As a restorative dentist, have you ever had a patient present without ideal implant placement for restoring them optimally? Conversely, if you’re a specialist placing implants have you ever had one of your restoring doctors tell you that you put an implant in a less than optimal position for them?

implant surgical guides

If this has ever happened to you, incorporating the use of surgical guides in your office may be exactly what you need. While fabricating a surgical guide may sound complex, the reality is that in many cases it's an easy process.

However, as the complexity of the case increases, so does the fabrication of the surgical guide. One of the simplest methods you can use is to form a material such as 1.5mm Biocryl over a model representing your final restorative goal and drill a hole through this matrix for each implant that is to be placed. Once this is done, the initial guide drill can simply be passed through this hole to start the osteotomy and subsequently guide the following drill. This will in turn guide the placement of the implant.

While this type of guide is relatively easy and quick to make, it does have its limitations. First, since you’re left with a shell with a hole or holes though the top of it, there is quite a bit of room for the implants to be unintentionally angled. This of course can pose challenges when it comes to restoring the implants.

The other main limitation is that this type of guide is flexible and is best reserved for simple cases with just a few implants and teeth to the implant site or sites to ensure that the guide is stable. The next step up in regards to surgical guides is to fabricate a template as described and fill the areas where any teeth are missing with acrylic. Once this is completed, holes are drilled through the guide where the implants are to be placed. This process has three benefits:

  1. It creates a channel through which the surgical drills are passed and aids in assuring the implants are placed at the desired angle.
  2. It increases rigidity of the guide.
  3. If you use a radiopaque acrylic such as Biocryl X, you can visualize this on your radiographs.

While there are clearly benefits, it’s important to note that there is a significant drawback. The acrylic that fills the surgical sites can impair visualization and irrigation of the surgical site. John R. Carson, DDS, PC, Spear Visiting Faculty. [ www.johnrcarsondds.com ] 


Comments

Johanna Tesoniero
January 26th, 2014
I think that stents are becoming more and more that standard of care, however, how many surgeons actually use that stent you send them based on some of the draw backs you mention? By the same token, I was at a Nobel Biocare course recently and CT scans are also now considered standard of care, even in simple implant cases. It was interesting that the speaker stated that if you do not have a CT scan on an implant case, you might as well write a check to the patient for UCF fees at a minimum.
John Carson
January 26th, 2014
I can only speak for the team I work with but if I send a surgical guide it gets used, I can't think of a time when it didn't. That being said I know that they do get tossed aside and not used by some. This being said do I use a guide or a CBCT in every case? The answer is no. In my opinion guides and CBCT's are an invaluable tool and yes in some cases I would consider them the standard of care however I do not believe this is the case for every implant case, and this is coming from a guy (me) that has a CBCT scanner and who takes a lot of scan and makes a lot of guides. This being said the trick is to figure out when you need or want them and when you don't, some of the indicators for using them will be case dependent and some will be operator dependent.
Doug Phillips
February 4th, 2014
Nice overview. The patient perception factor of costs needs to be considered and the time to make the guide. Some office include the guide as part of the surg fee. Others charge for it. We are presently using Anatomage-Invivo software for most of our guides. CBCT of the implant arch ( limited field of view to limit liability and radiation) , Diagnostic cast with ideal wax up of missing teeth ( we scan this too after duplicating the cast in stone), Merge the two scanned files- one of actual pt and one of ideal cast of teeth. Then we plan our guides. Anatomage can made a guide with steel surg tubes for each implant for less than 300.00. We do not always have to complete a wax up if adjacent teeth are in good alignment.
Anthony Benassi
April 5th, 2014
I feel using guides to place implants takes a great deal of the stress of placing the implant off the operator, increasing confidence and actually speeding the surgical procedure, taking stress off the patient as well. With the integration that is possible using a Cerec and Galileos, even single implant guides can be made quickly,easily, and cheaply leaving little reason to not use a guide.
Manjitsingh Bhalla
September 19th, 2014
An ever permanent dental restorative procedure – the dental implant! Yet, a correct placement is a must. Any sort of mistakes like (holes left through can be proven awkward with an unintentional angle for dental implants. Else, the processes from drilling through an operated site to inserting the implants, just superb – teeth structure restored, looks and functions so naturally!