Image Guidance in Implant Dentistry
Image guidance is defined as the general technique of using preoperative diagnostic imaging with computer-based planning tools to facilitate surgical and restorative plans and procedures.1 Practical applications of this technology permit clinicians to analyze CBCT or CT images and then plan the surgical procedures by placing virtual implants onto the patient’s scan. Typically, the systems have features that allow the clinician to then transfer the surgical plan from the computer screen to the patient’s mouth using either a custom surgical guide or a computer-based navigation system.2
Image-guided technologies can be divided into two general categories. Currently, the most popular leads to fabrication of a surgical template. Many companies provide the software and guide the manufacturing service for this technology. These guides may be tooth-supported, soft-tissue–supported or bone-supported. They are designed to position implant drills into planned locations using a combination of graduated-diameter sleeves and inserts with matched length drills to accurately locate planned osteotomies.
The other option for implant guidance is surgical navigation. Currently, commercial options are limited but development is underway by many groups. Surgical navigation differs from templates because the surgeon can virtually view the drill in real time while preparing the implant osteotomy. Surgical guides are not needed with navigation systems.
Image-guidance systems are generally considered accurate, although large deviations in depth or position have been reported.2 In cases with adequate bone and gingiva, transmucosal (flapless) procedures can be accurately performed.
The advantage of image guidance is that the systems facilitate thorough preoperative diagnosis and deliberate implant positioning. The process often stimulates enhanced collaboration and communication between the surgeon, restorative dentist, and laboratory technician. The benefits for patients are reported to be less surgical trauma with reduced risk to vital structures and better implant positioning due to more accurate implant placement. Image-guidance systems are not substitutes for meticulous surgical skill or comprehensive training, but are valuable adjuncts in delivering predictable implant dentistry.
New advancements in the software programs make using image guidance more intuitive, with a simplified workflow that allows patients to be diagnosed and treated more effectively. As we have seen the growth and use of CBCT in routine dental practice, patients are becoming more familiar with guided surgery. The most demanding and educated may have increased expectations and occasionally even demand these types of treatments from their clinicians.
Moving forward, it is clear that technology applications will only increase as a daily part of clinical practice. In implant dentistry, this technology may be used for diagnosis and case planning. Additionally, these tools should be seen as educational platforms for referrals, study clubs, professional staff, and patients to increase case acceptance. By incorporating image guidance routinely within a practice, clinicians will demonstrate that they are up-to-date with advancements in technology and able to provide the most current and predictable treatment options to their patients.
1. Laney WR, ed. Glossary of Oral and Maxillofacial Implants. Quintessence Publishing; Berlin: 2007.
2. Jung RE, Schneider D, Ganeles J, et al. Computer technology applications in surgical implant dentistry: A systematic review. Int J Oral Maxillofac Implants. 2009;24(suppl):92-109.
About the Authors
Louis F. Rose, DDS, MD
Jeffrey Ganeles, DMD