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Guided implant surgery

Also known as: Computer-aided implant surgery, Static guided surgery, Dynamic navigation, CAIS

Implant placement planned on three-dimensional imaging and transferred to surgery either by a manufactured surgical guide (static) or by real-time instrument tracking (dynamic).

Key facts

Clinical evidenceThe 6th ITI Consensus Conference (2018) reported mean three-dimensional deviations for static computer-aided implant surgery of 1.2 mm at the entry point (95% CL 1.04–1.44), 1.5 mm at the apex (95% CL 1.29–1.62) and 3.5 degrees of angular deviation (95% CL 3.00–3.96)Verified spec[1]
LimitationsThe same consensus recommends maintaining a safety margin of 2 mm from critical anatomical structures, and notes that its analysis rested on only 20 clinical studies of heterogeneous design — one randomised controlled trial, eleven uncontrolled prospective and eight uncontrolled retrospective case seriesVerified spec[1]
How it differsStatic guidance uses a guide made in advance, which fixes the drill path but cannot be altered during surgery. Dynamic navigation tracks the handpiece against the scan in real time and can be adjusted, at the cost of equipment, calibration and a learning curve. The two are often reported together as computer-aided implant surgery even though they behave differently in the mouth.
Main stagesA cone beam CT scan and a surface scan or impression; a plan made in software with the restoration in mind; manufacture of a guide or set-up of a navigation system; then placement through the guide or under navigation, in some cases without raising a flap.
Typical useMost often used where anatomy is tight, where several implants must be parallel to one another, or where a prosthesis has been made in advance and the implants must match it.

Overview

Guided surgery means the implant position is decided in software on a 3D scan before the operation, then reproduced in the mouth — either through a printed or milled guide that constrains the drill, or with navigation that tracks the handpiece live on screen. Its value is planning as much as precision: because the plan starts from where the tooth needs to be, it tends to catch conflicts with the nerve, the sinus or the neighbouring roots before anything is cut. The accuracy is good but not absolute, and the numbers deserve to be read plainly: pooled deviations of about 1.2 mm at the entry point, 1.5 mm at the tip and 3.5 degrees of angle, which is exactly why the same consensus advises keeping a 2 mm safety margin from important structures. Guided is therefore not a synonym for perfect placement, and the evidence base behind those figures is still modest — twenty heterogeneous studies with a single randomised trial among them.

This is general information. Whether any treatment suits you depends on clinical examination, including imaging — no website can determine that.

Sources

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Clinical evidence

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