end is illustrated. The guide can be made of metal, plastic, acrylic, porcelain or some other material known to those of skill in the dental arts. Such materials will be collectively referred to herein as “dental material.” This exemplary embodiment is placed into an initial osteotomy site at the time of implant placement surgery, prior to implant body placement to ensure and or to correct the proper location, angulation, and rotational position of the implant body.  
         [0028]      FIGS. 1   a,    1   b,  and  1   c  illustrate the dental implant aid in an exemplary alternative embodiment. As illustrated in  FIG. 1   a,  the dental implant aid, generally referred to as  40  in this figure, is configured as a one piece surgical guide with a tooth-shaped configuration  42 . The tooth shaped configuration  42  is further defined by its anatomical components, i.e. the incisal edge (for an anterior tooth) or occlusal table (for a posterior tooth)  30 , facial contour  31 , lingual contour  32 , interproximal aspect  33  and apical aspect  34 . Affixed to the apical end of tooth configuration  42  is collar  45  which has apical post  44  extending above it. Affixed to the coronal end of tooth-shaped configuration  42  is a protruding post which acts as finger grip  43 . Thus the surgical guide  40  can be held in the mouth and the tooth-shaped component  42  of guide  40  can be seen clearly by the surgeon during the course of surgery with out the surgeon&#39;s fingers obscuring the view.  
         [0029]     This tooth-shaped configuration  42  can be represented by any tooth shape found in the mouth (central incisors, lateral incisors, cuspids, premolars, and molars of both the upper and lower jaws) and can therefore be used as a surgical guide to verify implant body placement with respect to any tooth and its corresponding position in the mouth prior to implant placement. For example,  FIG. 1   b  represents a jaw bone  48  to which an osteotomy site  46  (a surgical procedure in which bone is cut or prepared for the placement of an implant) has been prepared in jaw bone  48 . As illustrated in  FIGS. 1   b  and  1   c,  by holding finger grip  43 , the apical post  44  of implant surgical guide  40  is placed into the osteotomy site  46  so that collar  45  of implant surgical  40  rests against jaw bone  48  at the opening of osteotomy site  46 . This is done at the time of implant placement surgery, but prior to implant body placement.  
         [0030]     By using existing intra-oral guidelines as a reference (i.e. adjacent teeth  50 , lips, shape of the arch as but several examples), the tooth contour  42  and its corresponding anatomic components of implant surgical guide  40  with apical post  44  in osteotomy site  46 , can be used to verify and/or correct the proper location, angulation, and rotational position of any implant body and it&#39;s corresponding system prior to it&#39;s insertion. This is accomplished by comparing the location, angulation, and position of the tooth shape-contour  42  and its corresponding anatomic components of the implant surgical guide  40  with some facial and/or intra-oral guideline or reference such as the adjacent teeth, gingiva, shape of the arch and lips, face etc., while apical post  44  of implant surgical guide  40  is engaged in osteotomy site  46 .  
         [0031]     Verification of osteotomy site position, angulation, location, subsequent proper implant location and placement and proper prosthesis location, requires the tooth contour aspect  42  of implant surgical guide  40  be in proper alignment with the facial and or intra-oral guide lines or references previously noted. This alignment is verified by comparing the position of the anatomic components of tooth contour  42 , for example, the incisal edge (for an anterior tooth) or occlusal table (for a posterior tooth)  30 , facial contour  31 , lingual contour  32 , interproximal aspect  33  and apical aspect  34  of tooth contour  42  of the surgical guide  40  while engaged in the mouth with facial and or intra -oral references previously noted.  
         [0032]     If the alignment of the anatomic components of tooth contour  42  of surgical guide  40  are in harmony with and are symmetrical to the facial and or intra-oral references previously noted, osteotomy site location, position and angulation are verified, and osteotomy site and subsequent implant placement can be completed.  
         [0033]     If there is disharmony and/or an asymmetrical position of the anatomic components of tooth contour  42  of the implant surgical guide  40  is noted with respect to the facial and or intra-oral references previously noted, a correction as to position and location can be made and verified prior to final implant placement.  
