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Benefits of Guided Surgery

By: Dr. Leo Malin

When it comes to the precise placement of dental implants, there are four components that make a solid foundation in a precise placement protocol.

  • A volumetric CT dataset
  • A comprehensive treatment plan generated by an experienced clinician
  • A treatment planning software system that utilizes the CT dataset
  • A surgical stent that translates the treatment plan into a controlled surgical event

When an experienced clinician starts to formulate a comprehensive treatment plan, accurate implant site(s) information is needed to help guide that plan. We can physically evaluate the implant site or sites by looking (to evaluate soft tissue issues and make preliminary inferences about the hard tissue), we can take PA’s or other portrait type x‐rays to look inside the bone and tissue, and we can use our experience and knowledge of anatomy to guide our plan. All of these components help with the initial evaluation, but there is no substitute for a volumetric CT dataset to completely evaluate the implant site(s) in all three dimensions. With a CT we can achieve exact measurements of the entire implant site(s). There is no distortion. Anything less than a CT and there is an unknown component in the evaluation.

Once we understand the implant environment, an experienced clinician can begin to formulate a “comprehensive” treatment plan. Knowing why there are missing teeth may be just as important as knowing where to place the implant(s). If a tooth or teeth are missing due to trauma, just replacing those missing teeth in the same occlusal scheme with proper angulations and size will probably provide long‐term clinical success. If the teeth are missing because of a poor occlusal scheme, just replacing those teeth in the same position will probably not provide long‐term clinical success. Experience and judgment are critical components of an effective treatment plan.

The third critical foundational aspect relative to effective implant placement is treatment planning software. This is the vehicle that allows the clinician to exactly place the implants(s) according to his/her comprehensive plan. The length, width and angle of the proposed implant can all be measured exactly to achieve an optimal placement. This optimal placement of the implant(s) incorporates final occlusion, non‐stressing cortical plates, avoidance of nerves and vascular supply, non‐angled abutments, soft tissue management and overall positive esthetic results. All of these factors must be incorporated into the implant plan. Virtual treatment planning software facilitates bringing all these treatment components into the final comprehensive plan.

The last critical foundational aspect of an effective implant placement is the surgical guide that allows the clinician to exactly place the implant(s) according to the dental plan developed above. Without the surgical guide, any plan formulated cannot be exactly achieved. Judgment and experience, a CT dataset, and virtual treatment planning software can be used to formulate the best plan for the patient, but unless you can take that plan into the surgical field with precision, all the plan shows is what’s possible, not what will be achieved. I personally believe that all surgical guides should be fully guided. That means that if the implant is to placed using a four drill sequence, all four drills should be guided.

All four components listed above make up an “Expert” system. If any of the components are not used in the implant placement process, there are bound to be compromises in that placement. Exactness can only be achieved by not guessing or making inferences about a plan. Exactness can only be achieved by knowing what’s possible, planning an outcome that’s exact, and placement that’s completely guided.

That truly is an “Expert” system.

Dr. Leo Malin graduated from Marquette University School of Dentistry in 1991. Early in his career he discovered that the implant techniques currently in use could not deliver a standard, predictable result. Therefore, with the help of other experts in the field of radiology and occlusion, Dr. Malin developed an implant technique which focuses on occlusion and cosmetics for implant placement and crown restoration. This technique has been so successful there several patents have been granted! In addition to a dental implant practice in La Crosse, Wisconsin, Dr. Malin is also the Implant Director at the prestigious Las Vegas Institute of Advanced Dental Studies. He lectures throughout North America on Full Mouth Reconstruction and Advanced Dental Implant placement and technique.

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