Introduction To Guided Implant Surgery

Introduction to Guided Implant Surgery
Table of Contents
1 What is Guided Implant Surgery?
2 The Pros and Cons of Guided Implant Surgery
3 Cone-beam CT
4 Implant planning software
5 Surgical Template
6 Guided Implant Surgery kit
7 Surgery
8 How Surgical Templates Work
Introduction to Guided Implant Surgery In2Guide™
1 What is Guided Implant Surgery?

Guided implant surgery is the process of planning the implant surgery on a computer using the patient’s
CT image. The conventional method of using the patient’s panoramic x-ray to plan implant surgery
cannot transfer the planning exactly as planned, however, guided implant surgery can transfer the plan
as exactly as the doctor plans on the computer.
To carry out the surgery exactly as the surgery plan, a custom surgical template and guided implant
surgery kit are needed.
The followings are needed for guided implant surgery.
Medical or Cone-beam CT
Implant planning software
Guided implant surgery drill kit
Custom surgical template
The general workflow for guided implant surgery is as shown below.
>> Figure 1.
Order
CT scan Treatment surgical Surgery Workflow of guided implant surgery
planning template
2 The Pros and Cons of Guided Implant Surgery

Guided implant surgery uses the patient’s CT data to diagnose the patient beforehand, can
mimic the surgery according to the surgery plan, and has the following advantages:
Surgery can be precise, safe, and predictable.

Surgery time is shorter.
Generally carried out as a flapless surgery and shorter recovery time for the patient.
Less invasion, blood, and pain for the patient.
Immediate loading is possible.
Bone grafts can be minimized.
The disadvantages of guided implant surgery are as follows:
Expensive CT machine is necessary.

When doing a flapless surgery, the patient’s bone situation cannot be assessed.
The surgery planning time takes longer.
The user must learn the planning software.
Any unexpected situations during surgery are hard to be dealt with.
Surgical kits and surgical templates must be purchased.
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3 Cone-beam CT
A Cone-beam CT is an x-ray machine capable of taking 3D images of the patient. Using a cone-beam
CT and software allows for accurate patient diagnosis, and more realistic visualization.
>> Figure 2.
Cone-beam CTs from various manufacturers
4 Implant planning software

Cone-beam CTs generate data in a special format, called a DICOM. Implant planning software uses
DICOM data and renders the data in 2D and 3D. Implant planning software provides various tools for
implant surgery planning, allowing the user to view important anatomical structures and plan implant
surgeries safely.
>> Figure 3.
Implant planning software screen
5 Surgical Template
A surgical template holds the surgical planning information made with implant planning software.
Generally, surgical templates are shaped like orthodontic splints and are designed to fit into the patient’s
oral cavity during surgery. Surgical templates have small metal objects called sleeves inserted in place
to guide the drilling and implant direction.
Surgical templates must be fabricated to snugly fit the oral cavity according to the surgical plan, and
many companies offer surgical template manufacturing services. Surgical template manufacture
companies usually provide implant planning software along with the surgical templates, fabricate and
send out the surgical template when the user sends in the planning data using the software.
>> Figure 4.
How a surgical template generally looks like. There are
6 sleeves for guiding the implant drilling and 2 sleeves
to place the anchor pins in place. An anchor pin allows
the surgical template to be fixed tightly in the patient’s
oral cavity.
>> Figure 5.
Image of surgical template fitted inside patient’s oral
cavity
6 Guided Implant Surgery kit

To use a surgical template for implant surgery, a special drill kit designed to be used with the surgical
templates must be used. The shape of a surgical template and implant specifications vary by manufac-
turer, resulting in differences in guided surgery kits. Therefore, it is essential to know which surgery kit is
used for the different surgical templates.
Table 1. Surgical Kit manufacturers of Guided Implant Surgery
Manufacturer Product
Cybermed In2Guide
TM
Nobel Biocare NobelGuide

TM
Biomet 3i Navigator
TM
Guided surgery kit Straumann Guided Surgery
Astra Facilitate
TM
Densplay ExpertEase
TM
Materialise SAFE SurgiGuide Kit
Cybermed In2Guide
TM
Planning software Nobel Biocare Procera
Materialise Simplant
Cybermed In2Guide
TM
Surgical template Nobel Biocare NobelGuide