         [0034]     It will be apparent to those skilled in the art that, not only can different tooth shapes be represented, but also different sizes of tooth contour  42  of the prefabricated dental implant surgical guide  40  can be used to conform to the size teeth and arch form of the dental implant patient.  
         [0035]     Referring now to  FIGS. 2   a  and  2   b,  another alternate embodiment generally referred to as  51  is illustrated. In this embodiment, the prefabricated implant surgical guide is made of a dental material so that once implant placement has been verified and the implant body has been placed, either at the time of surgery or at a later date subsequent to healing, the surgical guide can be converted to a provisional crown as illustrated in  FIGS. 2   a  and  2   b.    
         [0036]     Referring again to  FIG. 2   a,  apical post  24  of implant guide  51  having a collar  25  is placed into osteotomy site  46  of jaw bone  48  to verify proper implant location and angulation prior to implant body placement as previously described in  FIGS. 1   a - c.    
         [0037]     Referring now to  FIG. 2   b,  implant body  52  is shown having been placed into jaw bone  48 . At the time of surgery or subsequent to surgical healing, the finger grip  23  and apical post  24  of implant surgical guide  51  are removed via a cutting procedure known in the art. The tooth contour  22  of implant surgical guide  51  is then hollowed out so that a concavity  26  is formed on the internal aspect  27  of tooth contour  22  of implant guide  51 . At the time of surgery or subsequent to surgical healing utilizing either a 2-stage, 2-piece implant system, a one-stage, 2-piece implant system or a one piece, one-stage implant system, the concavity  26  of internal aspect  27  of tooth contour  22  of implant guide  51  is relined with a dental provisional material, known to those in the art (for example and without limitation, acrylic) to the abutment aspect  54  of implant body  52  to create a custom fitting, retentive provisional crown which can then be either cemented into place with some provisional dental cement (for example and without limitation zinc oxide-eugenol)) or screw retained.  
         [0038]     Referring now to  FIGS. 3   a,    3   b,    3   c  and  3   d,  another embodiment of the prefabricated implant surgical guide, herein referred to as  53  having separate graduated apical post lengths is illustrated. In this embodiment, implant guide  53  exists in a multiple set format with apical posts  13 ,  15 , and  17 , connected to tooth contours  12 ,  14 , and  16  respectively via collars  7 ,  9 , and  11  respectively. Tooth contours  12 ,  14  and  16  are further defined by their anatomical components, that is, the incisal edge (for an anterior tooth) or occlusal table (for a posterior tooth )  1   a,    1   b  and  1   c  respectively, facial contours  2   a,    2   b  and  2   c  respectively, lingual contours  3   a,    3   b,  and  3   c  respectively, interproximal aspects  4   a,    4   b  and  4   c  respectively and apical aspects  5   a,    5   b  and  5   c  respectively.  
         [0039]     The tooth-shaped configurations  12 ,  14  and  16  can be represented in the form of any tooth shape found in the mouth (central incisors, lateral incisors, cuspids, premolars, and molars of both the upper and lower jaws) and can therefore be used as a surgical guide to verify implant body placement with respect to any tooth and its corresponding position in the mouth prior to implant placement.  
         [0040]     Apical posts  13 ,  15 , and  17  increase in length to be used as described in  FIGS. 3   a,    3   b,    3   c  and  3   d.  Finger grips  6 ,  8 , and  10 , respectively allow for manipulation of the surgical guide during the surgical implant placement procedure.  
         [0041]     Referring now to  FIG. 3   b,  the use of the embodiment of  FIG. 3   a  is illustrated. An initial oseotomy site  46  of minimum depth is prepared into jaw bone  48 . By placing implant guide  53  with the shortest apical post  13  first into initial osteotomy site  46 , an initial and preliminary evaluation as to proper implant position, location and angulation can be done. At this time, verification and or correction to the initial osteotomy site  46  can be done with minimal trauma to jaw bone  48 . This is accomplished by comparing the location, angulation and position of the tooth shape-contour  12  of the surgical guide  53  with some facial and/or intra-oral guideline or reference such as the adjacent teeth, gingiva, shape of the arch and lips, face etc. with apical post  13  of surgical guide  53  engaged in osteotomy site  46 .  
