Guided implant surgery workflow in edentulous patients: A precise and rapid technique

Germana V. Camargos DDS, MS, PhD , Eder F. Rangel DDS , Keuler F. Rangel DDS , Asbel R. Machado
DDS, MS , Lúcio F.F. Damis DDS, MS, PhD , Luiz Carlos Gonçalves DDS, MS, PhD , Guilherme J.P.L. Oliveira
DDS, MS, PhD

Abstract
A new technique of guided implant surgery is presented. A conventional complete dentureis converted into both tomographic and surgical guides and later into an interim implantsupported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

Guided flapless surgery for implant placement in edentulous patients is still a challenge because of the high costs associated with this technique and the low accuracy of mucosasupported guides. Surgical guides have been produced by combining 3D computed tomography (CT) bony imaging with the planned prosthesis. However, any deviation caused by the CT scan, the image segmentation, and/or guide production can affect the accuracy of guided surgery.

Another critical point in guided implant surgery is the positioning and stabilization of the mucosa-supported surgical guide in exactly the same position as the CT guide. The resiliency of the mucosa can lead the surgical guide to be seated in a rotated position. Additionally, the mucosa might be swollen after local anesthesia administration, impairing the correct guide positioning. Any malpositioning of the guide results in inaccurate
positioning of all the implants.

As guided implant surgery is sensitive to cumulative errors, reducing the number of steps needed from imaging acquisition to guided implant placement should improve accuracy. This report describes a new technique of guided implant surgery for edentulous patients, which eliminates the need to obtain computer-aided surgical guides and ensures both CT
and surgical guides are located in exactly the same position. Furthermore, as the complete denture (CD) is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis, treatment time and costs can be reduced.

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➡️ Guided implant surgery workflow in edentulous patients: A precise and rapid technique