Reports have recently been made about a number of guided surgery systems in implant dentistry with details of their respective modes of surgery and with details of clinical applications. Such systems, computer-assisted with CT data for simulated implant placement, are now in a great deal of public attention because they seem to guarantee benefits to both the surgeon and the patient. They offer the surgeon a safer and securer treatment mode, and the patient is to benefit from a physically less onerous, that is, less invasive treatment.
Given a typical surgical guide, the surgeon can now perform a three-dimensionally accurate drilling in terms of the placement site, angle and depth of an implant. And that is made possible because the surgeon can gain access to the appropriate surgical field during the operation. There even exist guides with which placement of an implant itself is minutely controlled. And under an optimal set of conditions, it is even possible to manufacture a temporary prosthesis for immediate loading. We are presently at the stage where a precisely preplanned ultimate prosthesis is in the surgeon’s mind before he/she proceeds to actual surgery. This type of prosthesis-guided surgery will surely enhance the degree of biodynamic, and esthetic, compatibility of the end product, rendering a prognosis more accurate. And that will eventually lead to a longer-lasting reliability of the treatment.
There are also reported cases of incompatibility between a manufactured guide and what was actually found in the oral cavity at surgery, warped or damaged guides, and troubles that arose out of human error due to a lack of thorough understanding of the system on the surgeon’s part, or to his/her mishandling of the guide. What is required to minimize such cases is establishment of a safer and securer guide-dependent mode of surgery, easier availability of information on the guide products and the surgical modes assumed for them, and setting of guidelines. Even when the above requirements are satisfied, not all patients will receive ‘humanly’ infallible treatment unless all members on the team working with a guided surgery system, the guide’s manufacturer included, share common objectives and detailed information prior to surgery.
To make implant dentistry fail-safe, as it were, I would propose introduction of a surgical navigator that the surgeon can always refer to, and its monitoring should be done by the entire team.
At this session, I shall first give an overview of noted characteristics of the guided surgery as a whole, followed by ways of its application and cases of indication. I shall then briefly discuss some of the issues still to be resolved. And, while introducing some of the cases that I have encountered in my own practice, I would like to offer you a few tricks of the trade and things to bear in mind as an implant surgeon.