Page 54 - DP Vol 20 No 3

Implant dentIstry sectIon

GUIDED IMPLANT SURGERY AND

PROSTHESES DELIVERY WITH STACKABLE

TEMPLATES IN FULL DIGITAL WORKFLOW

Guided surgery techniques in implantology have been available for many years.
Despite this, their adoption has been limited, and the percentage of implants inserted
using guided surgery procedures remains limited.

Carlo E. Poggio, Mario Zangarini

In clinical conditions such as completely edentulous arches or
partially edentulous areas where teeth cannot be used for prosthetic
purposes, guided surgery offers theoretical advantages. These include
the ability to design implant positioning three-dimensionally and to
create prosthetic structures in coordination with implant placement.
However, these advantages have often been overshadowed by practical
limitations in the eyes of many clinicians.
The resin templates typically used in guided surgery can create
problematic dimensions due to their bulk, limiting surgical accessibility
to the implant sites. This restriction makes guided surgery primarily
feasible in cases with abundant keratinized tissue and favourable bone
conditions—situations where a “flapless” approach is viable. Ironically,
these straightforward cases are also manageable with conventional
techniques.
Conversely, more complex clinical scenarios—such as those with
limited bone volumes, scarce keratinized tissue, and the need for
additional surgical procedures like extractions, flap repositioning,
and bone defect filling—pose significant challenges for the guided
approach. The margin of error in implant positioning with guided
surgery, combined with the difficulties of managing traditional
closed resin templates, often complicates treatment in these non-
ideal clinical situations. Thus, guided surgery has paradoxically been
more applicable in simpler cases, where its benefits are less critical,
and less achievable in more complex situations, where it could be most
beneficial.
In addition to these limitations, the higher costs associated with the
procedure (including software, jig production, and dedicated bur kits)
necessitate further evaluation of clinical convenience. For the higher
cost of guided surgery to be justified, it must offer tangible advantages.
In recent years, various methods have been developed to overcome
these limitations. Fig 1: Stackable guides (“P cube” Oxy Digital Solutions).
The development of advanced digital techniques has led to the
creation of stackable guides with excellent accessibility to the surgical better management of hard and soft peri-implant tissues, and precise
field and exceptional rigidity. These guides are fully coordinated with placement of the prosthetic structure in accordance with the initial
the positioning of prosthetic structures, significantly improving the project.
precision of prosthetic transfer.
These stackable guides feature modularity, rigidity, and accessibility, CLINICAL CASE
which justify the additional costs due to the management advantages A 75-year-old female patient with a partially removable lower
they offer. These advantages include improved implant positioning, prosthesis, made about 30 years earlier and supported by dental

52 Dental Practice I May-June 2024 I Vol 20 No 3