· 9 min
The most important part of an implant happens before surgery, in front of a screen. I am Pablo Atria, dentist, with a Master's in Biomaterials from NYU College of Dentistry and a PhD in Biomedical Sciences from NYU Grossman School of Medicine. I am Clinical Assistant Professor at NYU College of Dentistry, where I direct the Advanced Clinical Fellowship in Operative and Digital Dentistry. Computer-guided surgery starts from that idea: the exact position of the implant, its depth and its angulation are decided on a three-dimensional model of the patient, and only then do we bring that plan into the mouth. At AS Odontología Digital, in Vitacura, I plan and place implants with this workflow, and it is how I approach implant dentistry in most cases.
It helps to explain how this differs from conventional, freehand surgery. In the classic approach, the surgeon decides the implant position during the operation, reading the bone directly and relying on experience as a guide. It works, and for many cases it remains reasonable. Guided surgery moves the moment of decision: the position is defined beforehand, on the computer, with full information about the bone, the neighboring roots, the inferior alveolar nerve and the maxillary sinus in view. On the day of surgery, a plan that is already solved and documented gets carried out.
The workflow has two phases. The first is planning: I take a cone-beam CT (CBCT), which provides bone volume in three dimensions, and an intraoral scan, which captures the exact shape of the teeth and gums. With both files superimposed, I design the position of each implant relative to the structures that must be respected. The second phase is the surgical guide: a template that rests on the teeth or the mucosa and directs the drill to exactly the planned position. That guide is designed and 3D-printed inside the clinic, which lets me control the whole process and manage the case timeline. To see where this stage sits within the full treatment, from the first evaluation to the crown, read the complete guide to dental implants.
A conventional X-ray is a flat shadow: it compresses the whole volume of the jaw into a single image. It tells you how much bone there is in height, but not how much there is in width, nor whether that bone is a thin plate with a concavity behind it. The cone-beam fixes that. It delivers slices of the bone in any plane and lets me measure, in millimeters, the real distance between the bone crest and the canal of the inferior alveolar nerve, or between the crest and the floor of the maxillary sinus.
In practice, that changes concrete decisions. A lower molar that seemed to have enough bone on the X-ray can show, on the CBCT cross-section, a narrow ridge that calls for a smaller-diameter implant or a different angulation. An upper premolar can reveal a sinus lower than the panoramic suggested. Bone density is also easier to judge, and that influences the initial stability one can expect from the implant. Without that three-dimensional information there is no digital planning to speak of: the guide is only as good as the diagnosis it is designed on.
The plan starts by merging two files. The CBCT contributes the bone; the intraoral scan contributes the teeth and gums with a level of detail the CT lacks in soft tissue. Superimposed, they give a model of the patient where the bone, the mucosa and the neighboring teeth are visible at the same time.
On that model I work backwards from the result. Before fixing the implant, I design the crown that implant will support: where its margin has to sit, how it aligns with the adjacent teeth, where the screw or abutment will emerge. Only then do I place the virtual implant so that it emerges right beneath that crown, with bone around it, while keeping a safety margin from the nerve, the sinus and the neighboring roots. Depth, angulation and diameter are defined in the software and documented before the patient enters the surgical room. That is the logic of planning the prosthesis first: the implant serves the tooth it is going to replace.
With the plan closed, the software generates the guide: a rigid template that reproduces the surface of the teeth or gums and carries, at the exact position of each implant, a cylinder through which the drill enters. That cylinder sets the direction and limits the depth. The guide is 3D-printed in the clinic on the same digital model used for planning, so what reaches the surgical room is a physical copy of the plan.
On the day of surgery, the guide is tried in the mouth first, without drilling. It has to seat passively, without rocking, resting on the teeth when there are teeth to rest on. If few or no teeth remain, the guide rests on the mucosa or is fixed with small pins. Only when I confirm it seats exactly as it did on the virtual model does the drilling sequence begin, with increasing diameters through the guide until the planned implant goes in.
The first thing most patients notice is that the surgery is shorter and calmer than they expected. The hard decisions have already been made, so there are no pauses to measure or replan. Under local anesthesia, what you feel is pressure and vibration, without pain. If that part worries you, the article on whether getting an implant hurts explains what to expect on the day and over the following days.
The second change is the incision. In conventional surgery it is usually necessary to open a flap: lifting the gum to see the bone and decide where the implant goes. Because in guided surgery the position is already defined, in many cases it is possible to work without raising that flap. This is what flapless surgery means: only a small circle of gum is removed over the entry point, the size of the implant, and the drilling happens through the guide. Less detached tissue usually translates into less swelling, fewer stitches and a more comfortable recovery. Not every case allows it; when the bone needs to be seen or regenerated, it gets opened, guide or no guide.
Not every patient needs guided surgery, and I prefer to say so plainly. It is especially useful when little bone is available, when the implant sits close to the nerve or the sinus, when several implants must end up parallel to one another, and when a full-arch rehabilitation is planned where the position of each implant shapes the final prosthesis. It also helps in the front of the mouth, where a millimeter of difference in angulation shows later in the crown and the gum line.
