Limitations of tube-based surgical guides

CT-based surgical guides work well when they work, however tube guides face significant limitations in many situations. In our survey of 12,000 implant-placing doctors, the 875 respondents consistently faced these limitations:

• Visual and physical access: 97% would prefer to have a guide that allowed them to clearly see and work with the drill site. Most surgical guides have tubes and a flange that inhibit visibility and access.
• Vertical space in posterior cases: 77% were frustrated by the need for additional clearance. Respondents said they chose not to order a guide in 30% of cases because of vertical constraints.
• Reliability: 18% of the guides received are discarded before surgery.

Based on our experiences and in speaking to other surgeons, the reliability issue can be attributed to a number of factors, each of which we have addressed in our ThinLayer™ Guide design:

1. Planning error: Sometimes the virtually planned case looks good online, but it just doesn’t look right in the mouth. There can be visual discordance between the virtual plan and the mouth. Click here for a further discussion of tools we have developed to minimize planning error.
   
2. Inadequate vertical space: Most clinicians do not consistently measure the maximum inner incisal opening of our patients as part of a pre-surgical plan. There are situations where this issue is not appreciated until the surgical appointment. Click here for more information on vertical space requirements when drilling freehand or with our ThinLayer™ Guide system.
   
3. Poor fit: Most guides on the market are printed with stereolithography, and the resin can be subject to warping with heat, moisture, and time. We do not “print” our guides, which avoids these material issues, and allows for a thinner guide and more secure fit.
   
4. Can’t modify guide: Sometimes you want to modify the entry point or trajectory in surgery. Tube guides cannot be modified – either you go with the trajectory the tube guide gives you or you can’t use the guide.

Non-technical barriers to adoption of current tube guides on the market include:

• Upfront cost: The upfront cost of the software and surgical kit is a barrier to adoption, running $5,000-10,000 before using the first guide. Some reported receiving discounts based on the amount of guides they would commit to.
• Ongoing cost: Most surgeons pass the cost of the guide through to the patient, and 95% said the incremental cost was too high to justify use in most 1-2 implant cases.
• Customer service: Although not specifically queried in the survey, many doctors wrote in comments about the inadequate level of service received in guided cases.

Please visit www.guidedsurgerysolutions.com for further discussion on this and other topics related to guided surgery and surgical guides.