Is Guided Implant Surgery Necessary?

What do dentists mean by guided surgery?Click To TweetDental Implant Services in San AntonioThe terminology is a little tricky when thinking about “guided” surgery. Does it mean the implant is placed by a robotic arm?

It might be.

Technology like this does exists, but right now I would still consider robotic arms to be in “the development phase” when it comes to placing dental implants.

So if it isn’t a robotic arm, what do dentists mean by guided surgery?

All guided surgery options begin with a CT scan of the head. In dentistry, we call this Cone Beam CT or CBCT. This scan data is then used to create dynamic computer maps or models of the jaws.  Within these models, implant images can then be virtually placed. Reports from this study can then be produced and used to help patient’s understand where implants can or cannot be placed. Assuming all is favorable for placing the implant a surgical guide will then be 3D printed. [To see the mind-blowing future of 3D printing, click here]

There are a number of different surgical guide designs. Some enable every drill and even the dental implant to be placed through the guide. But it need not be this complicated to be useful. Even the placement of a single implant can be made easier by the using a surgical guide. They help avoid implants touching the roots of adjacent teeth, perforating the bone into soft tissues, as well as keeping them away from important nerves and sinuses. Guided surgical placement of implants also improves the ease of restoring the implants later.

But what about cost? Is it worth it to go through the additional expense that obviously goes into creating a surgical guide?

To answer this, let me offer one observation and then end with a new recently published scientific study.

My clinical experience in placing implants goes back to the 1980’s. Surgical guides, if they could even be made, were much more expensive. They were made in the dental laboratory by the dentist or technician and they were made off stone models by hand. Today’s surgical guides are made by 3D printing from an exact computer replica of the teeth and/or jaw of the specific patient. This means the cost is less, the speed of development is fast, and the accuracy of placement dramatically improved.

Now the study: In the September 2018 issue of the Journal of Periodontology, researchers studied whether or not the use of guided surgery improved treatment results. They also considered whether or not these guides were cost effective.

First, let me say that they had to narrow their study to a particular type of surgical guide. This means that their findings may not apply in all instances. But having said this, I do think they have confirmed what I have long believed and that is this.

The use of surgical guides is admittedly more expensive up-front, but the long-term failure rates are less when using surgical guides. 

As far as I am concerned, because the fabrication of surgical guides has dramatically dropped in cost over what it was even five years ago, it is now with rare exception that I will place a dental implant “free hand.” At the time of this writing, I believe mine is still the minority opinion – this is where innovation always begins.