Real candidacy depends on the health of the gums, the volume and quality of the bone, and each person's general situation. That assessment is always clinical, based on the examination and the CBCT. The factors that raise the likelihood of an implant failing, such as smoking, untreated periodontitis or poorly controlled diabetes, still weigh with or without a guide; I review them in the article on implant risks and failure.
When the case allows, digital planning enables immediate loading: placing a provisional restoration on the implants the same day as surgery, instead of waiting through the months of osseointegration with an empty space. Because the implant position is known in advance, the provisional can be designed before the operation. It depends on the stability the implant achieves in the bone and on how the bite distributes forces, so it is decided case by case. The details are in the article on immediate loading implants.
The final restoration is made in the clinic with CAD/CAM, in zirconia or lithium disilicate depending on the area and the aesthetic demands of the case. It is the same digital workflow that connects the surgery to the prosthesis without intermediate steps that lose precision. Which material suits which situation, and how that is decided, is covered in the article on dental crowns.
Guided surgery narrows the gap between what was planned and what ends up in the mouth, but it does not remove the biological variable or the human one. The guide can seat less well than expected if it rests on mucosa, or if the patient has limited mouth opening; at the last molars, there is sometimes not enough room for the drill and the cylinder. The bone quality felt while drilling can force a change in protocol to gain stability, or a postponement of the immediate loading that was planned. And if a bone defect the CT suggested but did not confirm appears once the site is open, the decision to regenerate has to be made right there.
That is why the guide is a precision tool in service of a plan, and the surgeon still answers for every millimeter. A sound guided workflow includes verifying that the guide seats, checking the position during drilling, and being willing to adjust if the bone does not match what the image showed. I would rather say it this way than promise an exactness no system guarantees on its own.
If you are looking for where guided implant surgery is done in Santiago, what sets one treatment apart from another is the complete workflow behind it, well beyond owning a scanner. At AS Odontología Digital, at Av. Kennedy 7440, Vitacura, implant dentistry is led by me, Pablo Atria, and that workflow is in-house: cone-beam and intraoral-scan diagnosis, 3D planning with the position, depth and angulation defined and documented before surgery, a surgical guide printed in the clinic, CAD/CAM restoration in zirconia or lithium disilicate, and immediate loading when indicated. You can see the detail on our dental implants in Santiago page. The first step is always the same: an evaluation with CBCT and a scan to determine whether your case is a candidate and what the right approach is for you.
If this article left you with questions, explore the related services or book an evaluation at AS Odontología Digital in Vitacura.
Book an evaluationIt is a technique in which the position, depth and angulation of the implant are planned on a 3D model of the patient before surgery, based on a cone-beam CT and an intraoral scan. That plan is transferred into the mouth with a printed surgical guide that directs the drill to the exact position defined on the computer.
At AS Odontología Digital, at Av. Kennedy 7440, Vitacura, implant dentistry is led by Dr. Pablo Atria, Director of the Advanced Clinical Fellowship in Operative and Digital Dentistry at NYU College of Dentistry, with a Master's in Biomaterials and a PhD in Biomedical Sciences. Every case is planned over a cone-beam CT and an intraoral scan, the surgical guide is printed in the clinic, and the final restoration is made in-house with CAD/CAM.
It is more predictable because the implant position is decided beforehand, with the inferior alveolar nerve, the maxillary sinus and the neighboring roots visible in three dimensions. That allows keeping a safety margin from those structures. Conventional surgery remains valid in many cases; the decision depends on each patient's clinical situation.
It means placing the implant without lifting the gum to expose the bone. Because the position is already defined in the digital plan, only a small circle of gum is removed over the entry point and the drilling happens through the guide. It is usually associated with less swelling, fewer stitches and a more comfortable recovery, but not every case allows it: when the bone has to be seen or regenerated, the site is opened anyway.
Under local anesthesia, what you feel during surgery is pressure and vibration, without pain. Because it is shorter and, in many cases, flapless, the discomfort afterwards tends to be lower than with a conventional approach. The experience varies from one patient to another, but the goal of the guided workflow is to reduce trauma to the tissue and time in the chair.
Candidacy depends on the health of the gums, the volume and quality of the bone, and each person's general situation. It is assessed with a clinical examination and a cone-beam CT. Guided surgery is especially useful when bone is limited, when the implant sits close to the nerve or sinus, or when several implants must end up parallel to one another.
In some cases yes, through immediate loading: a provisional restoration on the implants the same day as surgery. It depends on the stability the implant achieves in the bone and on how the bite forces are distributed, so it does not apply to every case. When it is indicated, it is planned from the start along with the implant position.
Two main studies: a cone-beam CT (CBCT), which shows bone volume in three dimensions and the position of the nerve and sinus, and an intraoral scan, which captures the exact shape of the teeth and gums. Superimposing the two is the basis on which each implant position is planned and the surgical guide is designed.
