Dental implants have become an everyday part of clinical practice. Despite this, designing and producing a functional and aesthetic implant prosthesis remains one of the greatest challenges. Unlike many other surgical implants, those used to restore teeth:
- Must be placed in what is often a very small and compromised bone; and
- Must be placed in close proximity to very important and fragile anatomical structures; and
- Cannot succeed by simply being placed within the desired tissue and successfully osseointegrating; and
- Must be precisely physically positioned and angulated in the maxilla/mandible to provide the requisite biomechanical functional performance and desired aesthetics; and
- Must remain connected to the oral cavity through the overlying soft tissue. Here they are exposed to and at risk from the harsh, bacteria-ridden and highly variable environment of the oral cavity.
Misaligned/ malpositioned placement of the implant is a common dilemma that frequently complicates the surgery, the clinical laboratory procedures and the performance of the final restoration. High accuracy in planning and execution of the surgical procedures is vital to securing a high-success rate without causing iatrogenic damage. The technology used to achieve this has advanced significantly in recent years. So much so that the treatment modalities that were standard practice just ten years ago are now completely outdated and considered to be below the standard of care. Central to this advancement in clinical practice has been the application of digital technologies and CAD/CAM systems.
What is a surgical guide?
Surgical guides are integral aids that are critical to ensure that the dental implant surgery is carried out according to the preoperative plan.
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The surgical guide:
- Controls the position of the surgical drills and placement tools; and
- Controls the angle of the surgical drills and placement tools; and
- Controls how deeply the surgical drills and placement tools can penetrate the patient's bone. In doing so the surgical guide:
- Controls the horizontal position of the implant; and
- Controls the angulation of the implant; and
- Controls the depth of placement of the implant within the bone.
Most clinicians we work with have discovered the amazing benefits of using surgical guides. Our overwhelming feedback is that it makes surgery easier, more predictable and with fewer complications.
Does the literature back the anecdotal reports?
Overwhelmingly, yes. More and more evidence is mounting in support of their use as best practice. Surgical guides are clinically proven to:
1
Reduce Implant Failure
A recent systematic review and meta-analysis published in the British Dental Journal found that the use of surgical guides reduced the number of implant failures by 64.95% when compared to free-hand surgery.1 This is a staggering number. Nearly two thirds of implant failures are completely avoidable. Without taking into consideration the other benefits this makes it hard to justify free-hand surgery nowadays.
2
Reduce Surgical Errors
Numerous studies have determined that surgical guides reduce surgical placement errors. These studies have found guided surgery to be more accurate in every regard. Specifically they:
- Reduces vertical placement errors;2,3,4,5 and
- Reduces horizontal placement errors;2,4,5 and
- Reduces angular placement errors.2,4,5 and
3
Save Chair Time
Guides have now been proven to simplify and reduce time needed for implant procedures.2,6,7 The use of a flapless guided procedure saves on average 24.28 minutes in surgical time alone.2 Add to this the time saved by avoiding surgical errors and restorative complications, and it's easy to see why guides have revolutionized implant productivity and profitability for clinicians.
4
Better Outcomes and Happier Patients
The treatment outcomes from reducing failure, surgical errors and restorative complications speak for themselves. These aren't the only reason that patients treated with guided implants report greater treatment satisfaction. Multiple studies and now even meta-analyses have concluded that guided surgery also reduces intraoperative discomfort,2 reduces post-operative pain2, 3, 7 and reduces post operative swelling.3
Clearly, the use of good quality surgical guides has made dental implant surgeries faster, safer, more predictable and with fewer complications. Both patients and practitioners prefer them for good reason. It is foreseeable that in the very near future guides will do for implants what rotary NiTi did for endo.
References
- Abdelhay N, Prasad S, Gibson MP. Failure rates associated with guided versus non-guided dental implant placement: a systematic review and meta-analysis. BDJ Open. 2021 Aug 18;7(1):31.
- Romandini M, Ruales-Carrera E, Sadilina S, Hämmerle CHF, Sanz M. Minimal invasiveness at dental implant placement: A systematic review with meta-analyses on flapless fully guided surgery. Periodontology 2000. 2022 Jul 30.
- Gargallo-Albiol J, Barootchi S, Marqués-Guasch J, Wang HL. Fully Guided Versus Half-Guided and Freehand Implant Placement: Systematic Review and Meta-analysis. Int J Oral Maxillofac Implants. 2020 Nov/Dec;35(6):1159-1169.
- Younes F, Eghbali A, De Bruyckere T, Cleymaet R, Cosyn J. A randomized controlled trial on the efficiency of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients. Clin Oral Implants Res. 2019 Feb;30(2):131-138.
- Fang Zhang, Xue Gao, Zhang-Yan Ye, Dong-Qian Xu, Xi Ding. The clinical accuracy of the implant digital surgical guide: A meta-analysis. Am J Dent. 2020 Dec;33(6):296-304.
- Frizzera F, Calazans NNN, Pascoal CH, Martins ME, Mendonça G. Flapless Guided Implant Surgeries Compared with Conventional Surgeries Performed by Non-experienced Individuals: Randomized and Controlled Split-Mouth Clinical Trial. Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):755-761.
- Leonardo Amorfini, Marco Migliorati, Sara Drago, Armando Silvestrini-Biavati; Immediately Loaded Implants in Rehabilitation of the Maxilla: A Two-Year Randomized Clinical Trial of Guided Surgery versus Standard Procedure. Clin Implant Dent Relat Res. 2017 Apr;19(2):280-295.
