Advanced surgical guidance technology: a review

To maximize the outcome of implant placement, the use of advanced radiographic procedures such as computerized tomography, along with fabrication of surgical guides, has been advocated to inform surgeons of ideal implant location. More recently, simulation computer software has been introduced to view radiographic images and test potential implant locations. Yet, surgical guides are processed based on ideal tooth position, with little consideration for underlying anatomical limitations, which creates a disconnection between diagnostic planning and surgical restrictions. In response to this "missing link," computer-assisted design and computer-assisted manufacturing, as well as real-time surgical navigation were recently developed to obtain fully integrated surgical and prosthetic planning. Today, there are several technologies available, but, to our knowledge, a systematic assessment of surgical guidance has not yet been performed. Therefore, the aims of this review are to introduce advanced radiographic and software modalities, and present a detailed assessment of computer-assisted design and computer-assisted manufacturing methods and surgical navigation.