         [0042]     To verify osteotomy site position, angulation, location, subsequent proper implant location, angulation and placement and ultimately proper prosthesis location, requires the tooth contour aspect  12  of implant surgical guide  53  be in proper alignment with the facial and or intra-oral guide lines or references previously stated. This alignment is verified by comparing the anatomic components of tooth contour  12 , that being the incisal edge or occlusal table  1   a,  facial contour  2   a,  lingual contour  3   a,  interproximal aspect  4   a  and apical aspect  5   a  of tooth contour  12  of surgical guide  53  while engaged in the mouth with facial and or intra-oral references previously noted.  
         [0043]     If the alignment of the anatomic components of tooth contour aspect  12  of surgical guide  53  are in harmony with and are symmetrical to the facial and or intra-oral references previously noted, osteotomy site location, position and angulation are verified and osteotomy site and subsequent implant placement can be completed.  
         [0044]     If there is disharmony and or an asymmetrical position of the anatomic components of tooth contour aspect  12  of implant surgical guide  53  is noted with respect to the facial and or intra-oral references previously noted, a correction as to position, angulation and location of the osteotomy site can be made and verified prior to final implant placement.  
         [0045]     As illustrated in  FIGS. 3   c  and  3   d,  as the osteotomy site  46  is deepened and developed, the implant guide  53  with the increasing apical post lengths  15  and  17  can be tried into deepening osteotomy site  46  to further verify and or to correct the position and or angulation of osteotomy site  46  prior to final implant body placement. This is accomplished by comparing the position of tooth contours  12 ,  14 , and  16  (as the osteotomy site is deepened) of guide  53  with some other facial or intra-oral reference point (i.e. other teeth, gingiva, shape of the arch, lips, face, etc.) with posts  13 ,  15 , and  17  of guide  53  sequentially engaged in osteotomy site  46 . This verification process is accomplished as previously described in  FIG. 3   b.  In this fashion, osteotomy site  46  is gradually prepared (deepened) and continuously verified during the preparation process to ensure accuracy in final location, angulation and position of the implant body and final prosthesis prior to its placement.  
         [0046]     Referring now to  FIGS. 4   a,    4   b,    4   c  and  4   d,  yet another embodiment of the prefabricated dental implant surgical guide generally referred to as  70  is illustrated. Implant surgical guide  70  comprises a tooth contour  62 , collar  65 , finger grip  63  and apical post  64 . The tooth shaped contour  62  is further defined by its anatomical components: the incisal edge (for an anterior tooth) or occlusal table (for a posterior tooth)  61 , facial contour  58 , lingual contour  66 , interproximal aspect  69  and apical aspect  71 .  
         [0047]     The tooth-shaped contour  62  can be represented by any tooth shape found in the mouth (central incisors, lateral incisors, cuspids, premolars, and molars of both the upper and lower jaws) and can therefore be used as a surgical guide to verify implant body placement with respect to any tooth and its corresponding position in the mouth prior to implant placement.  
         [0048]     In this embodiment, the surgical guide  70  has a central bore  60  which extends the entire length of guide  70  (through tooth contour  62  and collar  65 ). This central bore  60  can be either smooth or threaded. An adjustable and removable post generally referred to as  67 , comprises a central portion  68  which is located in central bore  60 , finger grip portion  63  that extends beyond the coronal end of guide  70  and apical post portion  64  that extends beyond the apical end of guide  70 . The central post portion  68  of post  67  remains in the central bore  60 . Central post portion  68  and central bore  60  can be either smooth or threaded. If smooth, central post portion  68  of post  67  may be pushed through the central bore  60  thereby adjusting the length of apical post  64 . If threaded, central post portion  68  of post  67  may be turned through central bore  60  thereby adjusting the length of apical post  64 . In this fashion apical post portion  64  of adjustable removable post  67  can be adjusted and made shorter or longer to fit into a developing osteotomy site  46  to verify or correct final implant body location, position and angulation in jaw bone  48  prior to implant body placement.  
         [0049]     During this process, as in other embodiments described above, proper implant location and position can be verified by comparing the position of tooth contour  62  of guide  70  with some other facial or intra-oral reference point (i.e. other teeth, gingiva, shape of the arch, lips, face, etc.) with apical post  64  of guide  70  engaged in osteotomy site  46 .  
