Skip to main content

Navigation and Guided Surgery

  • Chapter
  • First Online:
Navigation in Oral and Maxillofacial Surgery
  • 239 Accesses

Abstract

In the last few years, the digital revolution along with the recent implantology advancements and imaging methods has pooled to introduce the computer-guided implantology. This technique is considered a reverse engineering protocol where the practitioner can visualize the final result prior to the surgical procedure. Without interfering with the main rules of implantology, this technique aims at controlling the implant position according to the prosthetic needed outcome using a precise digitally fabricated guide. This chapter discusses the principle of this technique, its advantages and limitations, and the step-by-step workflow to reach this concept.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Ganz SD. Computer-aided design/computer-aided manufacturing applications using CT and cone beam CT scanning technology. Dent Clin N Am. 2008;52:777–808.

    Article  Google Scholar 

  2. Guerrero ME, Noriega J, Jacobs R. Preoperative implant planning considering alveolar bone GRAFTING needs and complication prediction USING panoramic versus CBCT IMAGES. Imaging Sci Dent. 2014;44:213.

    Article  Google Scholar 

  3. Peretz B, Gotler M, Kaffe I. Common errors in digital panoramic radiographs of patients with mixed dentition and patients with permanent dentition. Int J Dent. 2012;2012:1–7.

    Article  Google Scholar 

  4. Kumar M, Shanavas M, Sidappa A, Kiran M. Cone beam computed tomography - know its secrets. J Int Oral Health. 2015;7:64–8.

    Google Scholar 

  5. Ardekian L, Dodson TB. Complications associated with the placement of dental implants. Oral Maxillofac Surg Clin North Am. 2003;15:243–9.

    Article  Google Scholar 

  6. Greenstein G, Cavallaro J, Romanos G, et al. Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: a review. J Periodontol. 2008;79:1317–29.

    Article  Google Scholar 

  7. Ganz SD. Presurgical planning with CT-derived fabrication of surgical guides. J Oral Maxillofac Surg. 2005;63:59–71.

    Article  Google Scholar 

  8. Katsoulis J, Enkling N, Takeichi T, et al. Relative bone width of the edentulous maxillary ridge. Clinical implications of digital assessment in presurgical implant planning. Clin Implant Dent Relat Res. 2012;14:213–23.

    Article  Google Scholar 

  9. Arisan V, Bolukbasi N, Oksuz L. Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia. Clin Oral Investig. 2012;17:1985–93.

    Article  Google Scholar 

  10. Sicilia A, Botticelli D. Computer-guided implant therapy and soft- and hard-tissue aspects. The third EAO consensus conference 2012. Clin Oral Implants Res. 2012;23:157–6.

    Article  Google Scholar 

  11. Pyo SW, Lim YJ, Koo KT, Lee J. Methods used to assess the 3D accuracy of dental implant positions in computer-guided implant placement: a review. J Clin Med. 2019;8:54.

    Article  Google Scholar 

  12. Arisan V, Karabuda CZ, Ozdemir T. Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res. 2010;21:980–8.

    Google Scholar 

  13. Farley NE, Kennedy K, McGlumphy EA, Clelland NL. Split-mouth comparison of the accuracy of computer-generated and conventional surgical guides. Int J Oral Maxillofac Implants. 2013;28:563–72.

    Article  Google Scholar 

  14. Amorfini L, Migliorati M, Drago S, Silvestrini-Biavati A. Immediately loaded implants in rehabilitation of the maxilla: a two-year randomized clinical trial of guided surgery versus standard procedure. Clin Implant Dent Relat Res. 2017;19:280–95.

    Article  Google Scholar 

  15. Vercruyssen M, Laleman I, Jacobs R, Quirynen M. Computer-supported implant planning and guided surgery: a narrative review. Clin Oral Implants Res. 2015;26:69–76.

    Article  Google Scholar 

  16. Deeb JG, Bencharit S, Loschiavo CA, Yeung M, Laskin D, Deeb GR. Do implant surgical guides allow an adequate zone of keratinized tissue for flapless surgery? J Oral Maxillofac Surg. 2018;76:2540–50.

