A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Advancing Guided and Free-Hand Techniques in Implant Therapy

Explore the latest advancements in implant placement procedures, including static and dynamic computer-aided techniques.


There are many benefits of cone-beam computed tomography (CBCT) —including inexpensive cost, relatively low radiation, and convenience of use — for patients undergoing implant therapy. The three-dimensional (3D) image produced by a CBCT scan can also be used by oral health professionals as an effective visual tool while educating patients chairside about recommended restorative treatment.1

Data from CT scans are used in virtual implant planning systems to evaluate bone volume, while 3D computer models are used to create the implant-retained prosthesis and surgical guidance. Guides may be fabricated using a model base or through a rapid prototyping technique. Surgical templates using model-based guides are fabricated manually or using computerized technology by milling or laser printing, and can be used with a traditional flap or flapless implant procedures (Figure 1).2,3

FIGURE 1. Surgical implant guide used with flapless
implant placement.

The guide is built to provide stability as the implant is drilled into the bone and eliminates the margin of error by restricting the permitted range of route trajectory and depth for exact placement.4,5 Several variables must be considered with any implant insertion technique, including the clinician’s expertise, condition of the patient’s hard and soft tissues, patient’s overall health, and nature of the surgical treatment itself, as they can affect the long-term clinical performance.6

As implant insertion accuracy-enhancing technologies gain significance in restorative dentistry, oral health professionals must become knowledgeable about implant placement procedures. Free-handed implant placement involves osteotomy preparation and implant insertion, which are both done by hand, with no surgical guides to affect the path of implantation into the recipient site.7

Cast-based partially guided implant placement uses a prosthetically driven nonrestrictive surgical guide while bone bed preparation and implant insertion are done freehand.These guidelines are made from dental casts and don’t consider the underlying bone shape.

When the drill partially guided implant placement method is used, although the implant insertion is done by free hand, the bone bed preparation is directed by a restricted prosthetically driven surgical guide designed with the underlying bone shape in mind.7

The static computer-aided implant placement uses a completely guided method that includes both restricted osteotomy preparation and implant placement using a prosthetically driven surgical guide that was created with preoperative computed tomographic and stereolithographic data.7,8

Finally, the dynamic computer-aided implant placement is a completely guided method for both osteotomy preparation and implant insertion using a surgical navigation system that immediately reproduces the virtual implant location using computerized tomographic data and allows for intra-operative alterations.7,8


  1. Gupta J, Ali SP. Cone-beam computed tomography in oral implants. Natl J Maxillofac Surg.2013;4:2-6.
  2. Weiss R 2nd, Read-Fuller A. Cone-beam computed tomography in oral and maxillofacial surgery: an evidence-based review. Dent J (Basel).2019;7:52.
  3. Kernen F, Kramer J, Wanner L, et al. A review of virtual planning software for guided implant surgery – data import and visualization, drill guide design and manufacturing. BMC Oral Health. 2020;20:251.
  4. Naeini EN, Atashkadeh M, De Bruyn H, D’Haese J. Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance. Clin Implant Dent Relat Res. 2020;22:454–467.
  5. Chrcanovic BR, Albrektsson T, Wennerberg A. Flapless versus conventional flapped dental implant surgery: a meta-analysis. PLoS One.2014;9:e100624.
  6. Gao X, Qin S, Cai H, et al. Comparison of general and aesthetic effects between flapless and flap techniques in dental implantation: a meta-analysis of randomized controlled trials. Int J Implant Dent. 2021;7:100.
  7. Nibali L, Gkranias N, Mainas G, Di Pino A. Periodontitis and implant complications in diabetes. Periodontol 2000. 2022;90:88–105.
  8. Kalaivani G, Balaji VR, Manikandan D, Rohini G. Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: evidence-based literature review. J Indian Soc Periodontol. 2020;24:398–408.

This information originally appeared in Monchik C, Marsh I. Innovations in implant therapy. Dimensions of Dental Hygiene. 2023;21(3)34-37.


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