As the name suggests, a tissue supported surgical guide uses intraoral soft tissues for support and stability. This guide is commonly fabricated based on an existing removable prosthesis. Possible concerns with mucosa! support involve the lack of retention during surgery and variation in tissue thickness and quality -which is a common complaint also seen with complete dentures. A tissue supported guide has the potential to undergo movement in varying directions that could increase the inaccuracy of implant placement. This, along with flap reflection, may introduce additional complexity during implant placement. Tissue supported guides are designed from existing or new full dentures, and always require a dual scan. If the denture is not well-fitting, please perform a hard reline (not soft, and remove the soft if it exists and perform a hard reline). Scan the appliance in the mouth with the patient biting on the guide, not open separated. Scan the appliance again outside the mouth resting on foam or cotton rolls. This is the dual scan. Send us a bite and the opposing model.