The implantology debate that remains open has always been: Do I start using surgical guides or are freehand surgeries enough?
The answer to that question is both individual and multi-factorial. To better understand the decision-making process in this topic, you need to first understand the limitations and requirements of each path. You would need to evaluate your skills in various aspects of the implant placement process to be able to make the right call.
The use of surgical guides and pre-planned surgeries is, undoubtedly, the most time-saving technique. However, to be able to master it, there are certain limitations.
First and most importantly, having access to a cone beam machine is the first step. Whether you have your own or can send your patient to a nearby scanning center for it, achieving a good CBCT is a crucial first step for pre-planned surgeries. The only thing more critical than obtaining a good CBCT is knowing how to accurately interpret one. You would need a lot of CE to be able to accurately read a CBCT scan properly. An easier option would be to send it to radiology experts online who can interpret it for you and discuss any concerns that may be seen on the radiograph.
A good intraoral impression (whether virtual or traditional) is the second critical step in pre-planned surgeries since the surgical guide can never be more accurate than the cast or the model itself.
Digitally planning the implant placement procedure can then be done either by the dentist or online by sending the scans to companies that offer treatment planning services. After that, the procedure is quick and smooth.
If all the previous steps were done accurately, the implant-placement procedure is foolproof. It can eliminate all the guesswork from your cases and offer optimum treatment for the patient.
The downside for pre-planned surgeries is the time elapsed during communication with the labs and treatment planning providers which can be overcome by choosing a provider with quick turn-around time, preferably one that can do the lab communication for you as well. 360imaging is one of the companies that deliver treatment plans in less than 4 hours and delivers the surgical guide to you along with the PMMA.
Moving on to freehand implant placement, it is no doubt the oldest technique. Before the introduction of CBCT and digital planning, all implants were placed by freehand. This eliminated the time needed for lab communication.
However, the surgery itself took much longer in order to precisely place the implant without jeopardizing any of the vital structures while in case of multiple implants, it was much harder to parallel the implants together.
The clinician was expected to make critical decisions based only on the cast and the traditional radiography techniques which made the precision of placement a bit doubtful. This, in turn, has affected the predictability of freehand implants greatly and the whole procedure depended on the surgical skills and experience of the operator, which can sometimes be inaccurate due to individual variation between patient’s anatomical landmarks.
In conclusion, each of the techniques has its own pros and cons. However, in a world where digital approaches are taking over, there’s no doubt that following a pre-planned surgical protocol, especially in cases of multiple implants, is the safer of both options.