- Hey everyone, how you doing?
In today's video lets look at Guided Surgery for Implants.
Okay so if you're thinking about having implant treatment,
what is guided surgery?
If you've done a bit of research on Google you may
have come across this term and it may confuse you.
It definitely confused me for a little while
when it first came out.
I'm gonna show you when it's usually a good idea
to have guided surgery and the pros, the cons,
why it's worth paying a little bit more
in the right situations for having guided surgery
and why every single dentist in the world
does not use guided surgery.
So lets first of all look at a typical situation okay,
it's not All-on-4, it's just a single tooth implant.
Here this lady came to see me a little while ago,
this tooth in the front has an ongoing problem.
Its got recurrent infections,
its actually got cracked down the middle of the tooth
and there is no treatment that we can do
which will definitely get rid of this ongoing infection
so we have to remove this tooth
and we have to look at then replacing the tooth
with something.
We could look at bridges or implants or dentures.
These are all good tooth replacements
but after going through all the options she wanted something
as close to her natural tooth without adjusting her other
teeth so we decided to go with a dental implant.
Now it's at the bottom,
it's at the front.
These are the four smallest teeth in the mouth
which means when you take it out you don't have a lot
of space to play with.
You see the teeth either side have long thin roots
and quite often the roots aren't perfectly parallel,
they kinda taper in a little bit
and lets say for arguments sake we've got
a five millimeter space okay and this is about typical
so we've got five millimeters from root to root
and the thinnest implant that I've got is 2.8 millimeters
so to keep the maths simple lets call it three millimeters
and for argument sake this is pretty realistic.
You know we want a millimeter of bone all the way
around this implant.
So suddenly this five millimeters of space that we've got
we need a millimeter of space on either side
so that's two millimeters taken up
and then we've got the three millimeters
of the implant thickness.
That's our full five millimeters taken up.
What this means is there is absolutely zero room
for error okay.
It's a lower jaw as well so when the dentist is trying
to make the hole the lower jaw moves
so you've got a moving target, you've got error of zero
that you can do.
I mean how many times if we was placing this implant
a 100 times on a 100 different days,
how many of those do you think would be pinpoint
perfect implant positions?
Okay I don't know I'm gonna guess at maybe somewhere
between 50 and 70 percent would be really good okay.
That means that 30 to 50 percent,
the implant position could be improved in some way
and it's very difficult to get everything right,
every single time without some additional help.
So that's where guided surgery comes in
so this is a surgical guide.
This is what it looks like and what it is,
if you imagine this pen is the drill
that we're going to use,
they surgical guide has a hole in it
which is the perfect size for this drill
and this drill's got little markers to tell us the depth
which means when the drill is placed,
the hole is in exactly the right position
and therefore our implant is going to be in exactly
the right position or so the theory goes.
You see I tried guided surgery about four or five years ago
and what I've found was that it wasn't as accurate
as it should have been.
Now before I tell you a little bit more about that
and the recent advances,
let me show you how this guide is made
because this is actually pretty interesting.
See lets say you were coming to see me
and we were thinking about having dental implants
and it was a good idea to have a surgical guide made.
The first thing I would get for any implant case
is a 3D scan.
We call it , it's a CT scan a cone being Dental CT scan
and this lets me navigate all around your bone
and I can see the thickness of the bone,
I can see the distance between the roots
and I can import that scan
into a specialist implant software
and I can virtually place the best implants.
These implants softwares have got a whole,
have got all the implants prebuilt into them
so I can virtually place
and decide what the best length of implant is,
what the best thickness of implant is
and the most ideal implant position
and this can all be done virtually just from a CT scan
but the CT scan isn't good enough
to make a guide on its own.
You see what we now need is a 3D model of your teeth
and I get this in a number of ways what,
first of all just with a standard dental impression,
a dental mold.
We can send this to the lab and get this scanned in to make
what we call an STL file which is a 3D model file
of your teeth.
At one of the practices where I work at,
we've got a pretty cool machine
and it's like a little camera on a stick
and it's a 3D scanner so we eliminate taking molds
in a lot of cases and we just do a 3D scan of your teeth
and this is pretty cool because this can just be emailed
to the guys who make the guide.
