Dentaltown August 2018 - 100

Advanced Full-Arch
Implant Surgery
Non-guided vs. guided: A retrospective study

by Daniel Domingue, DDS
and Cory Glenn, DDS
Dr. Daniel Domingue was born and
raised in Lafayette, Louisiana, and
received his bachelor's degree from
Louisiana State University in Baton
Rouge, followed by his DDS degree
from the LSU School of Dentistry
in New Orleans. While spending
three years in advanced training
at Brookdale University Hospital
and Medical Center in New York
City, he served as chief resident of the dental and oral surgery
department. His training included one year in advanced general
dentistry and two years in dental implantology.
The recipient of numerous awards and honors, Domingue was
awarded the Certificate of Achievement from the American
Academy of Implant Dentistry and a fellowship from the
International Congress of Oral Implantologists and received an
associate fellowship from the American Academy of Implant
Dentistry. He was also awarded Diplomate from the American
Board of Oral Implantology, the highest award possible for a
general dentist practicing implantology. In addition, Domingue
is a member of the American Dental Association, the Acadiana
District Dental Association and the American Academy of
General Dentistry.
Dr. Cory Glenn attended dental
school at the University of
Tennessee Health Science Center.
After graduation in 2008, he
went on to do an additional
Advanced Education in General
Dentistry residency with a focus
on comprehensive care and dental
implants. He lectures frequently
across the world on the topics of
CAD/CAM, cone beam technology and guided dental implants,
dental photography, digital smile design, complete dentures
and complex full-mouth rehabilitation.

100

AUGUST 2018 // dentaltown.com

Abstract
Digital technology has advanced to provide lower cost of entry and faster results,
making 3D-printed surgical guides a more reasonable option for practitioners.
Historically, the high cost and the complexity of planning kept many from utilizing
this technology. Now, with the development of affordable 3D printers and free
software such as Blue Sky Plan and Meshmixer, clinicians can now perform the
planning and fabrication entirely in-house in a time-efficient manner. However,
the surgical results can be no more accurate than the merging of the various data
sets, so it is incredibly important to properly acquire, merge and 3D print the data.
We will compare two cases and provide examples of which method would be
the best overall therapy in a private practice model. It is well known in the literature
that guided surgery is more predictable than non-guided/"free-handed" surgery.1
It's also well studied that pilot drill-guided surgery is within the same standard
deviation range as compared to fully-guided surgery.2,3 In essence, if you are using
a surgical guide, either fully or partially guided, it is more accurate for implant
placement than not using one at all.
Literature also states that using surgical guides shows comparable long-term
success rates compared to not using guides4 for implant placement. A more accurate,
inexpensive, easy-to-use, surgical guide for bone reduction and implant placement
is not only better for the patient, but also for the practitioner, and should be more
routinely utilized.

Purpose
Surgical guide fabrication takes extra effort in the planning phase by adding
costs (significantly lower than previously) and time to get trained and work up each
case as compared to free-handing implant placement.
While this topic remains hotly debated, it has been our experience after
performing many cases in a free-hand and guided approach that the time invested
on the front end in planning makes the surgery far easier and more predictable.
In this article we'll show a simple comparison of two similar cases for mandibular
implant placement performed by the same surgeon and treatment-planned for the
same restorative phase. The one key difference was the obvious use of a surgical
guide to reduce bone and direct implant placement. The comparable retrospective
study draws a conclusion to warrant guides for all similar cases and less invasive
procedures.
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Table of Contents for the Digital Edition of Dentaltown August 2018
