Understanding the Workflows in Non-Guided and Static Computer-Assisted Implant Surgery

Abstract

Contemporary implant dentistry aims to achieve long-term biological, esthetic, and functional successful outcomes. Thus, instrumental to this aim is designing an integrated system in which the supported prosthesis & components, anatomical and phenotypical tissue characteristics, and the fixture act synergistically to maintain peri-implant tissue stability and health. Central to these goals is (1) the definition of a patient-optimized three-dimensional (3D) implant position during comprehensive treatment planning and (2) the intraoperative transfer of the plan to the final implant position. Preoperative planning is supported by digital imaging, primarily via tomographic and surface scans of the patient's anatomy, and subsequent data processing in dedicated planning software, allowing for comprehensive case evaluation. The digital treatment plan which initiates computer-assisted implant surgery (CAIS), can be executed by means of non-guided or guided implant surgery approach; the latter involving static, dynamic, and robotic techniques. This white paper aims to provide a comprehensive overview of the required resources and workflows involved in digital implant treatment planning and subsequent implant placement using non-guided and static CAIS approaches.

Keywords: computer‐assisted implant surgery (CAIS); dental implants; digital dentistry.

Figure 1

Workflow for digital implant treatment plan in partial edentulism.

Figure 2

Clinical and radiographic workflow enabling digital implant planning in partially edentulous patients. A, B, C: Occlusal views of the mandible and bilateral single edentulous second premolar sites. D: Blocked‐bite cone‐beam computed tomography under soft‐tissue retraction. E: Segmentation of the mandible and the mandibular canal. F, G: Data registration and critical evaluation in axial (H), coronal (I), sagittal (J), and 3D (K) views. L, M: Virtual implant positioning. N: Definition of guide extension. O: Design of buccal fenestrations. P, Q: Virtual design of the guide and corresponding clinical presentation after surgical guide manufacturing.

Figure 3

Workflows for digital implant treatment plan in full edentulism. CBCT, cone‐beam computed tomograph.

Figure 4

Clinical and radiographic workflow enabling digital implant planning in fully edentulous patients with adequate existing dentures. Illustrated is the case of a fully edentulous patient after implant loss from a bar‐supported hybrid prosthesis. A, B: Occlusal and basal views of the existing denture, including the metal framework corresponding to the previous bar reconstruction. C: Creation of radiopaque reference markers. D: Relining of the denture base. E, F: Occlusal and basal view of the relined denture including reference markers. G, H: Digital data registration (superimposition) and critical evaluation in axial (I), sagittal (J), coronal (K), and 3D (L) views. M, N: After virtual implant positioning, the denture surface scan was incorporated into the surgical guide design. CBCT, cone‐beam computed tomograph.

Figure 5

Clinical and radiographic workflow enabling digital implant planning in fully edentulous patients with inadequate existing dentures. (A) Analog mock‐up of a removable denture to determine esthetic and occlusal parameters; denture stability and adaptation of the intaglio surface should also be ensured. (B) Occlusal, (C) basal, and (D) buccal views of the new denture after relining and placement of radiographic markers. (E, F) Digital data registration (superimposition) and critical evaluation. (G) Virtual implant position planning. (H) Surgical guide design following virtual implant positioning. (I) Clinical presentation after surgical guide manufacture. (J) Anchor pin drilling. (K) Guided drilling and implant placement through the sleeves. (L) Implants in place. (M) Connection of transmucosal abutments. (N) Placement of scan bodies to determine implant position for fabrication of an immediately loaded fixed prosthesis.

Figure 6

Radiographic template designed in a case of a fully edentulous patients with inadequate existing dentures.

Figure 7

Static computer‐assisted implant surgery (CAIS) workflow.

Figure 8

Radar chart of the main cost/effectiveness drivers when comparing ng‐ (blue) and s‐CAIS (yellow) in the case of replacement of one tooth with a single implant‐supported prosthesis. Each factor is scored on a scale from 1 (lowest) to 5 (highest). This visualization illustrates that ng‐CAIS (5/5) requires extensive clinical experience, while s‐CAIS (3/5) relies on training on the guided surgery protocol. Both approaches can handle the complexity of a straightforward single implant effectively when performed by a trained clinician. Regarding chairside time, ng‐CAIS (5/5) is fastest, as it requires no guide placement or guided surgery kit setup, and also has only baseline costs. This visualization supports that for straightforward cases, ng‐CAIS remains a valid, cost‐effective option, while s‐CAIS provides superior accuracy for clinicians who prioritize accuracy over efficiency. CAIS, computer‐assisted implant surgery.

Figure 9

Radar chart of the main cost/effectiveness drivers when comparing ng‐ (blue) and s‐CAIS (yellow) in the case of edentulous patients. Each factor is scored on a scale from 1(lowest) to 5 (highest). This visualization illustrates that ng‐CAIS (5/5) requires extensive clinical experience, but the application of s‐CAIS (4/5) in this case also demands training in a guided surgery protocol of higher complexity. At the same time, a guided surgery s‐CAIS protocol can facilitate the complexity of the edentulous arch much more effectively than ng‐CAIS when performed by a trained clinician. Likewise, s‐CAIS is anticipated to result in faster implant surgery, despite the additional time in placement/fixation of the surgical guide. Investment and costs remain lower with ng‐CAIS. This chart illustrates the significant trade‐offs in edentulous cases, where ng‐CAIS only excels in cost reduction and requires somewhat less pre‐op planning time, but lacks significantly in accuracy, chairside efficiency, and handling complexity. The visualization suggests s‐CAIS is essentially mandatory for predictable full‐arch implant rehabilitation, despite its higher upfront costs and planning requirements. CAIS, computer‐assisted implant surgery.