Surgery

The plan,made physical.

In short

A surgical guide is the plan turned into an object — so what was decided on screen is what happens in the mouth.

The CBCT scanner, the intraoral scanners and the face scanner are all in the practice, so every record is taken in a single appointment. The CBCT shows the bone. The intraoral scan shows the teeth. Merged, they show both at once — and that is the only view in which an implant can be placed where the final tooth needs it rather than where the bone is most convenient.

Once the position is decided, it is printed: a guide that seats on teeth, mucosa or bone and carries the drill to the planned depth and the planned angle. In full-arch cases the guides stack, so one reference carries through extraction, bone reduction and placement.

The benefit is not speed. It is that the position was argued over on a screen, at leisure, instead of being judged through a flap under time pressure.

  • Position decided by the finished tooth — not by the shape of the bone.
  • Flapless where the anatomy allows — less swelling, faster recovery.
  • Immediate provisionals become predictable — because the position is known in advance.
The difference

Same implant. Two ways in.

Freehand, the position is judged at the moment of surgery. Guided, it has already been judged — and the surgery only carries it out.

In freehand placement the surgeon works from the open field, from experience, and from a scan studied beforehand. It is a perfectly valid method and in many cases it is enough. What it does not offer is repeatability: the same decision, taken twice, does not produce exactly the same position.

A guide removes that freedom precisely where it is expensive — in the last millimetres. And millimetres are not a technicality: they are the distance to the inferior alveolar nerve, the thickness of buccal bone that will hold the gum line in place for years, the root of the neighbouring tooth, the floor of the sinus, and whether the screw of your crown emerges through the chewing surface or through the front of the tooth.

The comparison below comes from a systematic review and meta-analysis of clinical studies: how far the implant that was actually placed sits from the implant that was planned.

Angular deviation
Freehand
7.46°
Fully guided
2.57°
Deviation at entry
Freehand
1.56 mm
Fully guided
0.72 mm
Deviation at the apex
Freehand
2.22 mm
Fully guided
0.88 mm

Pooled mean deviations between the planned and the final implant position, for freehand placement and for fully guided placement with a static guide. Systematic review and meta-analysis, International Journal of Implant Dentistry, 2025.

In the field

Less trauma

Where the anatomy allows it, the implant goes in without opening the gum. Less pain and swelling, fewer painkillers, a quieter next day.

In time

Shorter surgery

No time spent raising a flap, suturing, or measuring between steps. The time has already been spent — on screen, before the day of surgery.

In the prosthetics

The tooth comes first

The implant is placed beneath a tooth that has already been designed. The screw emerges where it should, and the emergence profile does not need correcting later.

In the restoration

Same-day provisional

When the position is known beforehand, the provisional can be made before surgery and screwed on the same day, provided primary stability allows it.

A guide does not replace the surgeon. It removes the need to improvise. And when the field shows something the plan did not, the plan changes — the guide is a tool, not a binding contract.

How it goes

Step by step.

First

Records

All taken here, on the same day: CBCT, an intraoral scan on one of the practice’s two scanners and, where needed, a face scan. They are then merged into one model showing bone and teeth in the same coordinates.

Then

Prosthetic plan

The finished teeth are designed first. Only then are the implant positions placed underneath them.

Then

Guide design and printing

Tooth-, mucosa- or bone-supported as the case requires. Stackable for full-arch work. Its seating is checked before the day of surgery.

Finally

Fully guided placement

Drilling through the guide to the planned depth and angle — and, where the system allows it, to the planned rotation. Torque and stability are recorded.

The tools

Two planning platforms.

Why two

Software does not decide where the implant goes. It decides what kind of guide can be built — and how much of the data survives all the way to the finished tooth.

Planning is done in two environments, depending on what the case demands. One is open to every implant system and has the most carefully engineered guide design of any platform. The other is closed around a single system, and precisely because of that it can control something the rest leave to chance: the rotation of the implant.

They are not rivals. They are two different answers to the same question, and the case decides which one is used.

Platform 01

SMOP · Swissmeda

A Swiss planning platform that runs inside the browser — nothing to install, and the case opens from anywhere. What sets it apart is not the screen; it is the design of the guide itself.

  • A “light” construction built on defined contact points. The guide is not a solid shell that grips everywhere; it rests on specific, chosen points. It seats one way only, seating can be confirmed by eye, and the field stays visible and irrigated.
  • No radiographic scan template. No separate template has to be made before the CBCT — one appointment and one laboratory stage fewer.
  • An open library of systems. The planning does not dictate the implant; the implant is chosen for the case.
  • Stackable guides. For full arches and immediate loading: extraction, bone reduction, placement and the provisional all share a single reference.
  • The case is shared. Surgeon, prosthodontist and technician see and comment on the same plan before the implant goes in, not after.
  • Where it wins: freedom of implant system, and complex full arches.
Platform 02

R2GATE · MegaGen

A closed but complete loop: planning, guide, surgical kit, implant and prosthetic components all belong to one line and speak the same language. That allows something an open guide struggles to do.

  • Hex position control. The guide sets not only where and how deep the implant goes, but which rotation it stops in — through a window in the guide and matching markings on the implant carrier.
  • One body, no metal sleeves. Drill hole, depth stop and rotation control are a single piece — fewer tolerances, fewer parts that can shift.
  • A restoration made in advance. Because the rotation is known before surgery, abutment and provisional can be manufactured beforehand and seated the same day.
  • One design, one chain. The same file runs from the tooth design to the guide to the laboratory, with no conversion between systems.
  • Where it wins: immediate restoration with components ready before surgery.

The choice is made per case, and it is made before the records are taken rather than after. The criteria: which implant system suits this particular bone, whether there will be a restoration on the same day, and how many stages need to share one reference.

The third dimension

An implant has more than a position and a depth. It has a rotation.

Inside every implant there is a hex — the socket the tooth is screwed onto. It is not round: it engages in six defined orientations. If the implant comes to rest turned differently from what the plan assumed, a tooth made in advance will not fit, and the stage that was meant to happen the same day is postponed.

Freehand, rotation is whatever the bone gives you: the implant stops where it stops. With most guides, position and depth are controlled but rotation is still left open. Hex control closes that gap — and it is the reason a restoration can already exist before the surgery begins.

For a patient it translates into one thing: fewer return visits for something that could have been anticipated.

Cases

Treated here.

All cases

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