As growing numbers of general dentists add implant placement to their practices, digital treatment planning (DTP) and guided implant surgery have emerged as crucial tools for smoothing the path to success in the general practice, saving chair time and achieving a predictable outcome. Here, we outline five key points that dentists should know about DTP and guided surgery, including insights from our digital treatment planning team at Glidewell. Read more to learn:

1. How to Get Started with Digital Treatment Planning and Guided Implant Surgery

2. Why Guided Surgery Is the Simplest, Most Efficient Way to Place Implants

3. The Role of Digital Treatment Plans and Surgical Guides in Maximizing Safety

4. Why Not All Surgical Guides Are Created Equal

5. How DTP and Guided Surgery Improve the Patient Experience and Help with Case Acceptance

To begin a DTP and guided implant surgery case, the dentist typically takes a cone-beam computed tomography (CBCT) scan and digital impression. However, the DTP team at Glidewell also is set up to accept traditional VPS impressions, which are converted to a digital format upon receipt. From there, our DTP specialists develop a treatment plan that maximizes safety and efficiency by precisely controlling the trajectory and positioning of the implant via a surgical guide.

“The data from the impression and the CBCT scan are merged together, with care taken to ensure that they align perfectly so that every detail can be accounted for when we devise the surgical plan,” said Rueben Romero, manager of digital treatment planning at Glidewell. “We use the precise anatomical data to identify and create a surgical plan that accounts for any challenges, such as areas in close proximity to the maxillary sinus or inferior alveolar canal, where bone density might be questionable, and where adjacent tooth roots are too close to the implant site.”

For DTP cases submitted to Glidewell, the proposed surgical plan is reviewed by the doctor either through email or the dedicated DTP portal. After the doctor has submitted any feedback and the final surgical plan is approved, the surgical guide design is sent to a 3D printer. Once printing is complete, excess material from the printing process is trimmed away and the surgical guide is thoroughly cleaned and sanitized.

Next, a titanium sleeve that matches the doctor’s selected implant system is incorporated into the guide via a light-curing process. The titanium sleeve ultimately controls the angle and position of the implant osteotomy in precise accordance with the approved surgical plan, resulting in high-precision implant placement that maximizes safety and the efficiency of the surgical appointment. The surgical guide is then sent to the doctor. Once the guide is seated over the patient’s teeth, the doctor begins the surgery.

“Digital treatment planning is the optimal, most efficient way to plan implant surgery,” Romero said. “The highly detailed, three-dimensional data tells our DTP team and the doctors everything they need to know about bone volume and the surrounding anatomy. We give the doctor all the information they need to confidently move forward with implant placement, and the surgical appointment goes relatively quickly as a result.”

By following the drilling sequence and creating the osteotomy through the surgical guide, there’s no need to worry about the depth or angulation of the drills. This approach to surgery ensures the implant is situated in a maximum amount of bone while supporting an ideal prosthetic outcome.

“There’s no other way to place an implant with this degree of accuracy. Modern DTP software is so sophisticated, and our DTP team members at Glidewell are so experienced — they develop a conservative surgical plan that facilitates a predictable outcome,” Romero added. “Once the surgical guide is in the patient’s mouth, the drilling protocol is quick and simple. There’s a template on the patient’s teeth and it doesn’t move. The drills fit exactly through the titanium sleeve in the guide, and there’s nowhere else the doctor can possibly drill except the precise location determined in the digital treatment plan.”

Because the surgical guide removes any guesswork from the surgical procedure and avoids any unexpected challenges or surprises once the surgical procedure begins, dentists require substantially less chair time to place the implant.

“The experience that the doctor and patient have is remarkable. I always hear doctors say, ‘Wow, it was just 10 minutes and I was done!’ The implant is in, the healing cap is on, and the patient goes home,” Romero said. “Their business is more profitable, too. A lot of doctors have told me: ‘Rueben, thank you so much. My business is making more money because of guided surgery. We can handle more surgical appointments than we could before, and we’re spending far less time examining each case and figuring out how to make it work.’”

The guided surgical approach to implant placement can be especially useful to dentists who are early in their learning curve with implant placement. “When you don’t have a lot of years under your belt in implant surgery, the last thing you want is uncertainty or having to pause mid-surgery to figure out the best way forward,” Romero says. “With guided surgery, the digital treatment plan makes everything easier, yet dentists still have complete control over the procedure because they review and approve everything ahead of time.”

Many implant cases are located close to vital anatomical structures or where the volume of horizontal and vertical bone is uncertain. Due to the precision and detail of three-dimensional treatment planning software, digitally determined implant positioning avoids pitfalls in what could otherwise be complicated implant surgeries. Romero described the benefits in this way:

“Many doctors opt for freehand implant surgery and are quite good at this technique; for a lot of cases, this approach to implant placement is the best choice for experienced clinicians. With freehand, the challenge is accuracy, especially if you’re placing an implant in an area, for example, where you might hit a nerve or an adjacent tooth root. With digital treatment planning, you can eliminate that risk for a very reasonable cost.

