A widely published researcher and international lecturer, Prof. Alessandro Pozzi is an Adjunct Associate Professor at Augusta University’s Goldstein Center for Esthetic and Implant Dentistry. In this lecture from the Nobel Biocare Global Symposium, Prof. Pozzi presents his practice’s guidelines on when they consider the implant site to be suitable for static, template-assisted guided surgery, and when dynamic navigated surgery with X-Guide is well suited. To demonstrate this, he presents one clinical case in which a static surgical template was used in the maxilla and X-Guide navigation in the mandible.

Video presentation

 

Static guided implant surgery or a dynamic navigation system: When to use which?

Prof. Pozzi outlines that he uses a template for static guided implant surgery in these situations:

  • In the anterior zone, particularly in the upper jaw, when they prefabricate teeth;
  • Whenever strategic teeth can be kept in a patient with terminal dentition;
  • For patients who possess an edentulous maxilla because of the wide area that can support the template; and
  • When there is no need for massive bone and soft tissue augmentation.

But in which situation does dynamic navigation offer a particularly beneficial solution? Prof. Pozzi prefers the system in the following scenarios:

  • Single and partially edentate patients;
  • If a patient has terminal dentition and no strategic teeth can be kept; and
  • For patients who possess edentulous mandibles.

The case study presented

Prof. Pozzi maintains a private practice in Rome, Italy, where he had a patient with terminal dentition requiring extensive treatment. Understandably, the patient wanted minimal invasiveness, short treatment time, and fast healing.

In the case presented, he quickly began the treatment planning with DTX Studio™ Implant. Several of the patient’s teeth in the upper jaw were able to be saved, and with these strategic teeth, it was possible to plan TempShell provisional restorations for immediate loading on the day of surgery. The strategic teeth also made the use of template-assisted guided surgery possible.

The dentition specifically designed by DTX Studio Implant for the lower jaw, however, was not in line with the patient’s existing tooth anatomy, making it impractical to keep any of the existing teeth.

According to Prof. Pozzi, when using a template, the implants cannot be positioned between two alveolar sockets, as the drill is likely to slide out of position. However, he makes clear that he does not want to be forced to change his decision making to meet the needs of digital technology: he wants digital technology to meet his demands and the patient’s needs. And, for this reason, he chose to use X-Guide to perform dynamic navigated surgery in the lower jaw, not a static template.

Conducting navigated surgery without a template allows for this kind of positioning, provided the trajectory outlined by X-Guide is closely followed. Doing so in this patient’s case allowed for an optimal biological environment to be established for the restoration that encourages soft tissue growth and healing.

A NobelProcera zirconia framework was created for the final restoration and as Prof. Pozzi showcases, the outcome for the dynamic navigated surgery achieved the same level of success as the static guided template.

Training courses with Alessandro Pozzi

Prof. Pozzi is providing training courses in the X-Guide navigation system in 2020. Contact us for more details on the upcoming courses.

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Posted by Chris Kendall