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Diagnostics, treatment, planning and guided surgery

by: Roland Glauser and Pascal Kunz

The first patient was treated using guided surgery more than a decade ago, in 2000.

Diagnostics, Treatment, Planning and Guided Surgery

Subsequently, the concept was cleared by the FDA and launched by Nobel Biocare in the spring of 2005. No other company has such extensive experience with guided surgery and 3D diagnostics.

Dr. Pascal Kunz, who is responsible for guided surgery solutions at Nobel Biocare, posed some questions this month to Dr. Roland Glauser on the current state of guided surgery.

An accomplished dentist as well as a respected academic, Dr. Glauser lectures internationally and runs a successful private clinic in Zürich, Switzerland. He is also an expert in emerging technologies that help improve patient care, such as NobelGuide and NobelClinician.

You were one of the first to work with the NobelGuide system. How has it affected the way you have diagnosed and treated patients over the last eight years?

Dr. Roland Glauser: First and foremost using NobelGuide has increased treatment predictability and given me access to more advanced treatment options—especially in regards to immediate function and the prefabrication of provisionals. The diagnostics and planning software was always quite straightforward to use. The new NobelClinician Software goes a step further, however, by offering even more options, particularly in general diagnostics.

With this system, I can reference significant visual information in a virtual 3D world to test for—and ultimately identify—locations for the best possible implant placement from both a prosthetic and surgical point of view. Rather than being forced to compromise between restorative requirements and surgical imperatives, I like to think that we can optimize instead.

From the patient’s point of view, comfort has been improved, as a reduction of chair-side time and less invasive procedures have become possible. The concept allows one to obtain a complete picture before surgery. This reduces potential surprises and also the stress level on the day of surgery. With a well-planned treatment already mapped out and implants installed at ideal prosthetic positions, the restorative process becomes a smooth, step-by-step procedure.

It should also be noted that communicating the treatment plan to colleagues—or the patient himself—is made much easier when a digital diagnostics and planning tool such as NobelClinician Software is used.

Have you seen a change in the type of questions posed by prospective implant patients over the years?

Glauser: Certainly, today’s implant patient is better informed than his or her counterpart ten years ago. A variety of media—not least of all the Internet—are full of information and commentary on dentistry in general and implants in particular. Patients simply know more today about the dental implant option—and many of the specific procedures, as well.

I find that questions are less general and more focused on the types of materials, procedures and prognoses today. What’s more, the sheer volume of questions asked is greater than it used to be.

More than ever before, correct and compelling pre-treatment information that meets the patient’s needs is an essential aspect of the practice of dentistry.

In which situations do you choose guided surgery today?

Glauser: In quite a few different situations, actually: For example, whenever a grafting case has to be transferred figuratively into a non-grafting case. In medically compromised patients—such as hemophiliacs—or whenever minimal invasiveness and reduced working times are preferable, so is guided surgery. Naturally, I also often use guided surgery when meager hard tissue and a demanding restorative set-up dictate precise implant positioning. Finally, whenever a provisional restoration has to be produced in advance of the surgery—in cases calling for immediate function, for instance—there is no better solution than guided surgery.

Over the last few years, more and more computerized systems for 3D imaging, diagnostics, treatment planning and even guided surgery have been introduced to the market, complicating purchasing decisions for clinicians. If someone were to ask you about introducing these technologies in their clinic or practice, how would you suggest they get started?

Glauser: I think they should start with a wish list that includes all the things they would like such a system to be able to do in their practice. Some people may only want help with diagnostics, while others would prefer a full range of diagnostic, treatment planning and guided surgery options in the same package.

Nobel Biocare has launched a new version of the company’s diagnostics and treatment planning software, called NobelClinician. As a user of the previous system, what’s in it for you?

Dr. Roland Glauser

Glauser: For one thing, I am now able to review all the CT scans within one software environment. For another, the new software certainly makes it easier to share data and to communicate one’s intentions with colleagues and lab technicians. That’s very important. I’m happy to see that the new package works equally well on the Mac as it does on a Windows PC and, as one might expect from Nobel Biocare, the user-friendly interface is highly intuitive in both design and execution.

For entry-level doctors, there’s even a built-in treatment assistant to guide the novice through the complete workflow, tracking all actions as they are carried out, and providing task-specific information at each step of the process. 

More to explore:

To learn more about the NobelClinician Software, please click here.

To learn more about the NobelGuide treatment concept, please click here.

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