    Article  Google Scholar 

  17. Sclar AG. Guidelines for flapless surgery. J Oral Maxillofac Surg. 2007;65:20–32.

    Article  Google Scholar 

  18. Mijiritsky E, Ben Zaken H, Shacham M, Cinar IC, Tore C, Nagy K, Ganz SD. Variety of surgical guides and protocols for bone reduction prior to implant placement: a narrative review. Int J Environ Res Public Health. 2021;18:2341.

    Article  Google Scholar 

  19. Arisan V, Bolukbasi N, Oksuz L. Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia. Clin Oral Investig. 2013;17:1985–93.

    Article  Google Scholar 

  20. Vercruyssen M, De Laat A, Coucke W, Quirynen M. An RCT comparing patient-centred outcome variables of guided surgery (bone or mucosa supported) with conventional implant placement. J Clin Periodontol. 2014;41:724–32.

    Article  Google Scholar 

  21. Pozzi A, Tallarico M, Marchetti M, Scarfo B, Esposito M. Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. Eur J Oral Implantol. 2014;7:229–42.

    Google Scholar 

  22. Raico Gallardo YN, da Silva-Olivio IRT, Mukai E, Morimoto S, Sesma N, Cordaro L. Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis. Clin Oral Implants Res. 2017;28:602–12.

    Article  Google Scholar 

  23. Boa K, Barrak I, Varga E Jr, Joob-Fancsaly A, Varga E, Piffko J. Intraosseous generation of heat during guided surgical drilling: an ex vivo study of the effect of the temperature of the irrigating fluid. Br J Oral Maxillofac Surg. 2016;54:904–8.

    Article  Google Scholar 

  24. Liu YF, Wu JL, Zhang JX, Peng W, Liao WQ. Numerical and experimental analyses on the temperature distribution in the dental implant preparation area when using a surgical guide. J Prosthodont. 2018;27:42–51.

    Article  Google Scholar 

  25. Kuhl S, Zurcher S, Mahid T, Muller-Gerbl M, Filippi A, Cattin P. Accuracy of full guided vs. half-guided implant surgery. Clin Oral Implants Res. 2013;24:763–9.

    Article  CAS  Google Scholar 

  26. Vercruyssen M, Coucke W, Naert I, Jacobs R, Teughels W, Quirynen M. Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template. Clin Oral Implants Res. 2015;26:1315–20.

    Article  CAS  Google Scholar 

  27. Younes F, Cosyn J, De Bruyckere T, Cleymaet R, Bouckaert E, Eghbali A. A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients. J Clin Periodontol. 2018;45(6):721–32.

    Article  Google Scholar 

  28. Arisan V, Karabuda CZ, Mumcu E, Ozdemir T. Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study. Int J Oral Maxillofac Implants. 2013;28:190–204.

    Article  Google Scholar 

  29. Block MS, Emery RW. Static or dynamic navigation for implant placement-choosing the method of guidance. J Oral Maxillofac Surg. 2016;74:269–77.

    Article  Google Scholar 

  30. Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hämmerle CH, et al. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2009;24:92–109.

    Google Scholar 

  31. Kaewsiri D, Panmekiate S, Subbalekha K, Mattheos N, Pimkhaokham A. The accuracy of static vs. dynamic computer-assisted implant surgery in single tooth space: a randomized controlled trial. Clin Oral Implants Res. 2019;30:505–14.

    Google Scholar 

  32. Brief J, Edinger D, Hassfeld S, Eggers G. Accuracy of image-guided implantology. Clin Oral Implants Res. 2005;16:495–501.

    Article  Google Scholar 

  33. Block MS, Emery RW, Cullum DR, Sheikh A. Implant placement is more accurate using dynamic navigation. J Oral Maxillofac Surg. 2017;75:1377–86.

    Article  Google Scholar 

  34. Sun T-M, Lee H-E, Lan T-H. Comparing accuracy of implant installation with a navigation system (NS), a laboratory guide (LG), NS with LG, and freehand drilling. Int J Environ Res Public Health. 2020;17:2107.

    Article  Google Scholar 

  35. Kalaivani G, Balaji VR, Manikandan D, Rohini G. Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: evidence-based literature review. J Indian Soc Periodontol. 2020;24:398.

    Article  Google Scholar 

  36. Jacobs R, Salmon B, Codari M, Hassan B, Bornstein MM. Cone beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health. 2018;15(18):88.