         [0050]     Referring now to  FIG. 4   b,  an osteotomy site is identified, and an initial osteotomy site  46  of minimum depth is prepared in jaw bone  48 . Surgical guide  70  is placed over osteotomy site  46 . Finger grip portion  63  of adjustable, removable post  67  is pushed or turned so that central post portion  68  of adjustable, removable post  67  moves through central bore  60  increasing the length of apical post portion  64  of adjustable, removable post  67  until it engages the base  49  of osteotomy site  46 . By comparing the position of tooth contour  62  of guide  70  with some other facial or intra-oral reference point (i.e. other teeth  50 , gingiva, shape of the arch, lips, face, etc.), with apical post portion  64  of adjustable, removable post  67  of guide  70  engaged in osteotomy site  46 , an initial verification or correction of position and or angulation of osteotomy site  46  can be done with minimal trauma to jaw bone  48 .  
         [0051]     This is accomplished by comparing the location, angulation and position of the tooth shape-contour  62  of the surgical guide  70  with some facial and/or intra-oral guidelines or references such as the adjacent teeth, gingiva, shape of the arch and lips etc. with apical post  64  of surgical guide  70  engaged in osteotomy site  46 .  
         [0052]     To verify osteotomy site position, angulation, location, subsequent proper implant location, angulation and placement and ultimately proper prosthesis location, requires tooth contour  62  of prefabricated dental implant surgical guide  70  be in proper alignment with the facial and or intra-oral guide lines or references previously stated. This alignment is verified by comparing the anatomic components of tooth contour  62 , that being the incisal edge or occlusal table  61 , facial contour  58 , lingual contour  66 , interproximal aspect  69  and apical aspect  71  of tooth contour  62  of surgical guide  70  while engaged in the mouth, with facial and or intra-oral references previously stated.  
         [0053]     If the alignment of the anatomic components of tooth contour aspect  62  of surgical guide  70  are in harmony with and are symmetrical to the facial and or intra-oral references previously noted, osteotomy site location, position and angulation are verified and osteotomy site and subsequent implant placement can be completed.  
         [0054]     If there is disharmony and or an asymmetrical position of the anatomic components of tooth contour  62  of implant surgical guide  70  is noted with respect to the facial and or intra-oral references previously noted, a correction as to position and location can be made and verified prior to final implant placement.  
         [0055]     Referring now to  FIG. 4   c,  as osteotomy site  46  is further deepened, guide  70  can repeatedly be placed over osteotomy site  46 , with apical post portion  64  of adjustable, removable post  67  further lengthened into osteotomy site  46  by turning or pushing finger grip portion  63  of adjustable, removable post  67  (See  FIG. 4   a ) to move central post portion  68  of adjustable, removable post  67  thru central bore  60 , thus providing a means of continuous verification and or correction of position and or angulation of osteotomy site  46  prior to final implant body placement. Again, this is accomplished by comparing the position of tooth contour  62  of guide  70  with some other facial and or intra-oral reference point (i.e. other teeth  50 , gingiva, shape of the arch, lips, face, etc.) with apical post portion  64  of adjustable, removable post  67  of guide  70  engaged in osteotomy site  46 . This verification process is accomplished as previously described in  FIG. 4   b.    
         [0056]     Referring now to  FIG. 4   d,  adjustable, removable post  67  can be removed from surgical guide  70 . Surgical guide  70  can be held in place in the mouth at osteotomy site  46  with a buccal and or lingual finger grip  45 . By stabilizing guide  70  with buccal and or lingual finger grip  45 , osteotomy bur  47  attached to surgical drill  59  can be placed thru central bore  60  of tooth contour  62  of implant guide  70  and activated allowing further preparation and continuous verification of osteotomy site  46  with surgical guide  70  in place in the mouth.  
         [0057]     This verification process is accomplished as previously described in  FIG. 4   b.    
         [0058]     As more fully explained below, in another embodiment, a bottom face of the apical end of the movable post comprises a marking agent. In this embodiment, the prefabricated dental implant surgical guide is placed in a desired position on the jaw bone at a proposed osteotomy site before a hole is drilled. Once the correct position and location of the osteotomy site is established, the movable post is pressed downward to engage the bottom face of the apical end with the jaw bone thereby marking the location of the osteotomy site.  
