Surgical guide for implant placement
When properly used, surgical guides can increase the predictability of implant treatment outcomes
A dilemma faced by every implant clinician is the option to place implants freehand or with the help of a surgical guide. With good technique, the utilization of surgical guide are often a confidence-building and predictable method for implant placement. It can assist the practitioner in avoiding damage to anatomic structures, also limiting fenestration of the gum ridge at implant sites. However, the surgeon must be confident in ability to put dental implants before using surgical guides to increased number of steps and processes involved — as each step may result in slight inaccuracies which will ultimately cause misplacement.
Guided surgery allows clinicians to develop a restoratively driven surgical plan, with the last word goal of patient-centered, positive outcomes. Several guided options are available, and therefore the dentist must choose the choice resulting in the simplest outcome . The selection between a tooth-, mucosal- or bone-borne guide is exclusive to the clinical situation. These may involve the sort of hard- or soft-tissue support available, quality of the diagnostic image, and potential errors within the fabrication process. There are advantages and drawbacks to every sort of guide.
Tooth-borne surgical guides are common and simply adaptable to varied clinical situations. One benefit is that consistently reproducible landmarks (namely, teeth) are often used for support, stability and retention. The improved accuracy and precision of implants placed through tooth-borne guides are evaluated in bench top and clinical models. foremost common utilization of tooth-borne guides is for single or multiple implants for fixed restorations. Although these guides are shown to end in predictable restorative outcomes, it’s important for the practitioner to be cognizant of obtainable space and best Luminers in extra guided drill length, especially when placing posterior implants.
As the name suggests, a mucosal-borne surgical guide uses intraoral soft tissues for support and stability. This guide is usually fabricated to support an existing removable prosthesis. Possible concerns with mucosal support involve the shortage of retention during surgery and variation in tissue thickness and quality — which may be a common complaint . A mucosal-borne guide has the potential to undergo movement in varying directions that would increase the inaccuracy of implant placement. This, alongside flap reflections, may introduce additional complexity during implant placement.
A bone-borne surgical guide is usually used for full-arch edentulous implant cases. This sort of guide derives its support from load bearing areas and the natural divergence of the gum ridge seen in both maxillary and mandibular arches . Bone-borne guides are difficult to fabricate and accurately place intraoral thanks to the extent of flap reflection needed for access. Although the difficulties related to bone-borne guides are well reported, they’ll be mitigated with proper planning and accurate imaging
Treatment planning in cases involving a totally edentulous patient provides several options. Stackable guides are getting increasingly popular thanks to their simple use and adaptableness . These guides derive support from one foundational guide. The inspiration guide is placed first, generally with support from bone, and followed by the sequential placement of required guides.
Surgical guides can also be wont to help treat patients transitioning from a failing dentition to an interim, implant-supported prosthesis. During a patient undergoing full-arch extractions followed by two implants to support a mandibular overdenture, a supported using multiple nonrestorable, but intact, teeth, also as mucosa. A Flexible Denture and standard treatment option could include extraction and alveoloplasty, followed by freehand implant placement. An alternative to the present method might include the implant planning software to virtually extract teeth. During this case, the canines and adjacent teeth are going to be extracted first, the surgical guide fitted, and made to depth at the sites.
The use of implant planning software for guide fabrication in these cases improved the predictability and efficiency of implant placement. It also contributed to raised patient-centered outcomes associated with reduced surgical exposure and improved prosthesis fit. This model allows the clinician to develop a positive surgical plan that’s restoratively driven. Surgical guide options include tooth-, mucosal- or bone-borne guides — or a mixture of those approaches.