Tools of the Trade

Nov 16, 2016 No Comments by

Increase Precision and Productivity with Surgical Guides.
My career in the dental industry started when I worked as a dental assistant for about five years. As a dental assistant, I specialized in implants—I did all the implant surgeries with the dentist. So when I took a job with Arrowhead Dental Lab, it was a natural fit for me to join the implant department.

It’s been about four years since I started in that role at Arrowhead, checking in cases and loading impressions, and now I work as the Guided Surgery/Implant Specialist, creating the surgical guides. Aesthetic Dentistry asked me to discuss some details about my job and how the surgical guides may offer benefits to doctors and patients alike.

What Is A Surgical Guide?
The surgical guide is exactly what its name suggests: it’s a guide that doctors can use for implant placement and implant surgeries. It helps refine angulation and placement so that implant placement is precise.

It is incredibly beneficial for new doctors learning to place implants. But it is useful for more seasoned doctors as well, because of the predictability it offers.


When creating a surgical guide, Arrowhead uses cone-beam scans from the doctor. With the scans, we can see a 3D image of the patient’s mouth, rather than just a 2D image available with an x-ray. The scans are great because we see all aspects of the patient’s bone when we place the implants in the software—it gives the doctor precise implant placement. It also makes implant surgeries super quick and easy, therefore the doctor doesn’t have to reserve so much time for surgery. With the surgical guide, he or she knows ahead of time exactly where the implants are going to be placed, and it limits the number of surprises that happen during the surgery.

The surgical guide is made from our 3D printers. It is made out of VarseoWax (the material used in the 3D printer), and fits similar to a night guard. Doctors slide it into the patient’s mouth and it just pops into place. The actual guide has little metal sleeves that show where the implants are to be placed. The doctor also gets a printout showing where the implants are in the bone.

Simplifying the Process
In my previous job as a dental assistant, I worked with a dentist who did not use guided surgery. Instead, he just case-planned all of our cases, working off x-ray images. We lacked a 3D image, and that made the process somewhat more difficult and time-consuming.

For our implant surgeries, the doctor would do one drill, then stop and take an x-ray to see where we were at with that drill. Then he would do the next drill, stop, and take another x-ray to see where we were at with that drill. Once he got the implant placed, the dentist would take still another x-ray.

If the implant was in the proper position, everything was great. If not, we would pull the implant out and drill some more, and then continue the process (drill, stop, x-ray) until the placement was correct. This is a common process that many dentists follow when placing implants.

I wasn’t aware of surgical guides until I started working at Arrowhead. With the surgical guide, the implant process is simpler and more precise. During the surgery, the dentist takes as many drills as he or she needs to, depending on the implant size. For example, if the doctor is doing a 3.0 implant, he or she may have a 2.0 drill, a 2.3 drill, and 3.0 drill (three drills).

A surgical guide helps doctors refine angulation and placement, so implant placement is precise.


With the surgical guide, the dentist puts the guide in, does all three drills, places the implant, and takes just one final x-ray to verify that the implant is where it should be. It’s straightforward for the doctor and more comfortable for the patient.

How It Works
Getting started with surgical guides is easy. Generally, the process begins with a phone call from a doctor asking about the implant guide. Then I send an information packet to the doctor with details about what exactly is needed to get started.
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At Arrowhead, we request a cone-beam scan and models of whichever arch the doctor is working on. After I receive the models, I upload the cone-beam scan into my software, do a model scan, and merge those two files together. From there, I virtually place the implants in the software. After this preliminary work, I send the image to the doctor for approval. Although the process typically begins with a phone call, most of the subsequent communication is done via e-mail. E-mail is the easiest way to communicate because we usually send screen shots or photos back and forth.

There are a few different ways for the doctor to approve images. I can send the doctors screen shots, or I can arrange a GoToMeeting™ or TeamViewer meeting and the doctor can view the image of the implant guide in screen share.

With TeamViewer or GoToMeeting™, the doctor and I can review details of the case simultaneously. If the doctor has an iPad, he or she can download an application that will show the image on the screen.

The doctor can’t make any changes to the image, but he or she can view it and rotate the pictures to see it from all angles. Then the dentist can call me and request any additional changes. Often, there is a back-and-forth discussion so the doctor can get a clear picture of the complications that might arise, and he or she can prepare in order to achieve the best outcome.

If doctors need help or have questions about the surgical guide, they can call and talk to me anytime.


Once the image meets the doctor’s approval, the next step is to manufacture the physical surgical guide. That typically takes about a day. Then the surgical guide can be shipped to the doctor, along with the necessary drill key. This entire process has a relatively quick turnaround time. In three to five days, we can get the surgical guide on its way.

Some doctors already have a drill key set from their implant company. If that’s the case, I can build the surgical guide to fit those drill keys. If not, Arrowhead has a drill key set that we can send to the doctor. I always include an explanation of the order of the drill sleeves with the surgical guide and drill keys.

