Why Guided When Freehand Is Easier, Quicker, and Less Costly?

Abstract

Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.

Relationship Between Implant Stability Measurements Obtained by Two Different Devices: A Systematic Review

“…After removing duplicated studies, 18 were selected from their title and abstract in accordance with inclusion and exclusion criteria 3,5,11,14,18‐31 . After complete reading, 11 studies were excluded for not fitting the inclusion criteria 11,18,21,23‐25,27‐31 . In addition, two of the selected studies 19 , 20 were conducted by the same authors, referring to the same groups of patients and implants, but one had a longer follow‐up (initial, 3 months, 1, and 5 years) 19 .…”

The Use of Orientation Templates and Free-Hand Implant Insertion in Artificial Mandibles—An Experimental Laboratory Examination in Fifth-Year Dental Students

“…The free-hand technique has been said to display adequate success rates but has shortcomings regarding prosthetic planning and handling of poor bone quality [ 2 ]. Regarding the determination of the implant position, there exists a widespread variety ranging from simply guiding the pilot drill, to full-guided preparation of the implant cavity and guided implant insertion [ 1 ].…”

“…Moreover, the use of implant guides may sometimes be limited due to reduced mouth opening [ 8 ]. Despite higher costs and increased time consumption when using drill guides, advantages were seen regarding an improved outcome and reproducible quality through using this method [ 2 ].…”

Guided implant surgery risks and their prevention

“…Use of guided implant surgery has several advantages, for both clinicians and patients. The most important advantage is the involvement of all dental care providers from the beginning, thus ensuring comprehensive diagnosis and treatment planning and better outcomes; the active collaboration of the maxillofacial radiologist, surgeon, restorative dentist, and technician results in predictable final outcomes and avoidance of problems that might otherwise require complicated and expensive surgical and prosthetic revisions or remain unsolved, thus precluding implant therapy for the patient …”