Then they will take the CT scan
where we've placed our implant
and they will take the STL file
and they'll merge them together
and from that information we can then 3D print
a little plastic guide which sits on top of your teeth
and has this little hole in it
and because it's sitting on teeth there's no movement
you see if the guide was sitting on gum you could move
it a little bit and that would introduce error
whereas if it's sitting on teeth
you can actually be very accurate
with the implant placement.
Now all the techy geeky stuff aside,
does it produce excellent results?
And I told you a minute ago that when I first used it,
it wasn't that accurate and the truth is
about four or five years ago when I first got into this,
the technology wasn't that accurate
and the reason is if you imagine there's a lot of steps
to actually making this guide.
You have to first have an accurate scan,
you have to have an accurate CT scan
and you have to have a system to merge
these two things perfectly together.
Now a small error earlier on in the first couple
of stages can then be amplified to a much larger error
later on at the time of surgery.
Meaning that there was literally no point in having
that guide made because you could have done
a better job free hand.
Now I actually stopped using guided surgery
after the first few attempts that I did
and it didn't you know work out as accurate as I wanted it
but I actually spoke with a friend of mine last year
and he introduced me into new system.
He said, hey look you know if we do it this way
we will working on reducing the error
and making excellent guides.
Do you want to give it a go?
And I was like okay if it's better for my patients,
if it reduces stress yeah you know I'm totally up for that.
So we then worked together and I did a couple of cases
and I was really really impressed at how accurate
and how things you know have advanced recently
so now days I will almost certainly for single tooth
implants or multiple teeth implants especially anything
at the front of the mouth,
I will use a guided system.
It's more accurate,
it means my patients get better results.
It does cost a little bit more to have the guide made
but I think it's just well worth it.
We don't make any money on the guide,
it's literally just something there to improve speed
and accuracy of dental implant treatment.
Now you might be thinking if this is such a great thing
why doesn't every implant dentist in the world use this
and the reason is multiple.
That one reason I've told you the reason I stopped is
because I tried it and it didn't work so well
and a lot of dentists will have tried it four,
five years ago
and it's not been that amazing
so they will stick with what they know
which is just to do it free hand
and that's fair enough because they are ultimately doing
what they believe is the best thing for their patients.
There might be another reason why some people don't
and that is the additional investment needed
to actually use guided surgery rather than stand-surgery.
You see for every implant system we use
we've got a set of drills.
This is called out surgical kit
and the surgical kit is pretty expensive you know,
in the UK, one, two, three thousand pounds you know
in that kind of ball park.
If you then want to move to guided you have to buy a new kit
and you have to buy a guided kit.
The guided kit costs typically one-and-a-half to two times
the cost of a standard kit
so you do have this additional cost
which the surgery will have to incur in order to get
on to guided but also there's the learning curve
and there's that whole trust factor in that is it as good
as everyone says it is.
So in my opinion that's not the best reason in the world
because you can borrow kits from company's
and if you think that it is as good as it is
then it's almost a no brainer to buy a surgical kit.
Now I don't use this and being as amazing as it is,
I don't use it for all cases.
Typically I will not use it for All-on-4 cases
and I don't use it for any case
where basically replacing a full set of teeth
on dental implants so implant dentures and things like that.
The reason is number one,
for really good accuracy you do need teeth there,
you need solid teeth so if your guide is siting on the gum,
it's a completely different ball game.
There are techniques and things to make that more accurate
but another reason is for All-on-4
you don't need to be as pinpoint accurate as you do
with a single tooth implant.
With All-on-4 there are a couple of guidelines
that you use and I do use guides
but not as accurate as the ones
that I'm describing here for that.
There are systems available for fully guided surgery
for All-on-4 but to be honest I would only consider
using those in very complex All-on-4 cases
and to be honest they don't come around that very often.
So I hope this video has helped to explain
what guided surgery is, why it's worth it
and when it is worth it.
If you've got any questions or comments,
you know you can always leave them below.
I will try to get back to anyone
and if you've got any questions,
if you think about having dental implant treatment,
you got questions things like that,
put them below and it might help inspire me
for my next video.
Okay until then, take care.