    Article  Google Scholar 

  37. Dreiseidler T, Tandon D, Kreppel M, Neugebauer J, Mischkowski RA, Zinser MJ, Zöller JE. CBCT device dependency on the transfer accuracy from computer-aided implantology procedures. Clin Oral Implants Res. 2012;23:1089–97.

    Article  Google Scholar 

  38. Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. American Academy of Oral and maxillofacial radiology. Position statement of the American Academy of Oral and maxillofacial radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:817–26.

    Article  Google Scholar 

  39. Chmielewski K, Chmielewska M. Guided surgery. Dental print 3D; 2020.

    Google Scholar 

  40. Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:25–42.

    Article  Google Scholar 

  41. Nagata K, Fuchigami K, Hoshi N, Atsumi M, Kimoto K, Kawana H. Accuracy of guided surgery using the silicon impression and digital impression method for the mandibular free end: a comparative study. Int J Implant Dent. 2021;12(7):2.

    Article  Google Scholar 

  42. Mora MA, Chenin DL, Arce RM. Software tools and surgical guides in dental-implant-guided surgery. Dent Clin N Am. 2014;58:597–626.

    Article  Google Scholar 

  43. Mattera M, Reginelli A, Bartollino S, Russo C, Barile A, Albano D, Mauri G, Messina C, Cappabianca S, Guglielmi G. Imaging of metabolic bone disease. Acta Biomed. 2018;89:197–207.

    Google Scholar 

  44. Cavallaro J, Tsuji S, Chiu TS, Greenstein G. Management of the nasopalatine canal and foramen associated with dental implant therapy. Compend Contin Educ Dent. 2016;38:367–72.

    Google Scholar 

  45. Borgonovo A, Fabbri A, Boninsegna R, Dolci M, Censi. Displacement of a dental implant into the maxillary sinus: case series. Minerva Stomatol. 2010;59:45–54.

    CAS  Google Scholar 

  46. Neiva RF, Gapski R, Wang HL. Morphometric analysis of implant-related anatomy in Caucasian skulls. J Periodontol. 2004;75:1061–7.

    Article  Google Scholar 

  47. Longoni S, Sartori M, Braun M, et al. Lingual vascular canals of the mandible: the risk of bleeding complications during implant procedures. Implant Dent. 2007;16:131–8.

    Article  Google Scholar 

  48. Kilic E, Doganay S, Ulu M, et al. Determination of lingual vascular canals in the interforaminal region before implant surgery to prevent life-threatening bleeding complications. Clin Oral Implants Res. 2012;25:90–3.

    Article  Google Scholar 

  49. Juodzbalys G, Wang HL, Sabalys G. Injury of the inferior alveolar nerve during implant placement: a literature review. J Oral Maxillofac Res. 2011;2(1):e1.

    Article  Google Scholar 

  50. Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. 1989;4:327–32.

    CAS  Google Scholar 

  51. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992;63:995–6.

    Article  CAS  Google Scholar 

  52. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000;71:546–9.

    Article  CAS  Google Scholar 

  53. Spray JR, Black CG, Morris HF, et al. The influence of bone thickness on facial marginal bone response: stage 1 placement through stage 2 uncovering. Ann Periodontol. 2000;5:119–28.

    Article  CAS  Google Scholar 

  54. Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19:43–61.

    Google Scholar 

  55. Marlière DAA, Demètrio MS, Picinini LS, Oliveira RG, Netto HDMC. Accuracy of computer-guided surgery for dental implant placement in fully edentulous patients: a systematic review. Eur J Dent. 2018;12:153–60.

    Article  Google Scholar 

  56. Tagger Green N, Machtei EE, Horwitz J, et al. Fracture of dental implants: literature review and report of a case. Implant Dent. 2002;11:137–43.

    Article  Google Scholar 

  57. Kessler A, Hickel R, Reymus M. 3D printing in dentistry-state of the art. Oper Dent. 2020;45:30–40.

    Article  CAS  Google Scholar 

  58. Kim SY, Shin YS, Jung HD, Hwang CJ, Baik HS, Cha JY. Precision and trueness of dental models manufactured with different 3-dimensional printing techniques. Am J Orthod Dentofac Orthop. 2018;153:144–53.

