Guided implants: what the guide does and why it matters

What an implant needs to go right

An implant is a titanium post placed in the jaw to carry a crown. For it to last, it needs enough bone around it, a safe distance from nerves and neighbouring roots, and an angle that lets the crown sit where a tooth should. Those three things are decided at the moment of placement, and they are hard to change afterwards. A millimetre out, or a few degrees off, may heal well but leaves the crown a compromise for as long as it lasts.

Freehand placement relies on the surgeon's judgement of what lies beneath the gum. Experienced hands do this well, but the view is limited and the bone cannot be seen directly. Guided surgery does not replace judgement. It moves most of it to a stage where there is time, a full three-dimensional picture, and no patient in the chair.

Two scans, one model

Planning begins with a CBCT scan on our Dentsply Sirona unit. This is a cone-beam X-ray that produces a three-dimensional image of the jaw, showing bone height and width, the sinus and the nerve canal. It is the only way to see the bone properly before surgery, and it is taken here, in the practice.

The second scan is the intra-oral scan we take at every appointment. It records the teeth, gums and bite in fine detail. Software merges the two, so the picture of the bone sits exactly beneath the picture of the teeth. For the first time we are looking at both what is there and what needs to go on top of it.

Planning on screen

On the merged model we design the final crown first and then work backwards. Where should the tooth be for the bite and the smile? Given that, where does the implant need to sit, at what angle and depth, to support it? The implant is placed virtually, checked against the nerve and the neighbouring roots, and adjusted until it is right.

This is also where restorative colleagues join the planning. Implant work here is usually shared, with the surgical and restorative stages planned together and a lead clinician keeping the parts in step. Plans for complex cases are reviewed at our regular peer-review sessions before anything is printed, which is a useful discipline.

The guide, printed in-house

Once the plan is agreed, the software produces a surgical guide: a thin resin template that sits over your teeth or gums, with a metal sleeve at the exact position and angle of the planned implant. We print it on a SprintRay 3D printer in our own printers, so there is no waiting on a courier and no third party interpreting the design.

On the day, the guide clicks into place and the drills pass through the sleeve. The depth is controlled and the angle is fixed, so the implant goes where the plan put it. The guide does not make the surgery automatic; it makes the surgery match the plan, which is the point of planning. We check the guide on the model before the day, so that any adjustment is made in the laboratory rather than in the chair.

What it means on the day

Because the position is known in advance, the surgery is usually smaller. In many cases the implant can be placed through a small opening in the gum rather than a larger flap, which generally means less swelling and a quicker recovery. The appointment tends to be shorter, and more of it is spent on the implant itself rather than on finding the way.

For anyone anxious about the procedure, there is also the option of IV conscious sedation with our dental sedationist, planned at consultation. Guided surgery and sedation suit one another well: a shorter, more predictable procedure is easier to sit through, and easier to sleep through.

An easier crown, and the fees

The benefit continues after the implant has healed. Because the implant sits where the crown was designed to go, the crown is simpler to make and more natural in shape, with less compromise in the angle or the way it meets the gum. In suitable cases the crown is designed and milled on site, or made by a master ceramist where the case calls for it.

As a guide, an implant consultation is from £150, a CBCT scan from £195, an implant from £1,500 and an implant crown from £2,000. Bone grafting, where needed, is quoted on application. Once examined, you get your plan and its fees in writing. Over-eighteens can pay for treatment of £1,000 to £30,000 in instalments, subject to a credit check.