Guided Implant Surgery

Michael Tischler, DDS


This month, a central focus of our discussion is on guided implant surgery. One of our Implants Today advisory board members, Dr. Michael Scherer, and Dr. Rick Winter have each submitted excellent case report articles that clearly demonstrate how guided surgery approaches are a critical part of implant dentistry, when indicated, and can yield excellent clinical outcomes.  

There is much discussion in the literature and on social media about how technology and guided applications are offering advances in the delivery of implant dental treatment. Technology can make a big difference in treatment outcomes. One example is the development of computer assisted tomography by Alan Cormack and Godfrey Hounsfield, who were jointly awarded the Nobel prize for Physiology or Medicine in 1979 for their achievement. Many of the recent advances we are seeing now are simply further developments from that technology, combined with other digital advances. 

It is my opinion, and that of others with experience with implants, that clinicians must have a knowledge of many fundamental principles of anatomy and surgery to correctly use most guided technologies. This is because there are times when any technology may require human judgment and intervention by the clinician to make the final and best clinical decisions. The human body is extremely intricate and variable in both physiology and anatomy, and there are times that calculations based on ones and zeros do not meet the clinical reality. I have seen this in my own practice during the process of attempting to use guides with larger cases.

One area related to fundamental treatment principles is in treatment planning cases that may not be best suited for guided surgery. A guided surgery may have increased challenges unless a clinician understands such things as the clinical estimate of bone density from a CT Scan, how pathology on a CT scan might predict increased variability in surgery, and recognizing abnormal anatomy that could be challenging in surgery. I am not saying that guided surgery does not have its place, as it certainly does. What I am saying is that through having a strong knowledge of fundamental principles of implant surgery and treatment, a clinician can best know when guides are best suited. If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at

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