When treatment planning dental implant therapy, one of the biggest questions practitioners face is whether to employ freehand or guided surgery. As with many clinical considerations, the correct answer to this question is contingent upon the unique circumstances of each case and the preferences of the practitioner.

Freehand surgery, in which a flap is reflected and the implant is placed according to the available diagnostic information, is a cost-effective approach that is advantageous in many cases. Guided surgery, in which the osteotomy is created through a digitally designed and printed surgical guide, has the potential to afford the highest level of precision and control, and can be invaluable depending on the complexity of the case and the anatomy of the patient.

In guided surgery cases, CBCT scanning and digital intraoral impressions are used to generate a virtual representation of the patient’s jaw and oral anatomy. This is utilized to develop a digital treatment plan in which the exact position of the implant is determined in advance of treatment. A surgical guide is fabricated that controls the osteotomy in precise accordance with the preplanned implant position. The depth, angulation, and mesial-distal and buccal-lingual location of the implant osteotomy are precisely controlled by titanium sleeves situated within the surgical guide.

The superior level of accuracy afforded by this approach makes it ideal in situations where there are concerns related to bone volume and the proximity of vital patient anatomy such as the inferior alveolar nerve, sinus and neighboring teeth. In cases of narrow ridges or other instances of limited anatomical space, guided surgery simplifies the task of situating the implant within the available bone. In full-arch indications, guided surgery should always be a strong consideration provided the complexity of such cases and the less invasive nature of the procedure, atraumatic healing process, and the complete control it affords of the inter-implant positions.

A drawback of guided surgery is the higher cost. In addition to the expense of the guide itself, the intraoral scanner and CBCT scanning equipment involved in producing the data needed to fabricate a surgical guide require significant financial investments.