    Article  Google Scholar 

  59. Oberoi G, Nitsch S, Edelmayer M, Janjić K, Müller AS, Agis H. 3D printing—encompassing the facets of dentistry. Front Bioeng Biotechnol. 2018;6:172.

    Article  Google Scholar 

  60. Rungrojwittayakul O, Kan JY, Shiozaki K, Swamidass RS, Goodacre BJ, Goodacre CJ, Lozada JL. Accuracy of 3D printed models created by two Technologies of Printers with different designs of Model Base. J Prosthodont. 2020;29:124–8.

    Article  Google Scholar 

  61. Brown GB, Currier GF, Kadioglu O, Kierl JP. Accuracy of 3-dimensional printed dental models reconstructed from digital intraoral impressions. Am J Orthod Dentofac Orthop. 2018;154:733–9.

    Article  Google Scholar 

  62. Favero CS, English JD, Cozad BE, Wirthlin JO, Short MM, Kasper FK. Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models. Am J Orthod Dentofac Orthop. 2017;152:557–65.

    Article  Google Scholar 

  63. Park M-E, Shin S-Y. Three-dimensional comparative study on the accuracy and reproducibility of dental casts fabricated by 3D printers. J Prosthet Dent. 2018;119:861.

    Article  Google Scholar 

  64. Sun Y, Ding Q, Tang L, Zhang L, Sun Y, Xie Q. Accuracy of a chairside fused deposition modeling 3D-printed single-tooth surgical template for implant placement: an in vitro comparison with a light cured template. J Cranio-Maxillofac Surg. 2019;47:1216–21.

    Article  Google Scholar 

  65. Di Giacomo GA, Cury PR, de Araujo NS, Sendyk WR, Sendyk CL. Clinical application of stereolithographic surgical guides for implant placement: preliminary results. J Periodontol. 2005;76:503–7.

    Article  Google Scholar 

  66. Anunmana C, Ueawitthayasuporn C, Kiattavorncharoen S, Thanasrisuebwong P. In vitro comparison of surgical implant placement accuracy using guides fabricated by three different additive technologies. Appl Sci. 2020;10:7791.

    Article  CAS  Google Scholar 

  67. Smith PN, Palenik CJ, Blanchard SB. Microbial contamination and the sterilization/disinfection of surgical guides used in the placement of endosteal implants. Int J Oral Maxillofac Implants. 2011;26:274–81.

    Google Scholar 

  68. Colombo M, et al. Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized controlled trials. BMC Oral Health. 2016;13(2017):150.

    Google Scholar 

  69. Moon SY, Lee KR, Kim SG, Son MK. Clinical problems of computer-guided implant surgery. Maxillofac Plast Reconstr Surg. 2016;38:15.

    Article  Google Scholar 

  70. Cassetta M, Bellardini M. How much does experience in guided implant surgery play a role in accuracy? A randomized controlled pilot study. Int J Oral Maxillofac Surg. 2017;46:922–30.

    Article  CAS  Google Scholar 

  71. Cassetta M, Altieri F, Giansanti M, Bellardini M, Brandetti G, Piccoli L. Is there a learning curve in static computer-assisted implant surgery? A prospective clinical study. Int J Oral Maxillofac Surg. 2020;49:1335–42. https://doi.org/10.1016/j.ijom.2020.03.007; Epub 2020 Mar 23

    Article  CAS  Google Scholar 

  72. Jones A. Accuracy of mucosa supported guided dental implant surgery. Clin Case Reports. 2018;6:2131–9.

    Article  Google Scholar 

  73. Sannino G, Gherlone EF. Thermal changes during guided flapless implant site preparation: a comparative study. Int J Oral Maxillofac Implants. 2018;33(3):671–7.

    Article  Google Scholar 

  74. Dreiseidler T, Tandon D, Kreppel M, Neugebauer J, Mischkowski RA, Zinser MJ, et al. CBCT device dependency on the transfer accuracy from computer-guided implantology procedures. Clin Oral Implants Res. 2012;23:1089–97.

    Article  Google Scholar 

  75. Hassan B, Couto Souza P, Jacobs R, de Azambuja Berti S, van der Stelt P. Influence of scanning and reconstruction parameters on quality of three-dimensional surface models of the dental arches from cone beam computed tomography. Clin Oral Investig. 2010;14:303–10.