“DTP is virtually foolproof because the surgical guide ensures the implant is positioned within the margin of safety and right where it needs to be with regard to the available bone and the type of restoration the doctor wants to deliver. Think about it like a basketball going through a hoop. There are many ways that the shots you attempt won’t make it into the basket, but when the ball sinks perfectly through the rim and makes a ‘swish’ — that’s guided surgery. The titanium sleeve contained within the guide enforces the position of the surgical drills and keeps the drills in alignment with the approved digital treatment plan, resulting in ideal implant positioning every single time.

“The treatment planning software that we use has a safety zone, so if the proposed implant site is getting too close to a nerve or the sinus, the software won’t even allow us to proceed. That’s the beauty of this amazing software and the incredible detail of CBCT technology. In addition, the team here at Glidewell plans the surgeries quite conservatively, so the safety of the procedure is never in doubt. Patients’ safety is, of course, front of mind for dentists as well, which is why guided surgery is such a valuable resource to the practices we serve.”

When it comes to DTP and surgical guide fabrication, the DTP team at Glidewell offers unique advantages due to the company’s expertise as the largest dental lab in the U.S., with more than 50 years of restorative expertise informing its approach to digital treatment planning.

“When you work with Glidewell, it’s simpler and easier to restore the case after the implant has integrated and get a beautiful outcome because we all have a dental lab background, several of us are CDTs, and we help the dentist position the implant right where it needs to be for their preferred restoration, whether it’s a custom abutment and cementable crown or a screw-retained prosthesis,” said Romero, who worked for more than 35 years as a dental technician before transitioning to a career in DTP.

“The entire DTP team is staffed with technicians who come from a restorative background in dentistry, which helps Glidewell achieve its mission of providing prosthetically driven treatment plans for our DTP customers. Having the implant knowledge from the bone down, which is DTP, and the background of working with the restoration from the bone up helps us understand the big picture and what the doctor is trying to achieve. Having that understanding of what occurs after the DTP and guided surgery process gives the doctor confidence that we know what we’re doing.”

Romero also takes pride in the knowledgeable technical support his team provides to dentists and his team’s diligence in making sure the doctor signs off on every aspect of the treatment plan.

“The customer service that we have here really makes us stand apart from the competition. Every member of our team has been with us a long time and they understand the surgical procedure,” Romero said. “Of course, we leave it up to the doctors to make the final decision on the surgical plan, but we help them out every step of the way and make sure they understand how the implant position affects the prosthetic outcome.”

“The reports we send clinicians for approval are very accurate and detailed, and outline every consideration the dentists should know about, like if the bone density is questionable,” Romero added. “If the doctor declines a plan, we make the changes and send the report back for another look. We require the doctor’s explicit approval before we complete the plan. We’re a department that plans the cases for the doctors, but the doctor is the one who finalizes the approval.”

As both a manufacturer of implants and the biggest dental lab in the U.S., Glidewell offers unique advantages for dentists, including cost savings and a restorative-driven approach to implant dentistry — from treatment planning to final restoration. For example, the Hahn^™ Tapered Implant System, which was developed by Glidewell in collaboration with implant pioneer Dr. Jack Hahn, includes a bundle package that helps significantly reduce the cost of treatment. For only $395, dentists receive a digital treatment plan, a surgical guide, a Hahn Tapered Implant, and a healing abutment or scan body. Additionally, Glidewell offers 20% off all restorations over Hahn implants, further lowering expenses for dentists.

Romero notes that this approach to treatment also simplifies inventory management for dental practices. “The Hahn Tapered Implant Bundle gives the doctor a sense of security because we send out exactly what’s needed to perform the surgery for each individual patient,” he said. “You don’t have to search around and find the correct sizes of components, the screws, and everything else you need to complete the surgical procedure. You won’t have a situation where you need a 3.5-mm-diameter implant and healing abutment, but you only have 5.0-mm-diameter components on hand. It’s one more thing you don’t have to worry about — in addition to having a slam-dunk surgical plan, you also don’t have to worry about your inventory.”

Guided implant surgery is more comfortable, enables a minimally invasive surgical procedure and requires less chair time. When these benefits are explained during consultation, many dentists find that patients are more willing and eager to move forward with treatment.

“We work with a lot of dentists who are first and foremost interested in the surgical plan,” Romero said. “So we’ll come up with the digital treatment plan and send it to the doctor for use in case presentation. A lot of doctors will use our reports to present the proposed surgery to patients, and when they see that the procedure is based on such thorough diagnostic information and has accounted for every safety consideration possible, they are ready to move forward with implant treatment.

“And it’s beneficial for the patient because they’re assured that the procedure will go quickly, the implant will be placed with precision, a smooth and relatively atraumatic healing period will follow, and there will be a nice prosthetic outcome. While our primary focus here is working with doctors to simplify implant surgery, at the end of the day, the patient is the one who’s receiving the benefits of all the treatment planning that we do in collaboration with the clinicians we serve here at Glidewell.”

The end result of this process is an experience that helps more patients gain access to the life-changing benefits of implant treatment.

“We get a lot of doctors sharing gratitude from their patients all the time,” Romero said when describing his favorite aspect of leading the DTP team at Glidewell. “We’ll hear that the patient cried when they got their implant in, and they’re so happy.”