I have been restoring more and more implants lately. The placement is often substandard.
The frustration you're feeling and what you are describing is exactly why I started planning services.
QUOTE="user name, post: 307517, member: 1719"]
Ive said it before...no need for a surgical guide. If I could just provide a model and draw a red circle where the tooth is missing we'd be ahead.
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Without 3d scan data your red circle is merely a suggested position. Without seeing the condition of the cortical plates, nerve channel, sinus walls, and other anatomical features specific to each patient's condition it's a guessing game.
2d xrays give some information, but scant at best. I attended a radiology lecture once where the instructor posted a 2d xray of what appeared to be a perfectly integrated implant. When he asked the crowd how it looked they all agreed that it was 'textbook'. That's when he informed us that it was a cadaver and he placed the implant inside the cheek and took the xray a few times to get the image just right. His lesson was that 2d xrays can be deceiving depending on the angle of the exposure.
I get 'esthetic' cases to restore anterior teeth with implants placed at wild angles centered interproximally.
Bone level implants right at tissue level.
This is why it is important to do a digital work up or even a hand wax up and scan it to merge with the CBCT data. Implants can be planned and placed as ideally as the patient's anatomy and/or wallet will allow.
3d scan data would let you know in most instances if the platform is too close to the tissue crest.
If the surgeon doesn't have landmarks to orient themselves with, it's a crap shoot if the will be able place the implants ideally for aesthetics. With 3d data sets and digtital work up it is possible to see before the surgery if the implants will be at wild angles or in the embrasure areas. We've had cases that appear to have adequate width buccal/lingual only to get a ct scan and find the ridge is nearly as narrow as a credit card.
Ive talked to the Dentists about these, and the standard answer is, 'They are a surgeon. Theyre doing the best that can be done'.
I've heard it said that an implant case is a success when the patient pays the lady at the desk up front. It's not uncommon to have an old school surgeon say I've veen doing it forever without a guide with success. Point them to the facepalm thread here. Realistically, how much experience do you think a surgeon has restoring their own implants? If they did you would see much better placements.
Without digital planning and the information that brings to the case they are NOT doing the best that can be done.
Does anyone think an attorney would buy it, the best that could be done? The attorney's first question would be did you use a surgical guide? Oh, you're a surgeon, you did the best you could do. Would you like to tell the jury why you didn't use all of this technology available to you? Lol
It all lands in the techs lap, and they wonder why the lab monkey cant do better.
Get involved, steer the boat rather than going with the flow.
Do something about it!