How printing my own surgical guide makes me a better implant surgeon
I have been doing guided surgery for about 4 years. Like most people, I started with Simplant. I still use Simplant a lot. It is perhaps the easiest and most user friendly program. However, Simplant is a proprietary implant treatment planning software which does not allow you to export an STL file of your designed surgical guides to be printed. I now only use Simplant in a case when I will not use a surgical guide. In that case, usually a single tooth implant or a few simple implants, I would do several measurements between the desired implant positions to the adjacent structures, e.g. natural teeth, maxillary sinuses, inferior alveolar canals, buccal and lingual alveolar bone plates. Using multiple measurements, we have found that our single tooth immediate implant placement can be very accurate, within 0.5-1 mm or less in all directions and about 2-5 degree angulation or less different between the placed implant position and the planned implant position. (Edelmann et al J Oral Implantol 2016)
While I can place implants in a reasonable position with conventional surgical guides and computer-aid placement (with measurements), I am not satisfied with the accuracy of the implant placement. As a prosthodontist, I want to maximize my implant placement accuracy by all the mean necessary without bankrupting my faculty practice or my poor patients. Recent development of cost-effective and high precision 3D printer such as Form 2 from Formlabs allows me to print my own implant surgical guide using an open-platform software such as 360 imaging or Blue Sky Bio. My former student and good friend, Dr. Daniel Whitley and I had found the way to print our own guides for implant surgery. In our hands, we improve our accuracy of immediate single implant placement to ~0.2 mm and ~2 degree deviation from the planned position. (Whitley & Bencharit 2015 Formlabs White Paper)
We are continuing to improve our digital workflow and learning more about implant planning and software associate with the process. I have found that by looking at the implant fixtures in silico, I become more aware of the implant positioning in relation to surrounding adjacent anatomical structures as well as the position of the definitive prosthesis. I enjoy making the virtual teeth during the implant planning to determine the relationship between the implant and the definitive prosthesis. Before we print out the guide, we have to position the surgical guide tube. I personally found that positioning the guide tube gives me an information of the screw access hole position, angulation of the implant in relation to bone and definitive prosthesis as well as the vertical position of the implant. The latter part is often neglected in the conventional (non-guided) implant placement. I hope to continue my journey through digital technology that is rapidly continuing to be improved. I foresee that just like cone-beam computed tomography (CBCT), guided surgery will in the near future become part of the routine implant therapy.
