Article

Feature Article
Nov 17, 2014 // 17 min read
Guided Surgery in Implant Dentistry – An Overview
Ali Tahmaseb
Daniel Wismeijer
Wiebe D.C. Derksen
DOI: 10.3290/iti.fi.45699
guided surgery dental implants computer planning
Abstract

Computer-guided surgery has been a subject of interest to clinicians and dental implant research for many years. Different levels of evidence have been presented showing different levels of accuracy. Different protocols have also been presented in the literature distinguished by i.a. different guide production, support and surgical protocols.

The purpose of this overview is to clarify the different concepts in guided surgery and their respective advantages, disadvantages and, more importantly, their limitations. The ongoing evolution and trends regarding these techniques are also described.

Introduction

Prosthetically driven implant surgery in reference to surrounding anatomical structures has been a subject of interest to dental clinicians for a number of years. Correct implant positioning has a number of advantages, such as a favorable esthetic and prosthetic outcome and the potential to ensure optimal occlusion and implant loading. Moreover, the consideration of correct implant positioning may enable design optimization of the final prostheses, allowing for optimized function and adequate dental hygiene. Consequently, all of these factors may contribute to the long-term success of dental implants. Also, various rules and requirements such as the distance between implants, distance of implants from adjacent teeth, implant depth and many more have made implant planning crucial when aiming for optimal treatment success.

The introduction of cone beam computed tomography (CBCT) scanning into implant dentistry as a three-dimensional (3D) imaging tool has led to a breakthrough in this field, particularly because these scanning devices result in lower radiation dosages than conventional computed tomography (CT) scanners (Loubele et al. 2009). In combination with implant planning software, the use of CBCT images has made it possible to plan the ideal implant position virtually, while taking into consideration the surrounding vital anatomical structures and future prosthetic requirements. The resulting planning information is then used to fabricate so-called drill guides, and this process ultimately results in the transfer of the planned implant position from the computer to the patient.

Intraoral scanning (IOS) has recently been adding considerable value to these novel concepts (Ioda et al. 2014). By superimposing CBCT and IOS images, a realistic digital view of the patient’s hard and soft tissue can be created. A digital set-up can also be added to this data set, preparing the future prosthetic restoration. Implant planning can then proceed, taking the hard and soft tissue situation and prosthetic requirements into consideration.

Yet, while technology improves as we speak, there are still some issues that must be taken into account when these techniques are applied (Tahmaseb et al. 2014).