TM
Materialise SurgiGuide
Surgery kits are usually comprised of the following components.
Table 1. Component manufacturers of Guided Implant Surgery
Component Description
Used to affix the surgical template inside the

patient’s oral cavity during surgery.
Anchor pin
The anchor pin is placed to fix the surgical
Anchor drill template in place after drilling a hole with the
anchor drill.
Used to remove the tissue for flapless implant

surgery.
Tissue punch
Guides the drill direction along with the

Sleeve. There are various drill guides that
Drill guide match the diameter of the drills used for
surgery.
The direction is guided by the drill guide, and

placed with a self-stopper so that the drilling
Drill only goes in as planned.
The anchor pin is placed to secure the surgical template into the patient’s oral cavity so that the template does
not get detached during surgery.
>> Figure 6.
The surgical template secured into place with the
anchor pin
Table 3. Surgical procedure of guided implant surgery
Prepare the surgical template

· Remove any unnecessary ridges using a bur.
· Disinfect the surgical template.
Secure the surgical template in place

· Secure the surgical template into place using the bite index.
· Drill with the anchor drill.
· Insert the anchor pin in place.
Remove the soft tissue

· Use the tissue punch to punch out the soft tissue.
· Remove the anchor pin and surgical template from the patient’s
oral cavity.
· Remove the soft tissue from the patient’s oral cavity.
· Place the surgical template and anchor pin back into
the patient’s oral cavity.
Table 3. Surgical procedure of guided implant surgery
Drilling
· Begin drilling with the 2.0mm drill and 2.0mm drill
guide placed into the sleeve.
· Switch to the 3.0mm drill guide and 3.0mm drill
and continue drilling.
Implant Fixture Installation

· Place the implant fixture onto a guided surgery
mount.
· Place the implant into the patient’s oral cavity.
· Remove the anchor pin and surgical template
after all the implant fixtures are installed.
Placing provisional restoration

· Place the provisional restoration that has been
prepared beforehand into the patient’s oral cavity.
· This process can be skipped if the procedure

does not include immediate loading.
8 How Surgical Templates Work

It was explained above that if implant planning software is used to plan the placement of an implant
fixture, a surgical template must be fabricated. Here it is explained how the drilling angle and depth is
reflected on the surgical template.
>> Figure 7.
The location of the sleeve is determined by the implant
and drill used. Here the sleeve is placed in accordance
with a 0.5mm implant and 21mm drill.
The left image in Figure 7 shows an image of an 11.5mm implant fixture placed on tooth #36 by using
implant planning software. If the user uses a 21mm drill, the sleeve is placed 8.5mm above the bone
level of the implant planned. The remaining 1mm is the thickness of the drill guide, resulting in an ac-
curate depth drilling of the implant length.

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Introduction to Guided Implant Surgery

1 What is Guided Implant Surgery?

The followings are needed for guided implant surgery.

The general workflow for guided implant surgery is as shown below.

2 The Pros and Cons of Guided Implant Surgery

Surgery can be precise, safe, and predictable.

The disadvantages of guided implant surgery are as follows:

Expensive CT machine is necessary.

Cone-beam CTs from various manufacturers

4 Implant planning software

Implant planning software screen

6 Guided Implant Surgery kit

Table 1. Surgical Kit manufacturers of Guided Implant Surgery

Nobel Biocare NobelGuide

Guided surgery kit Straumann Guided Surgery

Materialise SAFE SurgiGuide Kit

Planning software Nobel Biocare Procera

Surgical template Nobel Biocare NobelGuide

Surgery kits are usually comprised of the following components.

Table 1. Component manufacturers of Guided Implant Surgery

Used to affix the surgical template inside the

Used to remove the tissue for flapless implant

Guides the drill direction along with the

The direction is guided by the drill guide, and

Table 3. Surgical procedure of guided implant surgery

Prepare the surgical template

Secure the surgical template in place

Remove the soft tissue

Table 3. Surgical procedure of guided implant surgery

Implant Fixture Installation

Placing provisional restoration

· This process can be skipped if the procedure

8 How Surgical Templates Work

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