Guided surgery in dentistry is becoming a stronger branch in the field of implantology as it is an increasingly frequently applied practice. In this article we will analyze the concerns and the most frequently asked questions of those who approach this type of implant surgery.
Before entering into the merits of guided surgery, it is worth anticipating, thanks to a market research organized by B&B Dental through Key-stone, two thirds of the clinics involved in the research declare that they use guided surgery. The average of the total surgeries is 9% of cases. One third of the users carry out the complete case from planning to implant placement, one third refer to the production of the provisional before the surgery, and the rest for planning with traditional surgery only.
It is important to underline that any technique or new approach that you decide to include in your dental practice requires a learning curve both at a clinical level and as an organization of work with the whole team (assistants, laboratory technicians and suppliers). A level of organization and identification of the ideal patients for this surgery the clinical measures are the same as for general analog surgery; there will therefore be the need to evaluate the volumes and typology of bone and soft tissues, but with guided surgery in the case of partially edentulous patients, the possibility of inserting the bushing between the remaining teeth will also have to be evaluated.
But what are the difficulties that are generally reported by doctors who decide not to adopt this technique?
According to the research carried out by Key-stone on a sample of Italian clinics questioned on guided surgery, the most common objections are:
- excessive costs compared to the possible benefits
- little aptitude for the use of digital systems
- lack of system accuracy
- lack of support from the implant house.
It is also very interesting to analyze the main resistances and it is important to distinguish between subjective resistances that are personal beliefs that are difficult to refute, from the objective ones that are refuted by different scientific articles.
The costs that are attributed to guided surgery concern all the additional steps and times that are usually not foreseen in a manual approach, guided surgery requires more time that intervenes between the patient’s decision to undergo the treatment and when the treatment can take place. During this period, all the clinical data will be recorded, analyzed, studied and digitalized so to design and print the surgical guide, which is the device that allows the management of the surgery. This time will be effectively optimized in terms of both time and costs, in multi-implant cases but in cases with a smaller number of implants the total time between preparation and insertion of the implant can be even longer.
This trend, however, must also be measured by giving weight to less tangible factors directly in the office: certainly, the patient who undergoes a guided surgery procedure will have less pain in the post-operative period and the operating times themselves will be significantly shorter. The ease with which immediate loading can be planned in the same surgical session has to be considered. The comfort in general of the clinician who can focus on the patient’s well-being and on the correct management of the surgery will be perceived by the patient as attention and care towards them. These factors add up and become an excellent word of mouth topic among patients who will report a generally more relaxed and innovative experience, especially if associated with a digital impression. It is from here in fact that with few cases the balance of costs will begin to tilt in favor of the dental practice.
The other step of difficulty is represented by learning a new method. Many clinicians may not have the aptitude for digital or experience difficulties in introducing new technologies because they do not find the support of implant houses. B&B Dental provides multiple support to this topic;
– offering intensive theoretical and practical training courses, to lead the clinician to autonomously manage the initially simpler cases up to the more articulated and complex ones,
– offering an internal service for planning and printing templates through its own laboratory within which there is a team of expert technicians and dentists
– through electronic support during the management of individual cases.
– Through a wide spread web of dealers and partners who are available for training and support.
B&B Dental has also created a kit that has been defined as the most complete kit ever in terms of clinical applications and instrument ergonomics and which offers different variants for the use of different clinical habits of the practitioner.
Here are some of the many advantages of B&B Dental Guided surgery kit:
Easy to use – implant dimensions (diameter and length) have their specific drills, each drill is rationally arranged into the kit, to ease the surgery and to reduce the possibility of mistakes when placing the implant.
Two sleeves with a bayonet fitting converter – precise and adjustable to drills.
All applications are practicable – compactors are included so that our kit can be used to compact low density bone and during sinus lift procedures. Countersink drills are also included in the kit, to be used in cases with harder bone.
Manual or mechanical mode – each instrument can be used with a surgical contra-angle handpiece or with manual support, according to instructions or preferences.
Minimal invasiveness, maximum stability – thanks to crestal and lateral fix pins, included in the kit, anchorage of the surgical guide can be done through the guide itself, without causing additional trauma to the tissue.
Easy removal of soft tissue – it is very simple to remove the minimum quantity of soft tissue around the implant placing position.
Easy to use in case of different gingival levels – it is possible to choose +2 and +4 mounters if a wider offset between implant and sleeve is required because of the higher gingival level.
Crestal levelling – quick and easy levelling of the implant plateau.
Implant location preparation, implant placing, sinus lift and prosthetic instruments – all in one kit.
The implant house approach has also pushed towards the creation of a free software signed by B&B Dental in order to offer the clinician a tool that can be easily managed by the implant house itself to keep up with the requests collected by their doctors
The B&B Dental GS software can be downloaded for free from the company’s website and allows the opening of DICOM files and directories of any type, the conversion of DICOM files into STL, the conversion of DICOM files into STL with manual or semi-automatic correction of the reconstructed surface, the creation of guides using double-scanning technology and the creation of files for printing the templates.
In closing, it is right to underline that although human skills and training can lead to an ever-greater precision of the operator, this is difficult to compare with the process in which the position of the implant is determined with Cartesian coordinates and by means of a device that guides the tools in a specific position.
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