         [0059]     Referring now to  FIG. 5 , embodiments as illustrated in  FIGS. 1-4  is described when placing multiple implants in a side by side format. Initial osteotomy sites  46   a - c  are identified, made and verified into jaw bone  48  as previously described. As an example, the most mesial osteotomy site  46   a  could be prepared and verified or corrected as previously described. Leaving the implant guide  40   a  in place, the next implant osteotomy site  46   b  can be prepared and verified or corrected as previously described. Now, leaving that implant guide  40   b  in place, another osteotomy site  46   c  can be prepared with implant guide  40   c  put in its place and verified or corrected as previously described. This type of verification process can be used to place implants side by side in a partially edentulous arch and or in a continuous fashion all the way around a completely edentulous arch. Thus all potential multi-unit side by side implant sites can be properly and accurately prepared, verified and or corrected prior to implant body placement.  
         [0060]      FIG. 6  illustrates another embodiment of the present invention generally referred to as  72 . In this embodiment, the surgical guide is formatted as a one piece, multi-unit surgical guide having tooth contours  72   a,    72   b,  and  72   c.  Affixed to these tooth contours are collars  75   a,    75   b,  and  75   c,  apical posts  74   a,    74   b,  and  74   c  respectively, and corresponding finger grips  73   a,    73   b,  and  73   c  respectively. The purpose of this embodiment is to guide the placement of multiple, side by side implants in a multi tooth edentulous site. Although formatted as such, guide  72  can be fabricated and used as described in  FIGS. 1-4 . In this embodiment, a proper guide size  72  and corresponding contour would be chosen that corresponds to the size and location of the edentulous site. Multiple initial osteotomy sites  46   a - c  would be made in jaw bone  48  with apical posts  74   a,    74   b,  and  74   c  tried in osteotomy sites  46   a - c  to verify and or correct position, angulation and location of osteotomy sites  46   a - c  prior to implant body placement as previously described in  FIGS. 1-4 .  
         [0061]     As will be appreciated by those skilled in the art, the multi-unit surgical guide may use movable (adjustable) posts as previously described in place of the fixed posts illustrated in  FIG. 6 .  
         [0062]     Thus the embodiments as described may be used to guide the placement of dental implants in a single tooth format, multi tooth format and fully edentulous format.  
         [0063]     Referring now to  FIG. 7   a,  another embodiment of the prefabricated dental implant surgical guide  40  is illustrated. Surgical guide  40  as depicted in  FIG. 1   a,  has fixed apical post  44  with bottom end face  75  and marking agent  77  on it for the purpose of marking and identifying an osteotomy site  46 .  
         [0064]     Referring now to  FIGS. 7   b  and  7   c  use of the embodiment of  FIG. 7   a  is illustrated. By holding coronal post  43  and by using tooth shaped contour  42  as a guide as previously described, osteotomy site  46  in jaw bone  48  can be located and demarcated by pressing end face  75  with marking agent  77  of fixed apical post  44  on top of jaw bone  48  leaving a mark denoting the osteotomy site  46 . Osteotomy bur  47  of surgical drill  59  can then be used to initiate osteotomy site preparation. Further preparation, verification and completion of the osteotomy site  46  via drill  59  can then be accomplished as previously described in  FIGS. 1   b  and  1   c.    
         [0065]     Referring now to  FIG. 8   a,  another embodiment of the prefabricated dental implant surgical guide  51  is illustrated. In this embodiment, surgical guide  51 , comprises a fixed apical post  24  with bottom end face  85  and marking agent  87  on it for the purpose of marking and identifying an osteotomy site  46 .  
         [0066]     Referring now to  FIG. 8   b  and  8   c,  by holding coronal post  23  and by using tooth shaped contour  22  as a guide as previously described, osteotomy site  46  in jaw bone  48  can be located and demarcated by pressing bottom end face  85  with marking agent  87  of fixed apical post  24  on top of jaw bone  48  leaving a mark denoting the osteotomy site  46 . Osteotomy bur  47  of surgical drill  59  can then be used to initiate osteotomy site preparation. Subsequent to osteotomy site preparation and implant placement, the tooth shaped contour  22  of guide  51  can be converted to a provisional crown (immediate or delayed) as previously described in  FIG. 2   b.    
