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An open approach to evaluate the accuracy of surgical guide-

based implant surgery
Siyu Wang BS,a and Shengtao Yang, MSb

Postoperative accuracy evaluation is sometimes an es­

sential part of surgical guide-based implant surgery,
especially for patients with limited bone volumes or
closely adjoining anatomic structures.1–3 Accuracy eva­
luation is typically conducted by using implant planning
software programs that have built-in evaluation mod­
ules.4 However, such evaluation modules are often
closed-loop or absent from some surgical planning
software programs, which restricts their application in
clinical practice.2 Although some third-party software
programs could also be used, the additional learning
curve should be considered.2 This article describes a
straightforward and open approach to evaluate the
postoperative accuracy of surgical guide-based implant
surgery, where only 1 implant planning software pro­
gram is needed and no extra evaluation module is re­
quired. This approach could be easily integrated into
most available implant planning software programs.

TECHNIQUE
The approach is illustrated by describing a patient re­
ceiving surgical guide-based implant surgery in the
maxillary right central incisor region.
1. Plan the implant position driven by prosthetic con­
siderations in the implant planning software program
(Implant Studio; 3Shape A/S), select the matching
guide sleeve and generate the surgical guide, and
save it as a standard tessellation language (STL) file Figure 1. A, Preoperative implant planning and surgical guide design.
(Fig. 1A). Print the guide with a 3-dimensional (3D) B, Surgical guide-based implant bed preparation.
printer (UltraCraft A2D; Heygears). Place the implant

The authors confirm that this manuscript is original, not under consideration elsewhere, and free of conflict of interest.
This work was supported by Sichuan University [SCU10374; 202310610205].
a
Undergraduate student, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, PR China.
b
Dental Technician, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of
Stomatology, Sichuan University, Chengdu, Sichuan, PR China

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Figure 2. A, Preoperative surgical guide design data and postoperative CBCT scan data superimposed, and preoperative implant position
reproduced in postoperative CBCT by using reserved space of sleeve on surgical guide as reference. B, Deviations between planned and placed
implants evaluated using measurement tools offered by implant planning software program. Coronal global deviation measured as 0.63 mm, apical
global deviation as 0.66 mm, and angular deviation as 1.35 degrees. CBCT, cone beam computed tomography.

THE JOURNAL OF PROSTHETIC DENTISTRY Wang and Yang

Month xxxx
through the surgical guide and obtain the post­
operative cone beam computed tomography (CBCT)
scan data (Fig. 1B).
2. Create a new order in the implant planning software
program and superimpose the STL file of the surgical
guide with the postoperative CBCT scan using the
preoperative cast scan as a reference. Select the same
implant and guide sleeve as in the preoperative
planning and then adjust their position to ensure the
selected sleeve is superimposed on the reserved space
of the sleeve on the surgical guide; thus, the pre­
operative implant position is reproduced in the
postoperative CBCT scan data (Fig. 2A). Subse­
quently, deviations between the planned implant and
the placed implant can be evaluated by using the
measurement tools offered by the implant planning
software program. For this patient, the coronal global
deviation was measured as 0.63 mm by using the
described approach, while the apical global deviation
was measured as 0.66 mm and the angular deviation
as 1.35 degrees (Fig. 2B).5
Wang and Yang
3
REFERENCES
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Non-radiological method for three-dimensional implant position evaluation
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2. Liu Y, Ye H, Wang S, Zhang L, Zhou Y. An open protocol for evaluating the
accuracy of guided implant surgery by using digital casts. J Prosthet Dent.
2021;126:731–734.
3. Son K, Huang MY, Lee KB. A method to evaluate the accuracy of dental
implant placement without postoperative radiography after computer-guided
implant surgery: A dental technique. J Prosthet Dent. 2020;123:661–666.
4. Varga Jr E, Antal M, Major L, Kiscsatári R, Braunitzer G, Piffkó J. Guidance
means accuracy: A randomized clinical trial on freehand versus guided dental
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5. Kaewsiri D, Panmekiate S, Subbalekha K, Mattheos N, Pimkhaokham A. The
accuracy of static vs. dynamic computer-assisted implant surgery in single
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2019;30:505–514.
Corresponding author:
Shengtao Yang, Department of Dental
Technology, West China Hospital of
Stomatology, Sichuan University, 14
Renmin South Road, 3rd Section,
Chengdu, Sichuan 610041, PR CHINA.
Email: 18328347164@163.com.
Copyright © 2023 by the Editorial Council of The Journal of Prosthetic Dentistry.
All rights reserved.
https://doi.org/10.1016/j.prosdent.2023.05.031
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