Clinical evidence and Science 47 Guided surgery and CAD/CAM workflow The possibility of accurately digitizing the oral situation by cone beam computed tomography (CBCT) and intra-oral scanning allows the surgeon and prosthodontist to virtually plan the implant position as well as the prosthetic restoration. With this progression, the patients can be treated less invasively and often with less treatment visits. The 3D based diagnosis of the existing bone and the anatomical situation, e.g., the inferior alveolar nerve, helps for an optimal position planning of the dental implant and for a predictable prosthetic outcome. For the Guided Surgery procedure with the support of a surgical drill template, guiding sleeves, guided drills, instruments, and implants are available in the portfolio of the CAMLOG® and CONELOG® SCREWLINE as well as PROGRESSIVE-LINE Implant Systems. The most commonly used implant planning software include the dimensions of Camlog’s guided implants. Secondly, for the preparation of individualized CAD/CAM abutments and restorations, system specific CAM blanks are available, in some countries even including CAD/CAM services (e.g., DEDICAM®). Accuracy of the CAMLOG® and CONELOG® Guided Systems During the multi-step process in the planning of an implant position from the CBCT, through the virtual planning in a software and the fabrication of a drill template inaccuracies during transfer may occur. A study group around Schnutenhaus et al. tested the accuracy of Camlog’s guided implant system with a procedure of superimposing the data of the virtually planned versus the actual achieved implant position and published several papers. Measurements were done on the 3D deviations between the implant positions relating to the radial deviation (implant shoulder and apex), the axial deviation (angular) and the vertical height deviation (Fig. 20). In a retrospective evaluation of 56 patients with 122 CAMLOG® SCREW-LINE implants, the aim was to assess the 3D deviations of the implant position as a function of type of edentulous space, residual dentition, and surgical protocol (gingiva punch versus full flap surgery) (1). A regression analysis revealed only one significant impact: i.e., the presence of adjacent natural tooth had an influence on the height and angle of the implant position. The overall results showed adequate accuracy of template-guided implant placement which were in the same range as seen in other studies. Due to the possible deviations, it was highlighted to keep appropriate safety distances from anatomical structures at risk while planning the implant positions. A conclusion which was also made by Beretta et al. 2014 who investigated the accuracy of CAMLOG® Guide in situations of treating edentulous jaws with drill templates fixed with surgical pins (2). Use of digital workflows in implant treatment with advantages in case planning and execution lead to more predictable implant and restoration outcomes. DIGITAL WORKFLOW
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