A Surgical Guide Template is not a substitute for a Brain!

Surgical Guide Templates like those provided by F.I.R.S.T. Laboratories can change the way you practice dentistry.  They are after all the key component in one-visit implant surgery and crown placement procedures.  But, the MDI surgical guides do have their limitations.  No matter how perfect these templates are designed the self-tapping nature of the system requires that the pilot hole be minimal.  As the Mini Dental Implant advances in the bone past the pilot hole terminus which course does the MDI take?  The answer we would all like is that it continues in the same path until final placement; alas this is often not the case.  The MDI also is not completely restricted by the surgical guide template.  This means that the MDI may deflect and course a different path than intended if it comes in contact with dense trabecular bone or other bony variations.  The good news is that it is often quite easy to keep the implants on the right path.  The trick is to realize that a surgical guide template is not a substitute for a brain…in other words, as you place the MDI be cognizant of the implants progress with respect to angulation and direction.  Here are some tips.

Before you use a surgical template ask yourself the following:

1. Does the template look right?
   
2. If I follow it will I likely perforate the buccal or lingual cortices?
   
3. Will I be angled too closely to a tooth? 

During Placement do the following:

1. Use firm apical pressure while deliberately placing the MDI.
   
2. Stay in the middle of the template.
   
3. If you start to veer off course you can correct the placement by putting pressure on the tool in the direction opposite that you want the MDI to go (to change course toward a distal direction of the implant tip put mesial pressure on the wrench while pressing in an apical direction.
   
4. Remove the template to check progress periodically.

The bottom line is if it doesn’t look right you should stop, reverse the implant, redirect or re-drill if necessary.  If the template is not working don’t use it.  Not every case is a great choice for a guided surgery option and sometimes you unfortunately can’t tell until you are in the middle of it.  When performed properly MDI placement can be very easy but your continuous concentration is important to the technique sensitive protocol.  Call or email me if you need any more advice and Good Luck!