IMPLANTOLOGY
Dental Implants and Guided Surgery
Guided surgery allows implant positioning to be planned in advance using 3D data, in order to improve precision, safety, and treatment predictability.
Schedule an initial consultation →Key points
Guided surgery allows the virtual planning of implant positioning before the procedure, based on 3D data (CBCT and digital impressions).
At the 47VH clinic in Nice, we use this technology when it provides a real benefit—complex cases, aesthetic zone, immediate loading—without systematic use in order to avoid unnecessary additional costs.
What is guided implant surgery?
Traditionally, the practitioner places dental implants using visual landmarks and measurements taken directly in the mouth.
Guided surgery goes further: using radiological data (CBCT) and a digital impression, we virtually plan the position of each implant before the procedure. We then fabricate a custom surgical guide, which is placed in the mouth on the day of surgery. This guide directs drilling and implant insertion with precision, according to the pre-established plan.
Advantages of guided surgery
- Optimisation of available bone volume, which often makes it possible to avoid a bone graft.
- Precise three-dimensional positioning — particularly useful in complex cases
- Flapless placement in selected cases, which reduces post-operative discomfort
- Fabrication of a provisional prosthesis before the procedure, allowing for immediate loading at the end of surgery.
Limitations of guided surgery
- The surgical guide occupies space in the mouth and may make instrument positioning more difficult.
- If bone quality is insufficient in the planned area, we remove the guide and proceed without guidance.
- When a bone or gingival graft is required, the guide becomes unusable—we must remove it to access the treatment site.
- The cost of the surgical guide is added to the overall treatment budget.
Three-step protocol
Planning
We merge radiological images (CBCT) with a digital impression of the jaw in a 3D planning software. This allows us to precisely define the ideal angle, depth, and position of each implant.
Fabrication
We transmit the data to a specialized manufacturing center, which produces a custom drilling guide in biocompatible material. In parallel, the laboratory may fabricate a provisional prosthesis intended for immediate loading.
Surgery
On the day of the procedure, we place the guide on the remaining teeth or secure it directly to the jaw. It directs drilling and insertion of the implant according to the pre-established plan. Once the implant is placed, we remove the guide and, if a provisional prosthesis has been prepared, we immediately screw it into place.
When do we use a surgical guide?
We recommend guided surgery only when it provides a demonstrated clinical benefit—complex cases, aesthetic zone, immediate loading, or high-risk anatomy. It does not replace the clinician’s experience: the fundamentals of implant surgery remain essential, with or without a guide.
Clinical case
Guided implant surgery
Bibliographic References
- Tahmaseb A. et al. — The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis. Clin Oral Implants Res, 2018. PubMed PMID 30328191
- Vercruyssen M. et al. — Guided surgery: accuracy and efficacy. Periodontol 2000, 2014. PubMed PMID 25123771
- Bornstein M.M. et al. — Cone beam computed tomography in implant dentistry. Int J Oral Maxillofac Implants, 2014. PubMed PMID 24660190
- Gallucci G.O. et al. — Consensus statements and clinical recommendations for implant loading protocols. Int J Oral Maxillofac Implants, 2014. PubMed PMID 24660204
- Li J., Yin X., Huang L., Mouraret S., Brunski J.B., Cordova L., Salmon B., Helms J.A. — Relationships among bone quality, implant osseointegration, and Wnt signaling. J Dent Res, 2017. PubMed PMID 28571512
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Dr Sylvain Mouraret’s opinion
In my practice, guided surgery is particularly useful when it allows precise adherence to the prosthetic plan. It helps control implant angulation, emergence profile, and implant positioning, while also making the procedure more predictable and streamlined. However, it is not essential in all cases, especially when anatomical landmarks are straightforward and implants can be placed reliably without a guide. We therefore select the most appropriate technique for each situation, with or without a surgical guide, avoiding any additional device unless it provides a clear clinical benefit.
FAQ
Is guided surgery systematically used at the clinic?
No — we only use it when it provides a real clinical benefit.
In many situations, our clinical experience combined with 3D imaging planning is sufficient to ensure optimal implant positioning. Therefore, we only propose guided surgery when it clearly improves precision or safety.
Is guided surgery more precise than conventional surgery?
Yes—it improves implant positioning accuracy, particularly in complex cases.
However, it does not replace the clinician’s expertise. If the actual bone conditions differ from the preoperative plan, we can remove the guide and adapt our approach in real time.
Is guided surgery painful?
No—it is performed under local anesthesia, like any implant procedure.
In some cases, the guide allows implant placement without raising a flap. This minimally invasive approach reduces post-operative discomfort compared to conventional surgery.
How long does treatment planning take before surgery?
Virtual planning and guide fabrication generally take one to two weeks.
After CBCT imaging and digital impressions, the data are sent to the manufacturing centre. This is why guided surgery is planned in advance during the pre-implant consultation.
Does guided surgery increase treatment cost?
Yes—the surgical guide represents an additional cost.
However, in situations where it avoids bone grafting or enables immediate loading, it may reduce the overall number of procedures and therefore the total treatment cost. We evaluate this on a case-by-case basis during the treatment planning stage.
Can a provisional prosthesis be placed on the same day with guided surgery?
Yes — this is one of the main advantages of this approach.
Because implant positioning is digitally planned in advance, the laboratory can fabricate a provisional prosthesis before the surgery. It is then immediately screwed in at the end of the procedure, allowing for immediate loading on the day of implant placement.