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The Benefits of Digital Treatment Planning
and Guided Surgery in Conjunction with
Small-Diameter Implants
n 3-D view to determine the quality and quantity of bone
as well as identify critical structures
presurgically
n Minimally invasive procedure through a flapless
approach
n Accurate transfer of the digital plan to the clinical
setting utilizing a pilot surgical guide
Criteria for Flapless Approach
u ≥7 mm keratinized gingiva
u Adequate bone to encase
implant
u Appropriate diagnostic
work-up (e.g., CBCT)
Benefits of Flapless
u Minimally invasive
u Less potential for bone loss
as there is no disruption of
blood supply
and frequently aids in patient comfort.
If keratinized tissue is minimal, I
prefer to raise a flap to preserve what
tissue is there. If less than 3 mm of
keratinized tissue is present, incise
lingually to the band and leave it on
the facial of the implant. If more than
3 mm of keratinized tissue exists, split
the band, putting some on each side
of the implant. If you leave a small
gap in the surgical margins around
the implant at closure, this gap will
fill in with keratinized tissue, actually
increasing its width.
If the bone architecture is not ideal,
laying a flap is often necessary to
correct the situation. This may require
alveoplasty to broaden and flatten
the ridge, or grafting to increase the
ridge width. These procedures may be
impossible without a flap.
Finally, use technology to make your
flapless approach successful and accurate.
CBCT scans are present in most
dental communities, and laboratory
support is readily available to facilitate
guide fabrication. This takes the
guesswork out of implant placement.
Although I am reluctant to admit it,
some of my most esthetic implants
have been placed with a surgical guide
based on CBCT analysis.
So when you have all three —
abundant keratinized tissue, favorable
bone architecture, and prior 3-D
planning — go for it! There is nothing
like that satisfied smile, especially
when it’s yours. IM
If the bone architecture
is not ideal, laying a flap
is often necessary to
correct the situation.
Benefits of Flapped
u Direct visualization
u Ancillary procedures
(e.g., grafting)
Figure 3: 3-D treatment planning technology
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