Guided implants, prosthetically driven.

What we need from you

• CBCT of the site, with enough surrounding anatomy to see the structures you need to avoid
• Intraoral scan of the arch and the opposing arch, plus the bite
• A scan of any existing prosthesis or provisional if it informs the planned restoration
• The implant system and the components you use — the guide is system-specific and sleeve geometry is not interchangeable
• Your surgical protocol: fully guided, pilot only, flapless or open

The sequence, and why it is this way round

We start by establishing where the restoration has to be — occlusal scheme, emergence, contact points, the axis the screw access needs to take. That is the fixed constraint, because it is the thing the patient uses.

Only then do we look at whether the bone supports a fixture in that position. Sometimes it does. Sometimes it supports one nearby, with an angled abutment bridging the difference. Sometimes it does not, and the honest output is a graft plan or a different restorative design.

Planned the other way round — fixture into the best available bone, restoration figured out afterwards — the classic result in the posterior maxilla is screw access emerging through a buccal cusp. Technically osseointegrated. Practically a compromise you did not choose.

What the guide has to get right

• Seating that is unambiguous. A guide that can seat in two positions will, eventually, seat in the wrong one
• Adequate support — tooth-supported wherever the dentition allows it, because it is the most predictable
• Sleeve geometry matched to your system and your drill sequence
• Irrigation access, which a fully closed guide compromises and which matters for bone temperature
• Mouth opening checked against the drill and handle length. A posterior guide that will not physically accept the drill is a common and entirely avoidable failure

What leaves the lab

• The planned implant position, with distances to the structures you are avoiding
• The planned restoration the position was derived from
• Screw access shown on the restoration, so you approve it before surgery
• The surgical guide, print-ready and system-specific
• Where the plan is a compromise, a note saying so and saying which way

Where these go wrong

• Planned from the bone, so access emerges somewhere unusable
• A guide that does not seat unambiguously, and the whole accuracy chain is lost at the first step
• Insufficient mouth opening for the guided drill in the posterior
• System mismatch between sleeve and drill kit
• A CBCT with scatter across exactly the surfaces the merge needs

The reasoning at length: why prosthetically driven planning is not a preference.

Timeline

Two working days from usable records, including the restorative design the position is derived from.