Guided dental implant surgery
Guided dental implant surgery is a method of surgically placing a dental implant in the most ideal position. It utilizes the best technology to create a guide that aids the doctor in implant placement.
What is guided dental implant surgery?
It consists of a surgical guide that fits on the patient in a precise position and therefore allows precise placement of dental implants.
How do we accomplish guided dental implant surgery?
We need a CBCT 3 dimensional x-ray of the jaw, a digital impression or model of the teeth and or gums, software to plan the dental implants, and a 3D printer. Next, we take the data from those things and stitch the digital information together in the software to design the guide. Finally, we print the surgical on a 3D printer and insert metal sleeves later.
There are 2 methods to fabricate a surgical guide for guided dental implant surgery.
We can make a guide from a model, known as model based, or from a CBCT based. There is few reasons to do a model guide in this day and age. Other options for the surgical guide include tooth, bone, or tissue born options.
- Stone cast on surveyor and use 2mm drill press to place hole at desired angle 5-10mm deep
- Place 2x10mm drill blank (McMaster-Carr Co) into hole
- Next, place 2mm bushing over blank
- Place appropriate guide sleeve over bushing
- Inject any light polymerizing gel (Triad Gel) around guide pins
- Need inserts for different sizes
|Cast should be marked as shown|
CBCT based 1
- Inital cast has teeth set in ideal location and barium sulfate flipper or denture that the patient wears.
- CBCT with flipper in place
- Implants placed on software
How to make a CBCT guide on edentulous patient.
Cory Glen video using BSB.
Guide surgery case example
What are the options and techniques for a 3D printed dental implant surgical guide?
What are the options for surgical guides if don’t print own?
$35 to scan stone model and print surgical guide. 3-5 day turn around Digi 3D
Dominion Milling Center will print a surgical guide for you for $35. Need scan of teeth no model printing.
What are the 3D printing in office surgical guide options?
Never absolute precision in CBCT. Most systems have 20-30% barium sulphate acrylic scan prosthesis (not Nobel that uses gp). If partially edentulous may not need at all, use teeth as reference.
Types – with any of these types it helps to have holes in guide or drill holes self to ensure fully seating. Post 35
- Tooth born=most accurate
- Tissue born
- Bone born
- SimPlant – Facilitate (bone guide available)
- 3D Diagnostix (bone guide available)
- Sicat – Sirona
- VIP3 – Biohorizons (no pilot)
- Blue Sky Plan (bone guide available)
- Cybermed – OnDemand (bone guide available)
- iGuide by iDent
- EasyGuide by Keystone dental (pilot only)
- gonyX by Straumann
- Guided Surgery Solutions
- Anatomage – InVivo5 (bone guide available)
- 360 Imaging
- Canada Bay
- Implant Concierge
- Jurim Dental Studio
- nSequence Great bone guide system
- Ottawa Dental Lab
- Swiss Meda/SMOP
- GuideSMILE V2R Biomedical Great pin referenced provisional in use Tischler article in dentalcetoday
- 3 or more implants in a row
- Proximity to vital structures, adjacent teeth
- Questionable bone volume (significant soft or hard tissue defects)
- Implant position critical to restorative success
- Flapless plan
- Multiple unit or complete arch immediate restorations planned
Large volume CBCT has 2.7-25 times radiation pano, kind of useless since we use limited image.
CBCT is about 20% conventional CT in radiation
Thyroid collar can reduce exposure by 40%
CAS (carotid artery stenosis) found in pano is about 2-5%. Duplex ultrasound is gold standard to confirm
Place cotton roll under upper lip before CBCT to prevent shadowing.