Does Guided Surgery Save You Time?
The commercialization of guided surgery has brought about many misconceptions about the technology. Most companies have indicated that guided surgery is synonymous with flapless surgery and that a drill guide is analogous to a drill press, and requires only that the surgeon place a drill into a guide tube, without concern about error or technique. Furthermore, guided surgery has been touted as a method for completing implant procedures quickly, with a minimum of surgical experience.
These misconceptions have contributed to failed cases by many implant surgeons, and have slowed the adoption of guided surgery by the dental profession. Guided surgery is a treatment planning tool, which allows the surgeon to virtually visualize a patient’s anatomy including critical anatomical structures, evaluate bone volume and density, evaluate occlusal relationships, determine future tooth position and virtually place implants in prosthetically ideal positions. A drill guide, which transfers the virtual implant position to the patient, is then manufactured. These steps are completed well before the patient’s surgical appointment.
Like every technique used in dentistry, guided surgery must be mastered before it can be used successfully. This requires an understanding of 3D imaging, data input, implant planning software, and the use of drill guides. Most important, the surgeon must understand the sources of error in the method and when the error is clinically significant. A drill guide is not analogous to a “drill press” and to view guided surgery as a method to do procedures quickly is a mistake.
However, when used appropriately, guided surgery allows implant surgery to be done at a level unattainable by any other method, with a high degree of accuracy and reduced surgeon stress. In the hands of an experienced guided surgery surgeon, operating time can be reduced significantly.
It has been our experience that successful guided surgery surgeons flap most of their cases in order to validate the osteotomy entry point and trajectory before completing the osteotomy. This is the key to the successful use of guided surgery, as an error can be detected and corrected before the osteotomy is completed. Flapless cases can be selected on a case by case basis.
Patient care at the highest level is the ultimate goal of implant therapy. Guided surgery is the safest and most accurate way to place implants. However, the method must be used appropriately by an experienced, trained surgeon, who understands the advantages, limitations and nuances of the technique.
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