Guided dental implant surgery is a procedure where a surgical guide or template is made to allow me to place your dental implants in a very precise position. This is done from a 3-D scan and some serious computer software. It can often help reduce the need for a bone graft!
First a 3-D scan is taken of your mouth areas that you’re considering having dental implants. Then I will do what I call “virtual surgery on the computer.” I will overlay the models of your mouth and the 3-D x-ray images. I use photography also. This allows me to do a virtual procedure without ever touching your mouth. It doesn’t hurt at all 😉
There are limitations of computer guided implant surgery.
Certain manufactures help me fabricate surgical guides such as Anatomage and Simplant. Ultimately safety and precise implant placement is what I am looking for. The surgical guide can limit your risk by avoiding the nerves, arteries, sinuses, and bone depressions and precisely place the implants for the best cosmetic and functional result. Implants can be placed in the areas were you have the thickest bone and avoid areas of thin, weak bone.
3-D guided dental implant surgery is not without drawbacks. The biggest issue is something people don’t even really think about. Your mouth has to be able to open fairly wide. The guides are thick and the drills are long so you must be able to open very widely to accommodate all the apparatus.
Another drawback is that oftentimes the gums can’t be opened for the initial drills. This means the implants are sometimes placed flapless by drilling through the gums. (no incision) This is an issue if you are already lacking gums. In these cases I do a gum procedure to move the gum out of the way and grow more gum for later.
3-D guided surgery seems to be super accurate, but there can be major issues. 3-D guides are not always a stationary. If it moves, it can change the position of the implant.
A very experienced implant dentist knows how to stabilize a surgical guide. This is often with the use of anchor pins but most importantly based on how I designed the guide on my laptop.
3-D guided surgery is indicated for very difficult areas such as a very tight space between two roots or full mouth dental implants placing 12 implants into thin bone.
An excellent reason to use a surgical guide would be a patient that is on a strong blood thinner such as Coumadin. This would be a reason to do a flapless, no incision dental implant procedure.
In my opinion, the 3-D evaluation and 3-D planning should be done in the office, by the dentist who is doing the implants. You may be surprised to know that many dentists do not know how to read 3-D scans so they send them out to be read! They pay other dentists to do the virtual surgery to know where to place the implants, and where the nerves, etc. are!!!!!!
It is my personal opinion that if you are doing complex implant dentistry your dentist should be planning the surgery and mapping the nerves and arteries sinuses bone depression so they know your anatomy inside.
I recently helped another dentist who did not plan his surgery and ended up drilling through the patient’s nerve… Yikes!
In this video you can see a case and I’m doing with 6 upper implants. The guide is stabilized with Anchor pins which go in from the side of the jaw so that it does not move while I am drilling and manually expanding the bone.
No amount of computerized guided surgery will ever replace the training, judgment, and skill of your implant dentist. It is just a tool that helps in some situations.
You have any questions or comments please list them below. Thank you!