Several types of surgical guides can be used during implant placement. Your selection will depend on your preferred treatment method and implant system. In turn, your choice of surgical guide influences the treatment planning process. Possible options include a pilot guide for initial drilling guidance that is compatible with all implant brands. A universal surgical guide is also compatible with all implant brands but provides full drill guidance. A Safe surgical guide is suitable for when you need the most accurate implant placement, providing drill and implant guidance. Surgical guides may be supported by mucosa, bone, or teeth.
A clinical examination of the patient will help identify which type of implant treatment is required. Points to consider include the patient’s needs, the number of implants required, and whether to use a fixed or removable prosthesis. Other factors include any potential tooth extractions, whether to choose an immediate restoration, whether flapless surgery is appropriate, and whether to visualize tooth set-up. Guided surgery allows you to plan surgery in advance, accounting for the patient’s esthetic concerns and clinical needs. Using the correct surgical guide will help to support your chosen implant solutions and your treatment plan.
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Using a Pilot Guide for Implant Placement
A pilot guide ensures that your initial drill achieves the correct angulation, depth, and direction right from the start of surgery. It ensures that the function and esthetics are optimized. Once the initial drill has been made, you can then remove the pilot guide, complete the drilling, and confidently continue with freehand surgery. The pilot guide increases the predictability of implant surgery and can be used to treat both partially edentulous and edentulous patients. When treating edentulous patients, you can achieve deeper implant placement using all of the available bone. If you are treating partially edentulous patients, a pilot guide provides more treatment flexibility, allowing for deeper implant placement and for bone reduction. It allows you to avoid critical anatomical structures and to overcome potential complications such as bone resorption.
Using a pilot guide is a very straightforward process that still allows maximum information to be precisely transferred from the digital treatment plan to the surgery site. Generally, anchor pins are not required to stabilize the surgical guide for single tooth and partially edentulous surgeries. The pilot guide is easy to situate, quick to remove, and suitable for use with all implant brands. A broad range of drill diameters are available, and a standard surgery kit can be used.
Using a Safe Guide for Implant Placement
A SAFE surgical guide is suitable for when you need full drill and implant guidance and where it is imperative to achieve the most accurate implant placement. A SAFE guide useds a brand specific surgical kit and is currently available for more than twenty of the top implant brands. These include Straumann, BioHorizons, Bicon, Dentsply Sirona Implants, Zimmer Dental, Biomet 3i and Nobel Biocare.
Using Fully Guided Dental Implant Insertion
If you prefer for your implant surgery to be fully guided, then your dental laboratory can fabricate the appropriate surgical guide. What constitutes an appropriate guide will depend on your chosen implant system and whether you intend to use a tooth-supported, mucosa-supported, or bone-supported surgical guide. Once you receive your surgical guide it’s important to confirm that the components of your surgical kit brand are compatible with the implant drilling and placement protocol.
A tooth-supported surgical guide’s position should be checked on the model and on the patient’s teeth. This is why it’s extremely important to make sure an up-to-date model is used for fabricating the surgical guide. If conventional impression material is used, check that the impression hasn’t become deformed in any way. Sometimes the patient’s teeth may not provide sufficient support, and it may be necessary to make an index to properly stabilize the tooth-supported surgical guide.
A mucosa-supported surgical guide should be checked on the patient’s soft tissue and will have been designed to have a unique position that makes it easy to place. To stabilize the mucosa-supported surgical guide during fixation, it is best to make a surgical index. You can fabricate the index directly in the patient’s mouth using normal index material. Ensure that the surgical guide is correctly positioned and properly fitted onto the mucosa while the patient’s jaws are in centric relation.
A bone-supported surgical guide’s position should be checked on the digital bone model delivered with the surgical guide. Make sure the surgical guide is in the correct location relative to other important anatomical structures and to any remaining teeth.
Steps to Follow Immediately Before, During, and After Surgery
Immediately before surgery, the surgical guide should be properly sterilized by placing it in a standard sterilization pouch and then into an autoclave set at 121°C for 20 minutes. It is vital that no mechanical forces affect the surgical guide during sterilization. Afterward, allow the surgical guide to cool to room temperature, still making sure it isn’t subjected to any mechanical forces before use.
When using a tooth-supported or mucosa-supported surgical guide, the soft tissue can be removed prior to or after positioning and fixing the surgical guide in the patient’s mouth. Your choice is dependent on the dimensions of your surgical instruments.
Bone-supported and mucosa-supported surgical guides can be secured with fixation screws. If you are using a mucosa-supported surgical guide, a surgical index is useful for stabilizing the guide while it is being fixed in place.
Once the surgical guide is in position the implants can be placed according to the implant manufacturer’s specifications. When placing multiple implants, mechanical considerations may dictate which implants should be inserted first. If flap surgery is used when placing the implants, the flap must be repositioned and stitched.
At this stage, the implants are immediately loaded if appropriate. A temporary restoration can be made and delivered prior to surgery, allowing the patient to leave the dental office with an attractively fabricated appliance. The restoration is constructed using a 3D duplicate of the patient’s jaw that accurately replicates the placement holes for implant analogs and the angulation of the implants. Using the right surgical guide ensures that an implant treatment plan is precisely delivered and that a temporary restoration will fit accurately, resulting in a very satisfied patient.
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