The simple lab made planning guide

What is a surgical guide in implantology?

A surgical guide in implantology serves to translate the prosthetically planned position of an implant into a practical orientation for diagnostics and surgery. The guide supports the planning process, visualizes the desired implant axis and position, and can also be used for pilot drilling and marking the cortical emergence profile.

In modern implantology, a planning and/or surgical guide is an important communication tool for transferring the prosthetically appropriate implant position from the model to the clinical situation in the patient’s mouth.

Surgical guide from the lab: The easy way to a planning guide in implantology

It should be clear beforehand which diagnostic methods will be used as the basis for planning and how much the surgical guide will actually serve as surgical support. In many cases, a planning guide or orientation guide can also be fabricated in the lab using analogous processes. The starting point is a situational model, prosthetic planning, and a wax-up, from which a surgical guide for diagnostics and surgical orientation is created step by step.

Unlike fully digital workflows, this approach relies on classic dental laboratory techniques. This makes it particularly interesting for dental practices and laboratories that want to produce a simple surgical guide in the lab.

The Workflow: Creating the Treatment Template

1. Study Model and Prosthetic Planning

The process begins with the study model. This forms the basis for model analysis and prosthetic planning (Fig. 1). In a further step, the plan is adapted to the occlusal relationship and created in wax (Fig. 2). This wax-up shows what the final restoration could look like and where the implants should ideally be positioned.

This workflow helps to adhere to a fundamental principle of implantology: the implant should be surgically feasible and prosthetically viable.

2. Duplicate Model and Vacuum-Drawn Template

Based on the wax-up, a duplicate model is created, from which a vacuum-drawn template is fabricated (Fig. 3). Other template techniques are also possible. This demonstrates that the process can be integrated into existing laboratory workflows.

The template is then further developed and refined into a complete surgical guide.

This process is then further refined and used to create the final treatment template.

3. Template with radiopaque resin

In the next step, the template is filled with resin (Fig. 4). For planning templates, a radiopaque resin is recommended, for example, one containing 10 percent barium sulfate. This makes the template visible on X-rays and allows it to be used for further orientation.

This is a crucial point for diagnostics in implantology: The template is not only used as a dental laboratory aid but also helps to better determine the potential axis, position of the implant, and bone dimensions.

4. Drilling, drill sleeves, and pilot drilling

A key component of every drilling template is the defined guidance of the drilling. The model with the guide is aligned in the desired position and axis in the milling machine. Drilling is then performed with a template drill, matching the drill sleeve used (Fig. 5). Single sleeves, outer sleeves, and inner sleeves from the StecoGuide system are typically used.

Using template drills creates a press fit precisely matched to the geometry of the drill sleeves, so the sleeves are simply pressed in instead of glued. A pressing tool facilitates handling. This saves work steps and supports an efficient workflow in the laboratory.

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Fig. 5

Sleeve Selection

For use as a planning template, cylindrical single sleeves are recommended because they are easy to measure in radiographs and, unlike a sphere, can also convey axis information.

Such a simple drilling template can also provide surgical orientation. In the simplest case, the desired cortical penetration point of the implant can be marked. A spherical burr smaller than the sleeve diameter (ø 2.35 mm, standard drill shank) is sufficient for this.

Alternatively, the pilot hole can be drilled to determine the position and axis. Single sleeves, collar sleeves, inner sleeves, and CeHa inner sleeves, among others, are used for this purpose and are available in numerous diameters.

Particularly popular diameters for orientation templates are ø 2.35 mm (standard drill shank) and ø 2.0 mm for many pilot drills. Due to the lack of a radiographic basis, the orientation drilling template can only provide prosthetic orientation. The axial guidance of a pilot bore must therefore rely on further radiographic planning data and surgical experience, particularly regarding drilling depth. The funnel-shaped inner sleeves allow easy access for the drill.

Advantages of a simple analog surgical guide from the lab

The fabrication of the planning or orientation guide using standard lab equipment is possible. The guide serves as a simple communication tool between the dental technician and the dentist. It can be used both as a planning guide and as an orientation drilling guide. This approach is particularly attractive for teams that prefer a pragmatic and transparent workflow. Fabrication remains manageable, the planning becomes visible, and the transfer to surgical orientation is carried out with clearly defined steps.

  • No investment in software
    Conventional processes are already available in the lab
    Planning with dental technician expertise
    Easy communication between dental technician, dentist, and surgeon

Limitations of the Analog Workflow

However, there is no radiographic basis for planning in the sense of comprehensive, radiologically supported implant planning; the planning is purely prosthetic. There is no implementation of digital planning data, and the dental technician cannot see the actual bone structure on the model.

This means that anyone seeking fully digitally integrated implant planning with direct data transfer will not find this workflow sufficient. However, those who want to use a simple surgical guide for planning and orientation in an analog or hybrid setting will find this a readily understandable approach.

Conclusion: Effectively Combining Surgical Guides, Planning, and the Lab

A simple analog surgical guide from the lab combines prosthetic planning, wax-up, duplicate model, radiopaque planning template, and orienting surgical guidance in a straightforward workflow. In implantology, this lab-based approach can help plan the implant position and axis based on prosthetic experience and, if necessary, even support the pilot drilling. By communicating the requirements of all parties involved in the process beforehand, errors can be avoided, and ultimately, happy patients leave the practice with suitable dental prostheses.

This makes the workflow particularly interesting for users seeking a practical, easy-to-understand solution that can be implemented using standard laboratory equipment. Its strength lies in its simplicity, while its limitation is the lack of digital planning integration. However, this is precisely where the clear positioning of this concept lies.

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