Dentaltown August 2020 - 37

Fig. 1

CASE 1
Many years ago, I helped in the design of a guided implant surgery system that is now
in use. I was frequently contacted by sales reps of that implant company to help doctors
who had questions or issues with their implant surgeries.
One afternoon, I was called by a dentist who was very concerned about her recent
implant case. She had done it fully guided and thought that there was a problem with her
guided surgery kit. She sent me the two-month postoperative radiographs (Fig. 1) to review.
I asked her many questions about her training and how she worked up the case and
did the surgery, from a technical aspect.
She had taken a five-day implant course in Mexico about three years prior. She said that
she placed about a dozen implants in that course and that she hadn't taken any implant
courses since. She didn't have her own CBCT, so she used a mobile CBCT that came to
her office parking lot. She didn't have implant planning software, so the mobile CBCT
lab also did the treatment planning and made the surgical guide for her.
The patient was fully edentulous, and there was no index to
position the surgical guide, nor skeletal fixation screws to stabilize
the stent. I was beginning to formulate etiology of her far-fromideally-placed implants when I asked her how many implant cases
she had done since her course three years ago. Her answer: "Oh,
this is my first case."
So, what can we learn from this example? I don't know the
details about her implant training course, but I can guess that it
was decent-but I have trouble remembering things from courses
I take unless I implement what I learned soon afterward. Three
years is a long time to remember what she was taught about implant
planning and surgical technique, given that this was the first time
she had used this knowledge in actual practice.
There are some implant planning services that use only welltrained technicians and are very good at knowing which criteria
are used when positioning an implant in the CBCT planning
software. Relying on a local lab technician with unknown expertise
and clinical knowledge can be very risky. This doctor stated that
she was given the opportunity to review the treatment plan before
stent fabrication, but she declined.
Remember, the clinician doing the procedure is the one who
is legally responsible for all aspects of the patient's treatment. It is
imperative for the doctor to review the treatment plan personally
for accuracy and appropriateness before the surgical guide is made.
And make sure to know all the nuances of the guided implant
system that you're using.
The other glaring issue here is patient selection. Fully edentulous
cases can be much more complicated than they appear. There are
no reference points to orient for the position of the implants, as
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Dentaltown August 2020

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