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?
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:
- It creates a channel through which the surgical drills are passed and aids in assuring the implants are placed at the desired angle.
- It increases rigidity of the guide.
- 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 ]