Top 10 tips for guided surgery in implant dentistry

By Nick Fahey

Guided implant surgery offers significant advantages, including reduced invasiveness, fewer surgical steps and minimised post-treatment discomfort for patients. Nick Fahey shares his top 10 tips for mastering this technique.

With its increasing popularity among implant dentists, there is a growing need to focus on best practices that ensure precision, safety and optimal outcomes.

As more practitioners embrace this innovative approach, it’s essential to understand the intricacies that make guided surgery successful. For that reason, I wanted to share my 10 top tips to help practitioners enhance their surgical planning, improve patient experience, and achieve consistently excellent results.

1.Thorough preoperative planning. Invest time in detailed preoperative planning, using advanced imaging techniques like CBCT (cone beam computed tomography) to assess the patient’s anatomy and plan the exact placement of implants or other surgical interventions.

2. Choose the right guide. Selecting the appropriate surgical guide is important for successful outcomes. Consider the patient’s specific anatomy, such as bone density and soft tissue thickness, to ensure the guide is customised and fits securely. Assess whether a tooth-supported, mucosa-supported, or bone-supported guide best suits the case. A well-fitting guide maintains stability and precision, reducing the risk of complications, so prioritise quality and make necessary adjustments to optimise performance.

3. Accurate data acquisition. Ensure that all data, such as digital impressions and scans, are accurate and up-to-date. Even small errors in data can lead to significant complications during surgery. Remember: rubbish in will mean rubbish out.

4. Verify guide stability. It is best practice to confirm that the guide is stable and secure before surgery. Any movement during the procedure can lead to deviations from the planned surgical path. Sometimes, this is impossible, for example, in cases where teeth need to be extracted for immediate placement. In these situations, have the necessary equipment ready in case you need to adjust the guide interoperatively.

5. Practice with the guide. Conduct a trial run with the surgical guide outside the patient’s mouth to familiarise yourself with the guide’s design, fit, and any potential issues that may arise during the actual procedure. Then place the guide in the mouth and make sure the armamentarium that you have for guided surgery fits accordingly.

Keep the patient informed about the guided surgery process, including its benefits and any potential risks. A well-informed patient is more likely to be cooperative and calm during the procedure. Be mindful of potential deviations during drilling or placement. Use the surgical guide to control depth, angulation, and position to avoid errors.

6. Minimise deviations. Be mindful of potential deviations during drilling or placement. Use the surgical guide to control depth, angulation, and position to avoid errors. If you use too much force or create stresses in the surgical guide whilst drilling, the guide will flex and bend, resulting in the osteotomy being transported from its intended location. In extreme cases, the surgical guide may even fracture or break.

7. Sterilisation protocols. Strict sterilisation protocols are crucial to prevent infections. Ensure the surgical guide and all instruments are properly sterilised, following the manufacturer’s guidelines and best practices. And always check specific material requirements.

8. Intraoperative imaging. Use intraoperative imaging techniques, such as real-time radiography, to confirm that the surgery is proceeding according to plan and to make any necessary adjustments.

9. Patient communication. Keep the patient informed about the guided surgery process, including its benefits and any potential risks. A well-informed patient is more likely to be cooperative and calm during the procedure.

10. Postoperative care. After surgery, ensure proper postoperative care and follow-up. Verify that the surgical outcomes align with the preoperative plan and address any complications promptly.

For more details about Nick Fahey’s Level-Up In Guided Surgery course, please visit education.theimplanthub.com.