Dynamic Surgical Guidance to Facilitate Dental Implant Placement

The long-term success of dental implant surgery is dependent, in part, on accurate planning and placement of the implant.1 Currently, there are many digital planning systems available to aid the clinician in pre-operative treatment planning, although the main challenge with these planning systems is to accurately transfer the digital plan to the clinical situation. Most systems involve taking a cone beam computed tomography (CBCT) or other three-dimensional scan of the patient, and then digitally placing implants using a software program.

Traditionally, static surgical guides are used to relate the digital planned position of the implants to the clinical situation. However, there are several drawbacks to static surgical guides. Specically, the surgical guide cannot be modied intraoperatively to adapt to chairside decisions that result in changes to the clinical plan. Furthermore, static guides are typically designed over the surgical site, and so there is some impediment to the visualization of the surgical field. Finally, the static guides have small but signicant distortions associated with them, resulting in an accuracy of implant placement that varies widely. Studies have reported wide ranges of deviations in implant placement relative to the planned position in both apico-coronal and angular dimensions for most commercially available systems.2-6 Inaccurate implant placement can result in short-term complications, such as damage to adjacent vital structures, as well as a long-term increase in implant failure.7-9.

A new technology to address these drawbacks is dynamic surgical guidance.10-12 Dynamic surgical guidance technology involves a computerized navigational system intended to provide assistance in both the planning (pre-operative) and the surgical (intra-operative) phases of dental implantation surgery. Dynamic surgical guidance provides two main modes of operation: preoperative case planning and intraoperative surgical treatment. In the preoperative phase, the system is first used to plan the dental procedure including the planned implant location within the CBCT image. During the planning phase, the clinician can select the implant system for each surgical site. Case planning can be done prior to the day of surgery, in which case the treatment plan can be saved into the case management database or, alternatively, the case can be planned immediately prior to surgery.