    Article  Google Scholar 

  76. Spin-Neto R, Gotfredsen E, Wenzel A. Impact of voxel size variation on CBCT-based diagnostic outcome in dentistry: a systematic review. J Digit Imaging. 2013;26:813–20.

    Article  Google Scholar 

  77. Widmann G, Bale RJ. Accuracy in computer-aided implant surgery--a review. Int J Oral Maxillofac Implants. 2006;21:305–13.

    Google Scholar 

  78. Pettersson A, Komiyama A, Hultin M, Näsström K, Klinge B. Accuracy of virtually planned and template guided implant surgery on edentate patients. Clin Implant Dent Relat Res. 2012;14:527–37.

    Article  Google Scholar 

  79. Meloni SM, De Riu G, Pisano M, Cattina G, Tullio A. Implant treatment soft- ware planning and guided flapless surgery with immediate. Eur J Oral Implantol. 2020;3:245–51.

    Google Scholar 

  80. Holst S, Blatz MB, Eitner S. Precision for computer-guided implant placement: using 3D planning software and fixed intraoral reference points. J Oral Maxillofac Surg. 2007;65:393–9.

    Article  Google Scholar 

  81. Viegas VN, Dutra V, Pagnoncelli RM, de Oliveira MG. Transference of virtual planning and planning over biomedical prototypes for dental implant placement using guided surgery. Clin Oral Implants. 2010;21:290–5.

    Article  Google Scholar 

  82. Flügge T, Derksen W, Te Poel J, Hassan B, Nelson K, Wismeijer D. Registration of cone beam computed tomography data and intraoral surface scans - a prerequisite for guided implant surgery with CAD/CAM drilling guides. Clin Oral Implants Res. 2017;28:1113–8.

    Article  Google Scholar 

  83. Yeung M, Abdulmajeed A, Carrico CK, Deeb GR, Bencharit S. Accuracy and precision of 3D-printed implant surgical guides with different implant systems: an in vitro study. J Prosthet Dent. 2020;12:821–8.

    Article  Google Scholar 

  84. Palazzo G, Ronsivalle V, Oteri G, Lo Giudice A, Toro C, Campagna P, Patini R, Bocchieri S, Bianchi A, Isola G. Comparison between additive and subtractive CAD-CAM technique to produce orthognathic surgical splints: a personalized approach. J Pers Med. 2020;10:273.

    Article  Google Scholar 

  85. Malo P, de Araujo NM, Lopes A. The use of computer-guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent. 2007;97:S26–34.

    Article  Google Scholar 

  86. Yong LT, Moy PK. Complications of computer-guided-design/computer- guided-machining-guided (NobelGuide) surgical implant placement: an evaluation of early clinical results. Clin Implant Dent Relat Res. 2008;10:123–7.

    Article  Google Scholar 

  87. Meloni SM, De Riu G, Pisano M, Massarelli O, Tullio A. Computer assisted dental rehabilitation in free flaps reconstructed jaws: one. Br J Oral Maxillofac Surg. 2012;50:726–31.

    Article  CAS  Google Scholar 

  88. Cassetta M, Di Mambro A, Giansanti M, Stefanelli LV, Cavallini C. The intrinsic error of a stereolithographic surgical template in implant guided surgery. Int J Oral Maxillofac Surg. 2013;42:264–75.

    Article  CAS  Google Scholar 

  89. Friberg B, Sennerby L, Gröndahl K, Bergström C, Bäck T, Lekholm U. On cutting torque measurements during implant placement: a 3-year clinical prospective study. Clin Implant Dent Relat Res. 1999;1:75–83.

    Article  CAS  Google Scholar 

  90. Marchack CB, Moy PK. The use of a custom template for immediate loading with the definitive prosthesis: a clinical report. J Calif Dent Assoc. 2003;31:925–9.

    Google Scholar 

  91. Lal K, White GS, Morea DN, Wright RF. Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part II a clinical report. J Prosthodont. 2006;15:117–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hani Tohme .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tohme, H., Lawand, G. (2022). Navigation and Guided Surgery. In: Parhiz, S.A., James, J.N., Ghasemi, S., Amirzade-Iranaq, M.H. (eds) Navigation in Oral and Maxillofacial Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-06223-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-06223-0_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-06222-3

  • Online ISBN: 978-3-031-06223-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics