Guided Implant Surgery: The Future?

Hi Dr. S, We here at Glidewell Labs believe that guided surgery is truly the future. As the technology improves and competetive price pressure brings down the overall cost, the solution will become more of a standard of care. My advise, before you invest in a system, is to do a few cases through a planning service. This will give you an opportunity to use the various systems before you write a big check. Consider it a test drive if you will. There are several planning companies out there, but make sure that you find one with an experienced implant DDS providing the service.

i would avoid implant surgery planning companies at all cost. is the planner going to be there to hold your hand when you put the fixtures in? Is the planner going to be there when things don't go "exactly as planned". Is the planner going to assume any responsibility if the outcome is not as expected? beware this service. when I mention services like these to other types of surgeons they laugh. the lawyers are sharpening their knives for this one.

sorry to be so bitter, and I didn't answer your question. guided surgery is a great advance for dentistry. the days of laying huge flaps and putting implants in wherever we can are over. i have used guided surgery - simplant and nobelguide - for small and large cases. i am constantly amazed at what we can do. guided surgery helps us practice restoratively driven implant dentistry. Is it necessary??? For the novice I think guided surgery is great. But please learn how to work up your own cases. Do not use third party planners. If you can't plan the surgery and understand the technology (which is actually very straitforward with simplant) - you probably should not be doing the case. For myself, I only use guided surgery for large cases. I don't like systems that attempt at securring the final implant placement in the apico-occlusal direction. I feel that this is a clinical judgement call and every site is different. But, I do like the smaller diameter drill guides. Many single tooth cases can be easily done with model based guides and a simple radiograph. This is a great tool for beginners. My final statement is this, Model Based and CT based guided surgery is here. If you don't consider it in your work up you may be outdated. It is not, however, a substitute for experience. As a patient I would rather have surgery done by an experienced practitioner with no guide verses a novice with a guide.

I'm doing guided surgery for some time and I consider it a step forward in Implant dentistry, of course there are some drawbacks, but really it is amazing how we can solve difficult cases with easiness. I wouldn't recommend novice to have a case completely planned by a planning service, but some advice can be helpful specially in first cases. Start with a simple planning software, there are some free downloadable programs out there in the web. If you re not able to plan a case by yourself, please don't do the surgery, look for a CE course to learn how to use a planning software ( if you are reading this post you have enough tech knowledge to use a simple planning software). I use guided surgery mostly for large cases. I use only mucosa supported guides. As a patient I would have my case planned and done by an experienced surgeon with a Ct planning software and a guide.

Every body wants everything easy. There is no substitute for the surgical/restorative doctor actually knowing what they are doing. That is having the hands,brains and education/training to do the job!

Dear Dr, I 've been using guided surgery succesfully for many years.I recommend you to join CAIAcademy (www.caiacademy.org )in order to improve your knowlege ..Computer aided tecnology is very much driven but also needs experiance and education..please visit te web of CAIA

I completely agree with dr.hughes. it's absolutely not necessary to use the guided surgery tecnique. in my practice, i never used this approach but only hands brain and a little pocket mirror in the mouth to verify parallelism and compatibility.

Great comments by Dr Hughes and sboralsurgeon. I couldn't agree more. I've had more problems when I blindly followed a guide someone else designed. Computer generate guides are a great tool but not a replacement for THINKING AND EDUCATION. At the minimum, you need to know when the guide is helping you and when it should be tossed in the trash (do enough guides and it will happen.) Maybe someday robots will be able to place implants but we're a long way from that, imo.

Maybe it is better to start with what digital treatment planning and guided surgery are not. They are not a replacement for proper training, experience,and sound clinical judgement. What they are are tools that, when used properly, can reduce operatory times, shorten recovery time,and improve prosthetic outcomes. Planning services are merely a means of facilitating the use of these tools. No credible planning service will take control of the treatment plan out of the hands of the treating clinician. Typically, you will upload your CBCT DICOM file to a web portal and fillout an online Rx. An experienced DDS will set-up your plan based on your Rx. Then, you will log on to an online session where you take control and direct the final implant positioning. In this scenerio, you are the surgical expert and the planner only offers suggestions based on prosthetic considerations if required. However, the planner never makes a decision for you. You make ALL of the decisions, this is your patient and your treatment plan. What you don't have is a large investment in software, or hours of software technical training, or ongoing efforts to keep up with technology advancements. What you gain is a support person who has hundreds of hours of experience with the software, working with radiology centers, and someone with deep laboratory and prosthetic knowledge to support your referral base.

I have been involved in many a case where I have been able to place an implant solidly in bone on the CBCT software and wished I could translate that plan to the patient. To that end, I think that the CT-guided stent would be wonderful. That being said, *I* am the one planning the case with the CT in front of me. I would not feel very much like a "doctor" if someone else planned the case and wanted me to only drill holes. That starts to sound like what a technician does. Just because the technology allows for it doesn't mean we have to use it or rely on it. Computers and robotics have already replaced most of the manufacturing industry workers. What's the point of having a brain and hands if we're going to let technology replace all that. Seriously, how far of a stretch will it be to have an automated drilling system drill implant osteotomies from a CT? Do we have to take humans out of everything?

As a general dentist I have restored implants for 30 years, and have consistently been disappointed by the final outcomes of cases where the implants are placed by various surgical specialists. The problem is that very few specialists are willing to fabricate the final prosthesis, and thus have no learning curve on the requirements for the final restoration, especially in multiple implant cases. I have undergone extensive implant training, both conventional and guided, and am convinced that the standard of care is to plan with a CBCT and planning software, even in the single implant cases. Details such as bone quality, angulation with available space, prosthetic requirements and length/diameter options simply can't be discerned with a flap and 2-D radiographs. Rather than be resistant to technological advances to protect their territory, specialists should get on board and work with the general dentists to plan even more difficult cases for the benefit of all. I can personally reccomend working a few cases with Dr. Bockhorst at Glidewell, and once you see the vast improvement in your final prosthetic cases, you will never go back to half-blind implant placements