Even with a surgical guide, you are not entirely immune to errors. Inaccuracies and mistakes in treatment can still occur in daily clinical practice. What are the most common pitfalls before and during guided implant surgery?
Pre-Treatment Inaccuracies
- Low-Quality CBCT Scans and Impressions: Guided surgery relies on one core principle: accurately superimposing the digital impression onto the patient's CBCT scan. Poor image resolution or distorted impressions compromise this alignment.
- Inaccurate Assessment of Mouth Opening: Restricted mouth opening can prevent the insertion of the guide together with the osteotomy drills posterior to the premolars. If the opening is less than 3.5 cm to 4 cm in the molar region, guided surgery may not be feasible.
- Tooth Movement During Silicone Impressions: This occurs most frequently in patients with compromised periodontium and mobile teeth, leading to registration errors.
- Poor Denture Fit During Dual-Scan Protocols: If the denture lifts off the underlying tissue during the scan, it cannot be accurately registered, making it impossible to fabricate a precise guide.
Intra-Operative Inaccuracies
- Improper Guide Seating/Adaptation: If the guide does not sit flush against the supporting tissue bed (teeth, bone, or soft tissue), the osteotomy axis can tilt, causing implant placement deviations. Clinicians must verify that the guide is fully seated and stable before initiating drilling.
- Improper Assessment of Incisions and Flaps: Soft tissue can push against parts of the guide and alter its trajectory, particularly with complex stackable guides. Proper flap elevation and careful guide seating are essential for surgical success.
