- Non-guided = “free-hand” approach.
- Experienced skills in implant dentistry.
- Profound knowledge of oral anatomy.
- Radiologic evaluation of implant site (panoramic x-ray and/or CT scan).
- Reduced costs for the patient.
The experienced surgeon may place implants non guided, i.e. in a “free-hand” approach. Especially in the early phase of the learning curve it may be advantageous not to force this approach as a guided-approach facilitates correct implant positions.
However, the free-hand approach is subjected to “easy” cases with sufficient amount of bone.
In cases of implant placement without a CT or CBCT scan, insufficient amount of bone may present after surgical incision and elevation of a mucoperiosteal flap. Additional costs would arise for the patient as simultaneous augmentation and implant placement or a 2-stage approach is indicated.
Limitations of this approach are that incorrect positioning of the implant may drive it useless for prosthetic rehabilitation – in severe cases even with angled abutments, damage to adjacent teeth, damage to neurovascular structures and loss of primary stability due to multiple correction of the position (after the first drill). In order to avoid the latter it is advisable to not prepare until the full length of the implant with the first drill and instead to check the axis (three-dimensional) after 6 mm (or even less).
Conventional free-hand implant placement reduces the costs for the patient, as a CT scan with consecutive virtual planning and printing of a surgical template are not required.
Studies have compared the accuracy between guided and conventional implant surgery and found significant differences in favor of guided protocols (Nickenig et al. 2010; Kramer et al. 2005; Hoffmann et al. 2005). As non-guided implant placement necessitates more experience, its use will be restricted to the experienced surgeon and “easy” cases. However, a panoramic x-ray and/or CT scan is important to allow identification of bone height and anatomic landmarks. Bone width may only be estimated by clinical palpation and intraoral measuring (in case of no available CT scan), which is strongly influenced by tissue width and may render false positive values of bone width.
Figure 1: Intermediate gap region #36 (#19 UNIV) Figure 2: Clinical situation after raising a mucoperiosteal flap Figure 3: Control of implant position: the direction indicator points to mesiopalatal cusp of the first upper molar
F igure4: Implant bed preparation Figure 5: Inserted implant in region #36 (19 UNIV) Figure 6: Wound closure with single and criss-cross sutures