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31 Jan 2016 | Australasian Dental Practice

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Guided surgery on your terms

By Dr Roland Glauser

Implant Planning Guided Surgery New Products

When using the NobelGuide treatment concept for guided surgery, two options are available today. The fully guided drilling approach can be used or - if you prefer - you can choose guided pilot drilling procedures instead.

A clinician and researcher for 25 years, Dr Roland Glauser of Zurich, Switzerland can base every treatment decision on extensive experience. Increasingly, this has led him to opt for guided pilot drilling with NobelGuide. Here's why:

Q: When did you first start using a guided approach for pilot drilling?

I started with guided pilot drilling some 20 years ago using the first lab-produced surgical templates during initial implant site preparation. Today, things have moved on. For two years now, I've used NobelGuide pilot drill templates for partially guided implant placement. I prefer this approach whenever accurate transfer of a diagnostically established implant position is crucial for an optimal outcome.

Q: What do you see as the main benefits of using a guided surgery template for pilot drilling only?

The first drill is so important. Done right, it provides a sound basis for the correct implant position. More bone volume is removed with the first drill than with any other, so with a correct initial osteotomy, the following drills should more or less find their way quite passively.

Guided pilot drilling is ideal because it enables the correct transfer of diagnostics and virtual planning into the surgical field, but you don't need to follow a fully prescribed workflow, with its associated instruments and tooling, to the very end. This can speed up and simplify the entire surgical procedure.

Q: What was the learning curve you experienced with guided pilot drilling?

The learning curve relates to precisely maintaining the path established with the pilot drill for each subsequent drill without shifting position. For those just starting with this approach, I recommend checking the established path and any possible shifts in direction by reinserting each drill into the osteotomy.

Q: Are there particular indications where you always prefer pilot drilling?

It usually depends on the bone. If extraction sockets or other bone defect configurations have bone volume that is sufficient for me to predictably guide the subsequent drills and implant into the position defined by the pilot drill, I'll usually go for guided pilot drilling only. If bone conditions are more demanding and there's a chance that the drills or the implant might shift from the path the pilot drill has set, then I prefer a fully guided approach.

Q: How does NobelClinician assist in planning for guided pilot drilling?

NobelClinician makes correct planning easy. For example, when working with narrow spaces, long crowns or significant distances between the incisal or occlusal planes and the bone crest, fully guided templates don't provide the correct fit. With its sleeve offset function, the latest version of NobelClinician makes adjusting the template for pilot drilling simple.

Q: Have you been pleased with the results you have achieved using NobelGuide for pilot drilling?

Absolutely! In healed sites, the pilot drill approach is absolutely fantastic; it is fast and the outcomes are well in line with the planning. Where bone volume is sufficient, a guided pilot approach has become my favourite. It's precise, easy to implement and can save time while - at the same time - allowing for an accurate transfer of the treatment plan to the case at hand.

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