Dental News - How do I improve guided surgery outcomes?

Dental Tribune USA

Wed. 23 September 2015

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Guided surgery for implant placement provides great benefits for clinicians but can also create complications. Because of this dichotomy, some dentists shy away from its use. As part of a webinar series for the Academy of Osseointegration (AO), Dr. Jaime Lozada presented the advantages and disadvantages of guided surgery. He also shared how to minimize some of the common complications associated it.

The webinar was titled “Guided Surgery: Heaven or Hell?” — but Lozada explained that it’s actually neither of those.

“It truly is a down-to-earth tool that we use in implant dentistry,” he said, emphasizing that guides do not replace insufficient level of training. “We need to use adequate clinical judgment and be well trained with our surgical and prosthodontics skills to execute some of these procedures.”

The AO chose Lozada to present on the topic as he is instrumental in the training of residents and fellows in the latest techniques of oral implant surgery and prosthodontics. He is a professor at Loma Linda School of Dentistry, as well as the director of graduate programs, restorative dentistry and oral implant dentistry there.

Guided surgery has a 16-year history, which yielded significant literature in the process. Lozada presented the consensus on the advantages and disadvantages of the treatment procedure, including:

Advantages of guided surgery (Heaven):

Reduction of surgical errors
Accurate implant placement
Less invasive and less pain for patients
Improved treatment time efficiency
Simplified prosthodontics rehabilitation

Disadvantages of guided surgery (Hell):

Increased treatment time preparation
Increased surgical errors
Some inaccuracies during implant placement
Increased cost
Not easier than conventional implant placement

Lozada also discussed the conclusions of a systematic review of the literature on guided surgery. The conclusions revealed there is no difference to implant survival rate between conventional and guided implant treatments. The systematic review also showed guided surgery cannot be considered easier than conventional surgery and there were some common complications.

“If we are able to deliver a very strong provisional rate, now we are going to minimize the very high complication rate that has been described in the literature,” he said.

Lozada recommended the following considerations to minimize the disadvantages or the “Hell” side of guided surgery.

Consider minor soft tissues reflection to minimize the damage and improve the bone support around the dental implant
Correct within the guide as needed if you feel the implant isn’t going in the right position (most of the newer guides allow for this type of correction)
Use preprocessed acrylic monoblock for digital dentures to minimize the complications
Avoid definitive restorations at placement
Ensure the provisional restorations provide soft-tissue support

Lozada emphasized that the treatment has merit and in the right hands it can be a great solution for today’s clinicians placing implants for their patients.

Members of the AO can download the webinar for free. Simply use your member login to the AO website and select the webinar to download to your device. Non-members may access it for a $50 fee. AO is an ADA CERP Recognized Provider and designates the completion of this webinar activity for one-hour continuing education credit.

(Source: Academy of Osseointegration)

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