By: Dr. David Chong and Dr. Brian Seo
We have all been there. We have spent countless hours and money sitting in weekend CE courses learning about the ideal position and angulation of implant placement. It’s not about whether we know what a good implant placement is anymore. The question now is “Am I going to be able to place the implant in THAT ideal position?” Many clinicians are very confident when it comes to a single unit implant. However, when the final prosthesis is fabricated, they are able to find that nagging 1-2mm positioning error or 1-2 degrees of angulation error that they weren’t able to see during the surgery.
Sometimes we are not able to detect the errors in position or angulation until the prosthetic phase of the treatment
Using a computer-guided system requires longer and more expensive pre-operative work-up of a patient. But using a well-planned and well-fabricated surgical template will reduce clinician’s anxiety, time, and stress during the actual surgical procedure and also during the restorative phase of the treatment.
Many different types of surgical guides are available in all shape and form
There are many criteria a clinician should consider before deciding on a guided surgery system to use for implant placement. A good guide system should be easy to use. Drilling sequences for osteotomy should be simplified and easy to understand. Also, presence of tissue punch in the kit, which does not require removal of guide template is a huge advantage. Tissue punch will save the hassle of raising a flap and trying to fit guide template around the surgical site with soft tissue interference from the flap.
Tissue punch designed to cut the margin of the tissue first, and remaining soft tissue is removed with the following osteotomy drills
Another major challenge that comes from utilizing a guided surgery system is difficulty of fitting the template around the second molar area. Due to limited interocclusal space, fitting the template around the site and trying to fit the handpiece and drill can be difficult if not impossible. Some guided systems offer the clinician choice of fabricating a template with buccal window around areas with limited patient opening. This design not only allows the clinician to approach the surgical site more easily, but it also allows for easier and more sufficient irrigation of the site.
Buccal window template design allows easy placement of implant in second molar area
Not every clinician is blessed with the best dexterity or have experience of placing hundreds to thousands of implants. But computer guided system will aid clinicians in placing implants in pre-determined position, angle, and depth. Most importantly, One Guide will save clinicians tremendous headache and hassle that come from placing implants blindly.
Dr. David Chong
Hiossen Faculty Member