Arrowhead always provides personalized support for doctors. If doctors need help or have questions about the surgical guide, they can call and talk to me anytime. If they’ve never used a surgical guide before, I can walk them through the steps of how to use it and explain everything that they receive with the guide.
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The Benefits
The surgical guide can benefit all dentists who are placing implants. It’s a great benefit to new doctors who are learning to place implants, but it’s also useful for more seasoned doctors because of the predictability it offers. Using guided surgery, doctors can case-plan the case before they place an implant. With surgical guides, the dentist knows exactly where the implant is going to go. The following list includes some of the most beneficial aspects of a surgical guide:

1. It makes case planning more comprehensive. With my software, I can place an implant, an abutment, or a crown at the initial planning stage. When I send that to the doctor, he or she can see up front what the end result is going to be. From the very beginning, when a doctor tells a patient they are going to place an implant, the doctor can see what that crown can look like once it’s placed.

2. It saves time. I work with several specialists who do surgeries every single day. These specialists are pros at placing implants and can easily work with or without a guide, but I often hear that they love the surgical guide because it saves them time. They can be more productive and work on more patients during the day than they could otherwise.

With surgical guides, the dentist knows exactly where the implant is going to go.


The doctor I used to work for typically blocked out an hour and a half for implant surgery—for a single implant. With the surgical guide, doctors can reduce that time down to an hour or even a half hour. The doctor needs time to get the patient numb, put the surgical guide in the mouth, drill, put the implant in, and it’s done! The guide makes the implant surgery quick and relatively easy.

3. It minimizes surprises. As noted earlier, there are usually few to no surprises during surgery with the surgical guide. After reviewing the cone-beam scan, we can recommend up front if a patient needs a bone graft or a sinus lift in order to have room to put an implant in.

When the doctor I was working with performed surgery, he would sometimes open up a spot and discover that there wasn’t enough bone available. He would then have to tell the patient that a bone graft would need to be done, and that he would not be able to complete the implant as planned that day.

If the patient agreed to the bone graft, the doctor would do the surgery and then the patient would have to let it heal before the doctor could place the implant as originally planned.

4. It’s easier to plan for finances. From a monetary perspective, if a dentist knows in advance that a bone graft or a sinus lift will have to be done, he or she can communicate that to the patient. The dentist can tell the patient up front that he or she will need to budget for bone graft surgery as well as the implant. It gives patients a more accurate cost and time frame. It helps everybody to prepare.

The surgical guide is often used by specialists who are more than proficient at placing implants, because it simply saves them time.

5. It makes complex cases more predictable. Even with a full mouth restoration case, we can do everything from placing the implants to fabricating a temporary, all in that one stage. Doctors can go from implant surgery to an immediate denture, or to a temporary bridge or whatever they need.

Occasionally I hear some doctors warn that a surgical guide can become a kind of “crutch” for doctors who place a lot of implants. The idea is that after learning and practicing how to place implants, doctors should be able to work without the assistance of the surgical guide. I understand that perspective and agree that all doctors should be comfortable placing implants with or without the surgical guide.

But once a doctor has gained proficiency at placing implants, the surgical guide is a great way to develop his or her skills even more. As mentioned, the surgical guide is often used by specialists who are more than proficient at placing implants, because it simply saves time and allows them to be more productive during the day. These doctors can do more implant cases with the guide.

Without a surgical guide, doctors go into the surgery somewhat blind. They may know how to place implants, but without the cone-beam computed tomography scans and the surgical guide, they really don’t know the specific details of the patient’s mouth.

If a dentist gets into surgery and discovers that he or she has to do a sinus lift, or that there’s not enough bone available, or that the bone density is too low to hold an implant, or if they hit a nerve—if any of these potential complications arise during surgery—the surgical guide can provide an early safety net. The surgical guide can help not only with the implant placement, but also with the overall treatment plan for the restorative side.
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Costs
There are additional costs associated with the surgical guide, but the majority of doctors find that it pays for itself in time savings. There’s a base price for the guide itself, and then depending on how many sleeves we put in the guide, there’s another charge for each sleeve. Drill keys (if needed) are an additional charge, but they are reusable.

Even if a doctor has done thousands of implants, it is always good to be prepared for any outcome. With the surgical guide, doctors know in advance what to expect during surgery, and with that predictability, doctors can communicate to their patients what they can expect during the procedure, so that the overall process is a smooth experience for everyone. n

For more information about surgical guides, including how to get started with surgical guides, or for answers to any other questions, please contact Mandi Fry at Arrowhead Dental Lab at 1-877-883-2751.

Best Practices, Fall 2016

About the author

Mandi Fry graduated from dental assisting school at Eagle Gate College in 2009. Since that time, Mandi has worked continuously in the dental industry, most recently at Arrowhead Dental Laboratory with the implant department. In her free time, Mandi enjoys spending time with her family and learning new things.
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