John III Beumer - Fundamentals of Implant Dentistry

Because the accuracy of guided implant placement largely depends on the quality of the CBCT image, the radiographic image should be obtained with minimal errors. If the patient has a significant amount of metal present in the mouth, heavy scattering within the CBCT image may occur (see Fig 5-9); hence, the patient may be required to wear a specific radiographic template during the CBCT scan to minimize artifacts in the segmented model. In addition, properly positioning the patient and ensuring that the patient is stable during the scan are especially important to eliminate the need to guess the desired outcomes.

Ultimately, the clinician is responsible for making an accurate diagnosis and carefully evaluating the needs of the patient and implant team when deciding to use digital treatment planning. The clinician may experience access difficulties while drilling and placing the posterior implants through the guide. This is more prominent for patients with limited mouth opening. In addition, long sleeves may interfere with the irrigation and cooling of the osteotomy drills. Poorly designed implant guides may have thin sections that can break during surgery. While the guided implant surgery is more accurate and reliable than conventional implant placement, it is still associated with errors. Studies have indicated the deviation of a placed implant compared to planned implant placement is within 1 to 2 mm in the horizontal dimension 105, 112and 5 to 10 degrees in angle orientation. 103, 113As result, it is crucial for the clinician to appreciate that these technologies, while beneficial, do not replace traditional surgical skills and pros- thodontic design fundamentals.

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