Guided implant placement is a sophisticated dental procedure in which dental implants are precisely positioned in the jawbone with the assistance of computer-generated guides. A lot of detailed digital planning and the use of surgical guides ensure the accurate placement of dental implants.
Beginning on this journey of implant placement is a transformative step towards achieving unparalleled precision and success in the dentistry world. The technology is ever-evolving and so are the techniques and strategies that define excellence in implantology.
Technically, a surgical guide carries all the information of prosthodontically guided implant planning. This blog post will discuss some of the tips and tricks that are used in guided implant placement in detail. It will help you achieve the best precision possible to boost clinical results. So, come along with us on this journey to explore new dimensions. Let’s get started!!
Strategies and Techniques in Guided Implant Placement
The following section of the blog post will shed some light on the different strategies and techniques used in Guided implant placement. So, without any further ado let us focus on them below.
Material Selection
The choice of materials greatly influences the success of any dental procedure. Various factors such as biocompatibility and strength must be taken into account before choosing the materials. Significantly, Titanium and its alloys are commonly preferred for implant components due to their excellent corrosion resistance.
These materials perfectly blend with the surrounding bones providing a perfect look to the affected area. The material selection process should also account for the specific anatomical and functional requirements of each patient thus ensuring optimal outcomes in guided implant placement procedures.
Guide Planning and Construction
Many important aspects such as implant positions and bone dimensions must be addressed when constructing a guide. Having a visible surgical field is vital as placing a surgical guide does not disturb the field of vision of the surgeon or the dental assistant.
It will further enable a correct osteotomy, and saline irrigation and ensure an accurate transfer of the digitally planned implant position to the surgical field. For this purpose, build a surgical guide with a slim or cut-out portion and stable parts crucial for guiding positioning.
Tooth-Supported Drill Guides
The interproximal space available between teeth is a major problem in tooth-supported surgical guides. It hampers the use of digital workflows sometimes. Always keep in mind that in the majority of implant systems, there is a minimum diameter of 5mm for drill sleeves.
So, the trick is to be sure that you have this interdental space in the presurgical appointment. Furthermore, it is a good opportunity to check if you can do interproximal guide plans to optimize the contact points. At the same time, you must allow space for the guide and the sleeve.
Pilot Drill Static Guided Surgery
Pilot drilling is a technique that allows one to pinpoint the correct 3D position of the implants about the teeth. This makes possible the first osteotomy through a drill sleeve. However, in the majority of cases of pilot drilling, there is no problem in the drilling osteotomy. Remember that implants with lengths of 14mm and 16mm set at 2 mm do not allow for standard drill lengths.
Fully Guided Static Surgery
When using static-guided surgery in a fully digital workflow, it is necessary to be aware of deviations listed in the literature. This includes information regarding implant depth and lateral deviation between planning and actual position.
Implant depth is one distinct feature that can be a potential problem. The implant’s rough surface may be exposed to the oral environment if you do not go the adequate length of the osteotomy. Furthermore, it can potentially cause peri-implant problems.
The tip is to always perform a radiographic exam to assess the depth of your final implant position. The implant position must be altered and corrected if required. Furthermore, it is better to correct it on the day of the surgery than to wait for short or mid-term complications.
Sleeve Selection
There are two separate parts to a surgical guide i.e. the guide itself and the drill sleeve. The first one is produced using additive or subtractive computer-aided manufacturing. Plus, the second one is provided by implant companies and is prefabricated. These two parts must merge with a perfect fit for a smooth and precise surgical procedure.
However, when a sleeve is placed into a surgical guide it is crucial that it has sufficient and secure retention within the guide. Sometimes it hampers the free movement of the drill with the greatest possible control. Therefore, sleeves must be correctly calibrated so that there is enough space for a passive but friction fit when inserted.
One trick to avoid misfits and the need for extra bur refinements of the guide sleeve hole is to print a calibration sleeve. It helps in correctly calibrating planning software with the 3D printer. There is no rule for how many times to print the calibration guides but it should be done regularly or when the software or hardware changes.
Fully Guided in Full-Arch Rehabilitation
In full mouth rehabilitation, merging bone with prosthesis is extensively made by placing radiographic markers on the prosthesis. This creates special landmarks to merge these two in an implant planning software.
One essential trick is to have gutta-percha markers that are as round as possible to avoid scattered radiation that can interfere with merging. Generally, 2 mm in diameter rounded gutta balls embedded in a patient’s prosthesis are a great solution. They are quite big enough to be easily identified and not cause distortion.
Drilling Protocol in Static-Guided Surgery
Various anatomical limitations are not visible during digital implant planning. Furthermore, mouth opening, muscle impairments and mispositioned teeth are the most common factors that interfere with guide placement, drilling protocols and instrument insertion.
The trick is to check the interocclusal space before implant placement. Also, the length of the drills may compromise the execution of guided implant bed osteotomy. This sometimes makes it impossible to perform guided surgery.
Primary Stability in Static-Guided Surgery
With the advancement in guided surgery implant bed preparation protocols changed and created new challenges. On one side drill sleeves and handles increase stability. Conversely, the operator’s sensitivity and perception of bone quality decreases.
This results in over-preparation of implant beds that would otherwise not happen. The absence of primary stability after removing the guide may present a clinical problem that is difficult to solve sometimes. If implants are placed deeper than planned all the provisional parts that were previously planned and fabricated may not be used.
Summary
In a nutshell, guided surgery with the aid of a customized transfer appliance is an individual choice for a specific implant-supported treatment. The potential for error is reducing as the technology is improving but conceptual and fabrication details have an impact on the outcome and performance of surgical guides.
As a matter of fact, the level of accuracy depends on the approach a clinician adopts to interpret each surgery and take the best advantage of them all. The above tips and tricks aim to provide some help when elaborating a surgical guide for implant-supported treatment.
