A short introduction to the surgical guidance available to achieve optimal implant placement and tissue aesthetics.
We can predictably regenerate vital bone in simultaneous procedures utilising malleable, form-stable materials in tissue-sparing approaches. More info here.
Mastering this leaves time to concentrate on optimal guidance of the osteotomy, implant placement, emergence and plaque control zones.
Drill Guiding

Implants placed free hand are reported to show huge deviations from the optimal position. Reducing deviation is key for all cases and especially critical for screw-retained restorations.
Surgical Implant guidance can be pilot-guided or fully guided. Fully guided covers the full implant bed preparation and implant placement itself. Pilot-guided surgery covers the initial osteotomy only.
Pilot or Fully Guided?

Kuhl reported no significant differences exist in outcomes when comparing pilot-guided to fully guided surgery. Pilot drill guidance is a reliable option especially when the implant drill depth can be controlled with stoppers such as those from BIONER. Pilot drill guides feature narrow sleeves placed at a fixed height that allow a 2-mm diameter pilot drill to create fixed-depth osteotomy. Implant Store pilot drills are available in 20mm, 25mm and 25mm lengths to allow perfect off-setting of the guide sleeve allowing precise drill depth control.

Our clinical partners at 4D Ceramix will create a customised digital plan for pilot-guided surgery along with a bespoke 3D printed guide from £175.
Thread Guiding

For immediate or early loading cases the balance of implant design parameters shifts towards increased mechanical stability. Implants such as Bioner Top DM combine an active apex for sharp bone engagement with a more aggressive tapered thread at the apical section. This type of design favours insertion in areas of poor bone quality and a dual-pitch thread critical for immediate placement.
Tissue Guiding

The Umbrella Concept (Dr Alberto Miselli) is a three-dimensional approach that describes the placement of the implant 4mm below the (future) gingival zenith in conjunction with a customised healing abutment.
The concept respects the biological width and preserves natural bone levels, soft tissue healing and emergence with no undue pressure on the soft tissue.
Management of the Emergence and Cervical Profile can help control the plaque zone in relation to the Implant platform and crown margin. A coronally located plaque zone away from the implant platform and crestal bone area reduces the risk or peri-implantitis. A location in proximity to the cervical margin also enabled easier oral hygiene for patients. A video tutorial discussing the full protocol is available HERE.