Digitally Guided Implant Placement by Dr. Dee Dee Meevasin

Digitally Guided Implant Placement 

Benefits include lower failure rate, less chair time and increased opportunity for practice growth

by Dr. Dee Dee Meevasin

There are so many avenues to consider when thinking about how to invest in the future of your practice; from new technology and continuing education to employee retention and marketing practices, it’s often hard to know which choices to make. At my practice, we’ve found embracing advanced innovations not only improves the standard of care but also checks the boxes on almost everything else. New technology comes with continuing education, helps retain team members by giving them something new to learn and be responsible for, and is a great way to market what makes your practice different.

Adopting new industry technologies also comes with a number of operational benefits. One technology that really changed the way we operate is digitally guided dental implantology. Since implementing this into our practice, we’ve reduced patient handling times, increased productivity and minimized the risk of needing to repeat implant surgeries. (Our practice implemented the automated, end-to-end Primeprint 3D Printing System by Dentsply Sirona, specifically.)

Without this new technology, many GPs and specialists are placing dental implants freehand, leaving much to chance. Others have gone one step further by implementing a lab-made surgical guide, but their implant process can begin only once the surgical guide is received from the lab—which is often days or weeks later.

According to a recent review,1 comparisons for template-guided implant placements versus conventional freehand implant placements showed significantly more precise results in favor of the guided procedures, with implant failure rates almost three times higher in the freehand implant placement category.

Improving the standard of care
When you take the process in-house and gain control over the entire process, the results can be worth the time and effort. The Primeprint system allows us to scan, plan and print guides quickly in-office, which has had a number of positive effects that help manage our practice better. And with guided technology, the procedure is designed to avoid anatomy while placing implants in a minimally invasive manner, which can result in less tissue trauma, which in turn can mean decreased patient postoperative pain and swelling. It has raised the standard of care, which is always our top priority, but there are also a number of other benefits:
  • Ideal implant placement. Because the surgical guide maps out a plan for the placement based on the final restoration, it provides for a more accurate and ideal positioning of the implant.
  • Lower failure rates. The use of the surgical guide allows for accurate placement based on the plan, reducing human error and resulting in lower failure rates. According to studies,1 the frequency of implant failure in freehand surgery versus guided surgery was nearly three times higher—6.42% and 2.25%, respectively.
  • Less chair time. By reducing the number of appointments and the amount of chair time for a patient’s implant surgery from four to six to one or two visits, we are able to open up appointments for additional patients and treatments.
  • Lab delays are eliminated. The process eliminates unexpected lab delays and production issues that could take up to two weeks, which results in increased efficiency and significantly lower costs.

Increasing productivity

In addition to creating guides for implants, we can use the 3D printer for occlusal guards, models, temporaries, custom trays and, soon, partial dentures. The smart hardware and software solution runs the entire printing process including postprocessing, and is extremely user-friendly. This simplifies staff training, because the interface is a click-through, step-by-step process. There’s virtually no cleanup needed afterward, either, because it eliminates direct contact with resins so there’s no mess to deal with. After receiving the Primeprint at the beginning of Q3 in 2022, we completed more implants in that quarter than we did in all of Q1 and Q2 combined.

Using the new system has drastically simplified our daily workflow by reducing the number of appointments for each implant patient. Fewer patient visits, coupled with the ability to provide accurate results in a quicker manner, makes it worth the cost to invest in new technologies like this. By opening up our daily schedule to see additional patients and provide more treatment services, our practice can continue to grow. Our new patient average was 30% higher in Q3 than in Q1 and Q2 combined.

Digitally Guided Implant Placement
Surgical guide printed in 3D using the Primeprint 3D Printing System by Dentsply Sirona

Case Study
Digitally Guided Implant Placement
FIG. 1: Crown down implant planning with Sicat Implant software.
Digitally Guided Implant Placement
FIG. 2: Axeos CBCT scan of final implant placement.
Digitally Guided Implant Placement
FIG. 3: Mounting surgical guide on the build plate with inLab CAM software.
Digitally Guided Implant Placement
FIG. 4: Planned surgical guide with implant-specific sleeve in Primescan.
Digitally Guided Implant Placement
FIG. 5: Final print from PrimePrint.

We recently treated a 43-year-old patient whose Tooth #20 had been previously extracted because of a vertical root fracture. The patient elected to restore the tooth with an implant to improve both function and aesthetics.

The entire process was completed within the Dentsply Sirona ecosystem. First, we took a 3D optical scan of the teeth with the Cerec Primescan and a CBCT image with Axeos. Then, we designed the surgical guide in-house by combining the optical scan and CBCT image, and 3D-printed the guide with the Primeprint machine. The Straumann implant was placed successfully without complications under local anesthetic (Figs. 1–5).

What to expect in the future
Currently, 3D printing allows you to design and print surgical guides quickly, but the future of 3D printing will make it possible to complete more procedures such as dentures and bridges. Implantology is likely headed toward robotic-assisted placement, or fully robotic placement supervised by a dentist, because we’ve already witnessed a robotic-assisted implant case, which was pretty remarkable.

To grow your patient base and expand your practice, you need to provide the best standard of care available, and guided implantology is one way to help achieve that goal. Taking the time to learn about the latest industry innovations and what they can do for your patients and practice can be the difference between remaining stagnant or launching your business forward.

Abdelhay N, Prasad S, Gibson MP. “Failure Rates Associated With Guided Versus Non-Guided Dental Implant Placement: A Systematic Review and Meta-Analysis.” BDJ Open. 2021 Aug 18;7(1):31.

Author Bio
Dr. Dee Dee Meevasin Dr. Dee Dee Meevasin has more than 22 years of industry experience. Her Las Vegas-based family practice, Dee for Dentist, provides state-of-the-art digital dentistry along with traditional dental services to promote the highest level of long-term oral health for every patient.
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