Dental Implant Placement Surgical Guide Choice and Usage During Training

Objectives: Implant fixtures are conventionally placed by using 2-dimensional (2D) radiographs and vacuum-formed surgical guides. These guides provide limited details on soft/hard tissue topography. Digital 3D technology using static computer-assisted guided surgery is recommended to overcome these limitations. The purpose of this study is to determine the preference and accuracy of different types of guides in a training center.
Methods: Implant placement surgeries conducted within an advanced training center were observed. Surgical guide type, anatomical location, implant dimensions, clinicians’ experience level and surgical details were recorded. In addition, each surgeon was interviewed during and after the surgery related to their experience with specific guide.
Results: Details from 46 surgeries (72 implants) were recorded. 34(74%) guides were conventional, prepared either without 3D imaging (CBCT) information [29(85%; Con)] or with CBCT [5(15%; Con+CBCT)]. Remaining 12(26%) guides were digitally prepared (CGT). All Con and Con+CBCT cases were for single edentulous sites (62%(21) maxilla; 41%(13) mandible), and all CGT cases were for multiple implants (67%(8) maxilla; 33%(4) mandible). Mean implant diameter and length were 4.2±0.1mm and 10.8±0.2; 4.2±0.2mm and 10.4±0.4mm; 4.4±0.1 and 10.4±0.2mm for Con, Con+CBCT and CGT, respectively (p>0.05). Clinicians for CGT group were 2^nd/3^rd year residents while Con and Con+CBCT guides were prepared by clinicians with varying experience levels. Guide was used as intended in 45%(13) Con, 80%(4) Con+CBCT, and 42%(5) CGT cases. Guide was not used at all in 14%(4) Con cases and had to be modified in 20%(1) Con+CBCT and 8%(1) CGT case. Misfit was common problem.
Conclusions:
Con is most commonly used for single implant placement in a training center. Independent of guide type, anatomical location and clinician experience, use of the guide for the entire procedure is often limited.