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Freehand vs. Guided Surgery: Clinical Considerations and Case Examples

Freehand vs. Guided Surgery - Case Examples - CE Course
Launch Course

Course Objectives (2 CE Credits)

Examining the advantages and disadvantages of utilizing freehand or guided surgery can help clinicians arrive at an informed decision regarding the appropriate means of placing an implant. With the cost-effective method of freehand surgery, a flap is reflected and the implant is placed according to the available diagnostic information. In guided surgery, the osteotomy is created through a digitally designed and printed surgical guide, which can be invaluable when a high degree of precision is needed. Because the chosen method of surgery affects many aspects of treatment, the proper approach is determined by not only practitioner preference but also the unique circumstances of each case. Topics include:

  • Benefits of freehand vs. guided surgery
  • Considerations involved in determining whether to employ a freehand or guided surgery treatment plan
  • Assessing the amount of available bone in freehand surgery cases
  • The utilization of CBCT scanning and digital intraoral impressions in guided surgery cases
  • Expenses and cost-effectiveness of both approaches
  • Managing the keratinized soft tissue in freehand surgery cases
  • Cases providing clear examples of the thorough evaluation, selection, implementation and ultimate success of both freehand and guided surgery


When it comes to guided and freehand surgery, the circumstances of each case and the situation of the patient ultimately dictate which approach to adopt. The cost-benefit analysis of guided surgery should include a careful assessment of bone levels, the keratinized soft tissue, and whether the increased level of precision is worth the added expense. While the precision of CBCT scanning and guided surgery is essential in many situations, there will always be cases indicated for a freehand approach.

CAUTION: When viewing the techniques, procedures, theories and materials that are presented, you must make your own decisions about specific treatment for patients and exercise personal professional judgment regarding the need for further clinical testing or education and your own clinical expertise before trying to implement new procedures.


  1. Noharet R, Pettersson A, Bourgeois D. Accuracy of implant placement in the posterior maxilla as related to 2 types of surgical guides: a pilot study in the human cadaver. J Prosthet Dent. 2014 Sep;112(3):526-32.
  2. Bruschi GB, Crespi R, Capparé P, Gherlone E. Clinical study of flap design to increase the keratinized gingiva around implants: 4-year follow-up. J Oral Implantol. 2014 Aug;40(4):459-64.
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