ADVANTAGES AND BENEFITS OF COMPUTER-GUIDED IMPLANT SURGERY

Originally developed for neurosurgery, computer-guided surgery provides dentists with several advantages, helping them achieve predictable and safe implant placements. Despite the advantages, the number of implant dentists choosing to use this technology remains low. Figures for the dental implant market in the United States show that in 2012, less than 15,000 computer-generated surgical guides were utilized. During the same year, it is estimated that more than two million implants were placed! The figure for computer-generated surgical guides is estimated to increase to 31,000 by 2019, but this is still remarkably low compared to the growing popularity of implant surgery.

Computer-guided surgery uses the images from the patient’s cone beam CT scan to precisely plan implant treatment. Guided surgery software allows you to visualize and manipulate images of the patient’s jawbone and the surrounding tissue, giving you the opportunity to plan the most accurate approach to treatment. Cone beam CT images clearly show the available bone, the thickness of soft tissues, vital structures, and the root anatomy and proximity of adjacent teeth.

What are the Main Benefits of Using Computer-Guided Implant Surgery?

The main benefits of using computer-guided surgery include precise and accurate implant placement. The ability to visualize vital anatomical structures allows you to better preserve them during guided surgery. In comparison, while traditional surgical guides can provide a predictable outcome, they tend to be trickier to use, especially in the absence of any anatomical references. Detailed treatment planning beforehand helps to reduce or eliminate unexpected events during surgery. Often the time required for implant surgery can be substantially reduced, which is of great benefit to the patient. When considering all these advantages, it begs the question: why do relatively few clinicians use this technology?

Are There Any Drawbacks?

One of the main drawbacks of guided implant surgery is the initial cost of investing in specialized surgical equipment and planning software, as well as the time needed for training. While computer-guided implant surgery may be more comfortable and quicker for the patient, it’s not unusual for clinicians to spend more time planning the surgery compared to traditional implant treatments. However, the technology required for computer-guided surgery is becoming less expensive; as the advantages become clearer, it’s likely more practices will invest in the necessary equipment and training.

When is Using Computer-Guided Implant Surgery Advisable?

Computer-guided implant surgery can be particularly useful in certain situations. You may wish to consider this treatment option if the patient requires three or more implants to be placed sequentially or when implant placement is critical to the success of the proposed restoration. Patients who have problems with the structure or volume of their bone, or require significant alteration of bony anatomy, may benefit from computer-guided implant surgery. Computer-guided surgery can help to reduce problems concerning the proximity of existing implants or adjacent teeth. People who are fully edentulous or patients who require immediate extraction followed by immediate implant placement could be suitable for this type of treatment. Despite the advantages, guided implant surgery isn’t necessary for all situations and you may have been routinely and successfully placing implants freehand or without guided surgery for years or even decades.

Using Computer-Guided Implant Surgery to Achieve a More Desirable Outcome

The main reason for choosing guided implant surgery is to increase the accuracy of implant placement. This is because the technology used to plan treatment also allows clinicians to plan the exact morphology and position of planned restorations before placing and positioning implants, helping to create the ideal treatment plan. By reverse-engineering implant surgery, it’s possible to achieve more accurate implant placement. You can ensure vital anatomical structures are avoided by using computerized software to fully visualize the anatomy surrounding the implant locations while still ensuring the implant is placed in the ideal position.

Digitally planning implant surgery allows your entire dental team to visualize and approve the treatment plan, including the final prosthesis. Experienced dental technicians are frequently able to adjust planned restorations to accommodate dental implants in less-than-ideal locations, often by using custom abutments. This type of digital workflow can result in a better treatment outcome, particularly when an immediate prosthesis is required. Using the precise model of the patient’s jaw and the surgical guide, it’s often possible for an accurate prosthesis to be manufactured prior to implant surgery. Using flapless surgery, digital planning can be especially useful for implant placement. Computer-guided implant surgery may not be the ideal choice when placing posterior implants or for situations where access is limited, especially with longer drills. When this is the case, surgery must often be performed before a guided template is fabricated. Other contraindications include certain bone grafting cases and cases where a completely edentulous ridge has become badly resorbed.  

Clinically, it’s been shown this technique can reduce pain and discomfort post-operatively. A 2012 systematic review of computer-guided implant placement concluded that guided implant placement provides patients with implant survival rates comparable to conventional implant treatment. However, the review cautions that clinical demands on the implant dentist are no less stringent than when using conventional implant treatment. While computer-guided surgery can be more accurate, just like all technologies it isn’t perfect. Small deviations from the planned locations are normal, but even when taken into account, can still result in more accurate implant placement compared with using freehand techniques to place implants.

In many cases, computer-guided surgery can be a valuable opportunity for the patient to become more involved in their treatment plan. People often find it fascinating to visualize their virtual treatment plans, making it easier for you to explain possible treatment options and potential risks, all while showing them the predicted outcome. This increased level of patient education can provide greater acceptance of a proposed treatment plan. Increasingly, implant dentistry is becoming restorative-driven; this is where virtual planning can be extremely helpful, providing patients with a predictable treatment outcome while meeting all surgical parameters.

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References:
https://www.periodonticsltd.com/docs/Gorin-Winter-2015.pdf
https://www.aegisdentalnetwork.com/cced/2016/06/guided-implant-placement-whats-new-and-when-to-use
https://www.ncbi.nlm.nih.gov/pubmed/23062137