Nowadays modern surgical techniques are more and more moving towards simplified and minimally invasive protocols, aimed at offering patients more effective and highly predictable solutions with shorter treatment times. In addition, this approach makes treatments better tolerated, faster, with more comfortable postoperative courses and reduced costs.
Implant surgery also aligns with this general trend, and one of the brightest and most impressive examples is the Computer Assisted Surgery, more simply and perhaps improperly called Guided Surgery.
It is a protocol by now definitively validated by the international scientific literature, acclaimed as a method able to offer the expert surgeon an extremely effective tool to plan the setting of implants in the maxillary bones, taking into account not only the bone structure but also, very importantly, the final prosthetic project, a project that can be viewed in advance through special software, in relation to the bone structure.
This method can be effectively applied not only to the most complex cases of partial or total edentulism, or in highly reabsorbed patients, in which it becomes possible to insert implants with angles and positions otherwise unlikely if not impossible to achieve by hand, avoiding complex regenerative procedures, but also in the simplest cases of single-edentulism or small edentulism, which however present numerous pitfalls, especially from the aesthetic point of view, if performed without a Computer Assisted Planning. This method, which is also very useful in the diagnostic phase, is very versatile and allows planning reconstruction treatments, both with late and immediate loading, offering the possibility to create, in a simple and precise way, temporary prosthetic devices, thus giving back to the patient both aesthetics and functionality in a single appointment.
All this is perfectly integrated in the context of that process currently in full development in the dental world, which goes under the name of “Digital Revolution”.
Thanks to modern DICOM data acquisition techniques, intraoral scanning and CAD-CAM techniques, whose effectiveness is now undisputed, the Computer Assisted Surgery Protocol becomes an integral part of the Digital Flow in our studies.
Computer Assisted Surgery to date does not have the diffusion and success it deserves, especially because of the scepticism that still arouses in many, as it is considered an inaccurate method.
This is despite the fact that the literature has now established that an implant inserted with such a protocol certainly has a significantly higher degree of precision than an implant inserted free-hand. This applies both to the mesio-distal and vestibulo-lingual/palatal position and to the apico-coronal position and angle (parallax error). I find the comparison with instrument flight in case of reduced visibility, where pilots are trained to “trust” the on-board computer, having verified that their senses can deceive them. Even the oral surgeon must learn to trust what is planned with the design software, if all the various steps have been performed scrupulously. This method has undoubted advantages for both the surgeon and the patient, advantages that we have already mentioned. Moreover, to date, management costs have been greatly reduced to the point of becoming almost insignificant.
It should be stressed, however, that this is still an advanced implantology and as such must be carried out by very experienced surgeons, who are able, where necessary, to deal with possible, although rare, unforeseen events and who are therefore able to switch to a traditional approach during the surgery, for example by sculpting and lifting a flap. The guide used in this case is a mucosa-supported guide, which has made it possible to exploit one of the potentials of this type of approach, namely to perform flapless surgery. This ensures maximum respect for the soft tissues, optimal healing of the same and a remarkable post-surgery comfort for the patient, almost painless and oedema-free. However, the versatility of the method allows, where there are indications for it, the use of various other types of surgical guides, such as dental or bone-supported guides, in which case the incision and the detachment of a flap become fundamental, or more complex guides, such as modular guides, which allow for example the execution of guided osteotomies. An encouraging fact that comes from the literature tells us that the use of computer-assisted flapless surgery in total edentulousness, has shown in 5 years results similar to conventional implantological treatments but with deferred load. It is to be hoped that in the light of these and many other data in the literature, this method can increasingly find the spread it deserves.
1. Terapia Implantare, Il Piano di trattamento Integrato, M. Merli
2. Manuale di Implanto – Protesi Computer Assistita, F. Maltese, R. Scaringi, A. Sisti
3. Valutazione in Vitro dell’accuratezza del Sistema di Chirurgia Guidata Omplantare ModelGuide Implant 3D, R. Guarneri, F. Turchini, A. Ceccherini. Implantologia 2014; 1: 11-22
4. Presurgical Planning with CT-derived fabrication of surgical guides, SD Ganz – Journal of Oral and Maxillofacialsurgery 2001 – Elsevier
5. Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant palcement procedures: A cohort study og consecutive patients, Anna M. Sanna DDS, Liene Molly, DDS PhD, and Daniel van SteenbergheMD PhD