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nmdental.org
Dynamic Dental Implant Surgery
By Sean M. Healy, DDS—Oral and Maxillofacial Surgery Center of Santa Fe
D
ental implant placement techniques have greatly
improved over the last decade. The earliest and most
commonly used technique involves placing implants
free handed. Over the last decade, digital treatment planning
has revolutionized our ability to place implants more accu-
rately. The information from cone beam CTs and virtual treat-
ment software allows much more precise implant placement.
Most recently technology has evolved to allow live navigational
surgical placement of implants (X-Guide by X-Nav) or dynamic
guided dental implant surgery. This allows for the possibility
of even better precision and accuracy for implant placement.
Traditional free handed dental implant placement
is still the most commonly used form of implant surgery. It
is relatively accurate, less time consuming, and has a lower
overhead cost. Free handed placement involves either visual
hand placement or surgical templates with crown forms to
determine the implant’s position within the confines of a
tooth shape. Minimal pre-operative lab time is required on
these cases. The issues with free handed implant placement
are lack of apical control, lack of depth control and with
multiple implants, alignment or placing implants parallel to
one another are a concern.
Static guided surgery
(traditional guided surgery) involves
the fabrication of surgical guides with specialized implant kits
for more precise placement of dental implants. This greatly
improves accuracy and precision. Guides can be tooth borne
or tissue borne for stability. This allows for a stable drilling
platform for implant placement. Guided surgery is not perfect
however, issues with guides do develop. Guides can and do
break during surgery. Guide flexure is a problem for unsup-
ported distal extensions, leading to differences in treatment
planned vs final implant position (usually angled after surgery
due to flex of guide). Also, guides may not fit due to occlusal
changes over time (if cases are delayed or imperfections in the
impressions or scans). Mouth opening also plays a significant
role in guided implant surgery. The guide can add an addi-
tional 10mm of height to the overall vertical dimension of the
case. Guided surgery drills are also longer than traditional
drills. These additional lengths can make guided implant
surgery for posterior teeth much more difficult. Finally, cost
is an issue with surgical guides. With additional cost, do you
pass that on to the patient or absorb this with your overhead
of placing implants?
Dynamic guided surgery
involves live tracking of the
surgical drills/implants in 3-D space. X-Guide utilizes special
pattern recognition devices that sit on the implant hand piece
and the patient’s mouth. Cameras track the live position and
the implant is placed in a virtual fashion. The process for
implant placement can be done in the same day. A thermo-
plastic bit jig is fabricated for the patient’s contralateral side,
cone beam CT is taken, and virtual implant is planned on the
software. Once planned, live navigational surgery is performed.
These steps add an additional 15 to 20 minutes onto most
cases. The main advantages of live navigational surgery is the
ability to actively control the apex of the implant and control
depth of the implant. Also, no lab fabricated guide is needed.
It is easier to place posterior implants and use in patients
with limited openings because you can also use conventional
implant drill kits. The treatment plan can also be sent to a
dental lab (STL format) for fabrication of temporaries prior to
placement. I utilize this technology at this time for multiple
implant placements for bridges, immediate implant placement
after extractions and cases involving compromised ridges in
both horizontal and vertical aspects (allow for up-fracture of
sinus floors, lateral augmentation, etc). The main limitation is
lack of ability to use in edentulous arches at this time, however,
techniques are being developed to allow for this in the future.
Advancements in placing dental implants
continues
to grow rapidly. There are many techniques now that can
allow very accurate and precise placement of dental implants.
Currently, the cost of technology is the main limiting factor
in utilizing these advancements. In time, cost should drop to
allow them to be used in nearly every implant case.
X Guide typodont showing virtual drill guide (bulls eye)
and radiographic views during implant placement.