Intraoral scanning and cloud: connecting practice and laboratory workflows
From scan acquisition to case sharing: evaluating data, collaboration, costs and operational continuity in a cloud dental workflow.
DENTAL INNOVATION · INSIGHT
Guided surgery and immediate loading: the value of a digital workflow
Lorenzo Riccelli · Dental Innovation
“Fixed teeth immediately” captures an understandable expectation, but not the complexity of treatment. For professionals, the central issue is how to coordinate planning, surgery and prosthetics while retaining the ability to adapt the pathway to the circumstances of each case.
Two concepts that need to be distinguished
Static guided surgery uses a guide to transfer the implant plan to the surgical stage. Immediate loading, by contrast, concerns the timing of rehabilitation. These are different decisions: using a guide does not automatically establish an indication for immediate loading. Planning remains driven by the prosthetic objective. [1]
Case selection comes before promises about timing
The ITI consensus on fixed prostheses in edentulous jaws highlights the importance of selection, clinical experience and primary implant stability. Favourable study results do not establish an indication for every patient. Bone augmentation procedures may also influence protocol selection. [2]
A provisional rehabilitation also needs to be distinguished from the definitive restoration: delivering an initial prosthesis does not mean the treatment pathway is complete. [2]
Digital tools should make each step verifiable
From an organisational perspective, I suggest viewing the workflow as a series of handovers with an identifiable owner:
- data and documentation available for planning;
- a plan shared by clinician and laboratory;
- verification of the guide and planned components;
- communication of the conditions encountered during treatment;
- checks and documentation of the prosthetic stage.
This perspective helps identify where a decision needs confirmation. It is not a surgical protocol.
A guide does not eliminate error
The ITI documents discrepancies between planned and achieved implant positions. Training, data assessment and control of plan transfer therefore remain necessary: “no margin for error” is an inappropriate promise. [1]
For the same reason, the organisation should establish how changes to the plan will be communicated. Agreeing responsibilities and alternatives in advance helps prevent the announced timeframe from becoming the dominant criterion.
The outcome depends on the working system
Digitalisation also contributes by making decisions easier to share and handovers easier to understand. Its value should be assessed in the specific case, without attributing universal reductions in time, costs or complications to it.
Photogrammetry in full-arch rehabilitation offers another example of why acquisition quality needs to be considered alongside subsequent verification.
Sources
- ITI, Accuracy of Static Computer-Aided Implant Surgery, 2018 consensus: academy.iti.org
- ITI, Loading Protocols for Fixed Prostheses in Edentulous Jaws, 2013 consensus: academy.iti.org
Consensus sources are identified by year, rather than presented as newly published guidelines. The earlier claims of 72%, +40% and −50% were removed from the draft because the original text did not provide identifiable references.
