Computer-guided implantology is said to be something for beginners – real surgeons work freehand as a matter of principle: with this deliberately pointed thesis the host opens the second episode of the trilogy on computer-guided implantology in the podcast Queens & Sons of Dentistry. His guest, an experienced oral surgeon and lecturer who himself places implants predominantly with computer guidance, takes the provocation calmly – and over the course of the conversation paints a differentiated picture of where the actual differences between the two approaches lie: less in the operating theatre itself, considerably more in the preparation and in the long-term perspective.
In the surgical experience the two methods are converging
Asked about the biggest difference between the freehand technique and the computer-guided approach, the surgeon initially gives a surprising answer: during the procedure itself there are nowadays no longer that many differences. Navigation systems are increasingly developing towards markerless procedures – the camera therefore recognises where the practitioner currently is even without a marker fixed in the mouth. The decisive gain during the operation is the system's permanent feedback about where one is and where one needs to go – feedback that the freehand operator naturally does not receive.
The real difference: the preparation
The two paths differ considerably more, according to the surgeon's account, in the preparation time invested. Anyone working with computer guidance must necessarily plan the implant in advance; there is no way around it. At the same time he puts this supposed additional effort into perspective: anyone wishing to operate well freehand must likewise plan and have a plan – where the implant is to sit, where the crown will later be placed, how deep the implant must be inserted and how much tissue is available. Ultimately the technology is merely an aid to becoming a better dentist and a better surgeon in implantology.
The time factor: freehand in the short term, more nuanced in the long term
On sheer operating speed the guest's verdict is unambiguous: freehand is of course faster in the first instance – open the cassette, drill, get going. But he broadens the perspective: the life of an implant does not end with the operation, it continues afterwards. If peri-implantitis or an aesthetic problem arises later because the implant was placed unfavourably and the crown has to be renewed, the patient returns to the practitioner – and then, in the end, neither was any time gained nor was anything gained economically. Planning everything well and implementing it accordingly is therefore by no means wrong.
With extensive restorations the time ratio in his experience even reverses: particularly with full-arch restorations and complete restorations, working with navigation, the necessary experience, the right structure and the right people alongside is definitely faster than freehand. The procedure is complicated enough; anyone working with navigation no longer has to consider where to drill and which implant belongs where, but knows the sequence of the drills and knows at all times what needs to be done. He describes this as an enormous relief – the more elaborate the procedure, the greater the benefit of computer-guided support.
Precision and predictability
On accuracy the matter is clear from the guest's point of view: navigation is more precise. As an example he cites immediate loading, which always represents a challenge: what was planned on the computer together with the dental technician can be screwed in at the end of the morning exactly as it was planned.
The host illustrates the difference with an image from everyday life: freehand corresponds to driving on the basis of approximate orientation, whereas navigation is like Google Maps, which announces precisely which way to go. The surgeon takes up the comparison and adds the warning function: if the planning shows, for instance, a strong alveolar vessel in the region of the sinus window, the access can be deliberately placed somewhat lower. Navigation is a support that makes life easier.
Conclusion: not an either/or
At the end of the episode comes the host's conclusion: freehand is not wrong – but perhaps not always, and no longer, the best solution. The guest himself warns in any case against dogmatism in both directions: there are three options – freehand, statically guided and navigated – and the art lies in choosing the procedure appropriate to the situation at hand.