Set your implant skills free with guided surgery
Stephen Quinn delves into the benefits of guided implant surgery as an addition to the free-hand implant skillset.
Awareness of the benefits of guided implant surgery is growing amongst dental professionals in the UK. In the right hands, the accuracy and reliability of guided surgery is undeniable, and I use it in perhaps 50% of my implant cases.
Why not 100%, I can practically hear you ask? Well, that is because I strongly believe that guided surgery is an addition to the free-hand skillset, not instead of it.
New technologies are wonderful; however, we must not pursue them at the expense of completing the skillset journey in any dental discipline. Not least implant dentistry.
We implant dentists need to achieve the right outcome with or without the technology we are so lucky to have at our fingertips today. Let me be blunt – what are you going to do if you’ve a patient in the chair and the guide won’t sit right or it fractures, and you only know how to place implants using guides?
That is why free-hand skills are so very important. Even if you never plan to do any implants without guided surgery again.
A new boon
All of that stated, I do believe guided implant surgery is an essential tool in any implant surgeon’s armoury. In essence, the final result is formulated, and the implant’s position is planned accordingly.
The guide is then designed and printed, which can vary from a pilot guide all the way up to fully guided with depths and rotation. That way, the positioning of the implants is pre-determined. This eliminates the margin for error and offers incredible time savings.
There are two ways in which you can get guides from my chosen company, Quoris 3D.
The first is that you design them yourself and they print it for you, which is how I operate because I’ve been coached on how do that really well. Alternatively, you can send your plan through, which I have had to do a couple of times when my software was glitching.
The team there design it and send the plan back to you for your clinical verification.
You get the proposed plan by way of a short video tutorial. They run through the case with you and show the implant position, where you might want it altered, or any issues that they see from their end. But ultimately you have the final say. So if you tell them to put it somewhere, they will do it.
I primarily use guided surgery in anatomically awkward situations. For example where perhaps there are lingual undercuts, or the inferior alveolar nerve position might be of some concern. I also use it for immediate placement, especially in the in the anterior maxilla.
I love that it is predictable, accurate, and prosthodontically driven. It also minimises complications and risks for patients, meeting their expectations in terms of treatment time and outcomes.
As part of my journey to becoming proficient in implant dentistry, I completed a year-long course, which was really good. But once I placed a few implants following that, I hit a wall and did not feel confident to move on to more complicated implant treatment on my own.
I wanted to take the next step, and happily had a great referral dentist already in the form of award-winning implant dentist, James Hamill, who happened, at that time, to be selling his practice and making some career changes.
We agreed that he would come to the practice where I was providing implant treatment. He could practise alongside our team, and he then became my mentor.
That made all the difference to me, and, in fact, it was James who started me on the guided surgery journey. As a trusted peer, I was happy to follow him into this new realm. So I became an enthusiast of what Quoris 3D had to offer in terms of the Chrome Guidedsmile system.
Nowadays, Quoris 3D also offers customers chairside support. This is particularly great for full-arch Chrome treatment.
I believe it is essential that you have chairside support when using a new system. Even if it’s just to have someone by your side with an awareness of all the little nuances, tricks and tips of the system, that alone enables you to avoid unnecessary pitfalls, which is invaluable.
Plan your journey the right way
If I could offer some advice to dentists considering the guided route, I would say go for it. But with one caveat, to which I have already alluded.
Being able to perform conventional and free-hand implant dentistry, and having the know-how that goes with that, provides an essential, solid foundation to build upon.
Bearing that in mind, it is true to say that the advantages that guided surgery brings are undeniable. I write that not just from personal experience; their benefits have been documented over the years, including by Vermeulen (2017). They concluded that, regardless of skill and experience, guided surgery achieved better results and better patient outcomes than free-hand.
Jung and colleagues (2009) also indicated positive results after 12 months in their systematic review. While Bover-Ramos and colleagues’ (2018) systematic review and meta-analysis demonstrated full-guided implant surgery achieved greater accuracy than half-guided surgery.
As a final note, in this litigious era, guided implant surgery ultimately forces you to plan a case to the fullest. You can’t skip steps; you can’t do it on a wing and a prayer.
This is really important for protecting yourself, because it allows you to demonstrate that the case has been well thought out and planned.
It’s a win for the team, the patient and the business when the guided implant surgery journey is begun and continued in the best possible way.
Bover-Ramos F,Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies. Int J Oral Maxillofac Implants 33(1): 101-15
Jung RE,Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants 24: 92-109
Vermeulen J (2017) The accuracy of implant placement by experienced surgeons: guided vs freehand approach in a simulated plastic model. Int J Oral Maxillofac Implants 32: 617-24
Stephen’s top three guided surgery tips
- Know your guided implant drill kit. If you don’t know how to use your actual drill kit it is a waste of time. Irrespective of how well you design the guide
- Take excellent quality first records. Whether it’s impressions, intraoral or CBCT scans, if that information isn’t perfectly accurate then it knocks everything else out of sync
- Print out the plan and stick it on the wall beside you when you’re doing the surgery. Then you have everything you need in your line of sight.
Chrome is available exclusively through Quoris 3D in the UK and Ireland. It offers pioneering full-arch stackable guide technology. And it was developed for dentists who desire a pre-planned, predictable guided ‘All-On-X’ type of surgery.
In its entirety, the Chrome service delivers anchored bite verification, anchored bone reduction, anchored site drilling, accurate anchored provisionalisation, and a method of transferring all surgical and restorative information for the final restorative conversion phase.