Freehand Implant Placement vs Guided Surgery: Which Is Better?

You have probably noticed that some dental clinics offer quick and painless implant placement using a surgical guide. But is it really necessary? This article reviews the advantages of digital technologies and the differences between placing implants with and without a navigation (guided) template.

Navigation surgical template — what is it and what does it look like?

A surgical template/guide for implant placement is a custom-made template (guide) with sleeves (holes) for the implants, fabricated for your jaws using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. As a result, you obtain highly accurate planning and placement; the incision can be smaller and the procedure minimally invasive.

Types of surgical templates

• Bone-supported. Used in complete edentulism (no teeth present) provided there is sufficient bone volume. For bone- and mucosa-supported guides, fixation pins/screws are often used to stabilise the guide.
• Tooth-supported. The most common type; indicated when some teeth are still present.
• Mucosa-supported. The guide rests on the gingival mucosa; suitable for patients with a fully edentulous arch or only a few remaining teeth. These guides frequently require fixation pins/screws due to soft-tissue compressibility.

Stages of making a surgical template

• Diagnostics. Assessment of the jaws and cone-beam computed tomography (CBCT) to determine the optimal implant position.
• Preparation. Intraoral scanning (digital impression) is performed and the data are sent to the dental laboratory to fabricate the guide.
• Modelling. Three-dimensional (3D) planning in dedicated software to determine implant positioning, angulation and depth.
• Fabrication. The guide is produced via 3D printing or with CAD/CAM equipment. Typical lead time: about 3–7 days.
• Placement. Before surgery, the clinician positions the guide on the jaws and fixes it. Subsequent steps proceed quickly and precisely; the guide is removed after the procedure.
  Safety zones: during planning, safe offsets are maintained from critical anatomical structures (the inferior alveolar canal, mental foramen, and maxillary sinus).

Benefits of using a surgical guide

Maximally accurate placement

Previously, all planning and placement were done freehand and were less precise. With a guide, the implant position, angulation and drilling depth can be planned to within approximately 0.1 mm or 1 degree, helping to avoid situations where the definitive crown cannot be attached, or where unfavourable loading leads to bone loss or even implant fracture.

Longer service life

Correct three-dimensional positioning within the bone can increase the longevity of the implant.

Ideal for the All-on-4® concept

Guided surgery is an excellent solution for All-on-4® full-arch rehabilitation. It provides accurate placement of implants that, with this method, must often be angled or positioned near anatomically critical structures (e.g., the maxillary sinus). Estimating this freehand is difficult, and even a millimetre’s deviation can matter.

No large incisions

Oedema, significant pain and prolonged healing often accompany entirely freehand implant surgery. Guided surgery helps avoid these in patients with sufficient bone who do not require augmentation, making the procedure minimally invasive. Fewer incisions mean less pain and faster healing.

Surgical guides can also be used for apicoectomy (resection of the root apex), helping to avoid extensive incisions.

Time savings

Surgery time can be reduced from about one hour to around 20 minutes.

Predictable outcomes

With guided surgery, the predictability of outcomes increases markedly. In some cases, implant placement can even be easier than tooth extraction.

Even where bone volume is limited, digital planning allows you to design appropriate prosthetics and, via the guide, plan where and how to add bone to avoid implant mobility or rejection.

Guided (template-based) vs Freehand Implant Placement

If we sum up all the above-mentioned advantages of implantation by a template, then according to all characteristics, preference should still be given to modern digital technology, rather than the old, but cheaper method.