         [0067]     Referring now to  FIG. 9   a,  yet another embodiment of the prefabricated dental implant surgical guide  53  is illustrated. Surgical guide  53  comprises a fixed apical post  13  with bottom end face  95  and marking agent  97  on it for the purpose of marking and identifying an osteotomy site  46 .  
         [0068]     Referring now to  FIGS. 9   b  and  9   c,  use of the surgical guide  53  is illustrated. By holding coronal post  6  and by using tooth shaped contour  12  as a guide as previously described, osteotomy site  46  in jaw bone  48  can be located and demarcated by pressing end face  95  with marking agent  97  of fixed apical post  13  on top of jaw bone  48  leaving a mark denoting the osteotomy site  46 . Osteotomy bur  47  of surgical drill  59  can then be used to initiate osteotomy site preparation. Further preparation, verification and completion of the osteotomy site  46  can then be accomplished as previously described in  FIGS. 3   b,    3   c  and  3   d.    
         [0069]     Referring now to  FIG. 10   a,  another embodiment of prefabricated dental implant surgical guide  70  is illustrated. Surgical guide  70  comprises an adjustable removable post  67  with apical post aspect  64  with a bottom end face  102 , and marking agent  104  on it for the purpose of marking and identifying an osteotomy site  46 .  
         [0070]     Referring to  FIGS. 10   b  and  10   c,  use of the prefabricated dental implant surgical guide is illustrated. By pushing or turning coronal post  63  of adjustable removable post  67  so that central post portion  68  moves through central bore  60 , thereby lengthening apical post portion  64  and by using tooth shaped contour  62  as a guide as previously described, osteotomy site  46  in jaw bone  48  can be located and demarcated by pressing end face  102  with marking agent  104  of apical post aspect  64  of adjustable removable post  67  on top of jaw bone  48  leaving a mark denoting the osteotomy site  46 . Osteotomy bur  47  of surgical drill  59  can then be used to initiate osteotomy site preparation. Further preparation, verification and completion of the osteotomy site can then be accomplished as previously described in  FIGS. 4   b,    4   c  and  4   d.    
         [0071]     Referring now to  FIG. 11   a,  still another embodiment of prefabricated dental implant surgical guide  72  is illustrated. The multi unit one piece surgical guide  72  comprises fixed apical posts  74   a,    74   b,  and  74   c  with bottom end faces  109   a,    109   b  and  109   c  and with marking agents  110 A,  110   b,  and  110   c  on them for the purpose of marking and identifying an osteotomy sites  46   a,    46   b  and  46   c.    
         [0072]     Referring now to  FIGS. 11   b  and  11   c,  use of the prefabricated dental implant surgical guide is illustrated. By holding coronal posts  73   a,    73   b  and or  73   c  and by using tooth shaped contour  72   a,    72   b  and  72   c  as a guide as previously described, osteotomy sites  46   a,    46   b  and  46   c  in jaw bone  48  can be located and demarcated by pressing end faces  109   a,    109   b  and  109   c  with marking agents  110   a,    110   b  and  110   c  of fixed apical posts  74   a,    74   b  and  74   c  on top of jaw bone  48  leaving marks denoting the osteotomy sites  46   a,    46   b  and  46   c.  Osteotomy bur  47  of surgical drill  59  can then be used to initiate osteotomy site preparations. Further preparation, verification and completion of the osteotomy sites can then be accomplished as previously described in  FIGS. 1-4 .  
         [0073]     A method and apparatus for using a prefabricated implant surgical guide during dental implant placement surgery has now been illustrated. It will also be understood that the invention may be embodied in other specific forms without departing from the scope of the invention disclosed and that the examples and embodiments described herein are in all respects illustrative and not restrictive. Those skilled in the art of the present invention will recognize that other embodiments using the concepts described herein are also possible. Further, any reference to claim elements in the singular, for example, using the articles “a,” “an,” or “the” is not to be construed as limiting the element to the singular.