Editor’s intro
Dr. Sonia Leziy explains how she is reducing risks, eliminating stress, and more efficiently developing her implant treatment plan with guided surgery. Read about how she uses her TRIOS scan and CBCT to move her practice forward.
Dr. Sonia Leziy discusses the merits of guided surgery
Over the past 3 years, your view on guided surgery has gone from a “mixed opinion” to “extremely positive.” What’s changed?
Dr. Sonia Leziy: Intraoral scanning, combined with the CBCTs that we take, has opened the opportunity for me to go back to fully guided surgery. What I found in the past 3 years is that I now prefer to not consider non-guided surgery and clearly see that type of surgical approach is less accurate and more time-consuming than a fully guided approach. It has become my norm to plan and execute guided surgery, other than in cases where there is inadequate space to place a static guide (restricted opening and access).
My principal reasons as to why it is so important for me to do guided surgery is that I’m an experienced clinician — and I think I do good work; I have good hand/eye coordination. However, the brain sometimes does not connect too well with the hand. We do make mistakes — all of us, regardless of our level of experience. Limited access, challenging patients and surgical sites, and restricted intra-arch space are among some of the factors that strengthen why guided protocols are so important.
Guided surgery takes the mistakes out of my hands
Guided surgery takes the mistakes out of my hands during the clinical event, and that is important because I can sit at my computer in a non-stressful environment and make all the decisions there — I can carefully develop the treatment plan and envision the prosthetically driven outcome.
What I’ve also found is that because I am going into surgery with a guide, my surgeries are faster. I am more efficient in my use of operatory time and have been able to reduce the surgical time. In some cases, I have been able to do more conservative surgery. Therefore, I’m also far more relaxed in surgery. To me it’s now a stress-free environment.
Eliminating the need for secondary delivery appointments
Probably one of the other very important aspects is that I’ve always been a strong believer in “guide tissues from the moment of surgery,” which means I build in some kind of transitional solution, whether it is a custom-healing abutment coupled with a bonded PMMA bridge or a full restoration, single or multiple in many cases. The insertion of a transitional component at the time of extraction/implant placement is important for tissue anatomy, patient function, and patient esthetics. Where I was previously making provisional components chairside or impressing at the time of surgery for lab-generated components to be delivered at a follow-up appointment, prefabricated components eliminate the time required to make transitional components and eliminate the need for secondary delivery appointments in many cases.
Interestingly, intraoral scanning has become an integral component to my recession documentation, helping me track gingival recession/tooth wear and NCCL stability. I also believe that it is a powerful and more accurate method to monitor the outcomes of treatment used to address these conditions.
Do you trust digital workflows?
Dr. Sonia Leziy: That’s a good question, because in my first 6 months of guided surgery, I would prep with my initial pilot drill, then remove the guide and place a direction indicator, and take a radiograph to verify two-dimensionally my progress throughout the surgery. Was I preparing the osteotomy as it was planned? Looking at how direction indicators fit through the guide — I did that for months and months, stopping and radiographing throughout a procedure. I don’t do this anymore. I basically place the guide, assess its stability, and verify its fit through my inspection windows. I have complete confidence in the concept and in the quality of the guides that can be printed, based on my TRIOS scan and excellent CBCT quality. The guides fit impeccably all the time.
Compared to the old days, is there a big difference?
Dr. Sonia Leziy: Night and day, apples and oranges. I can’t go backward.
I don’t understand today how even experienced clinicians still say, “I have a lot of experience, so I don’t need to do guided surgery”; that makes no sense to me. From what would be considered the simplest cases, which are single-teeth cases to fully edentulous, the standard of care is moving toward guided surgery.
This information was provided by 3Shape.
Editor’s call to action
Read about how Dr. Dean Vafiadis is reducing risks of full arch restorations with 3Shape TRIOS IO.
https://implantpracticeus.com/case-studies/full-arch-restorations-with-3shape-trios-io/.
Author
Sonia Leziy, DDS, received her dental degree from McGill University. She completed her postgraduate degree in periodontics at the University of British Columbia, Canada. Dr. Leziy is a Fellow of the Royal College of Dentists of Canada, a Fellow of the International Congress of Oral Implantologists, and a member of the British Columbia Society of Periodontists, the Canadian Academy of Periodontists, the American Academy of Periodontists, and the American Academy of Esthetic Dentistry (AAED). She co-mentors the Vancouver Implant Periodontal and Prosthetic Study Group (VIP), which focuses on total treatment solutions from diagnosis to final restoration. Dr. Leziy is the VP of Clinical Affairs for the Seattle Study Club. She is a member of the editorial boards of the journals Spectrum Dialogue, the Journal of Esthetic and Restorative Dentistry, the International Journal of Perio and Restorative Dentistry, and section editor for Aegis’ Inside Dentistry. She maintains a Clinical Associate position at the University of British Columbia. Dr. Leziy has been recognized among the top clinicians in CE in North America by Dentistry Today for more than a decade. She has published extensively on implant esthetics and lectures nationally and internationally on the subject of implants and advanced esthetics/periodontal plastic surgery. Dr. Leziy maintains a full-time interdisciplinary private practice in Vancouver, Canada.
Sonia Leziy, DDS, received her dental degree from McGill University. She completed her postgraduate degree in periodontics at the University of British Columbia, Canada. Dr. Leziy is a Fellow of the Royal College of Dentists of Canada, a Fellow of the International Congress of Oral Implantologists, and a member of the British Columbia Society of Periodontists, the Canadian Academy of Periodontists, the American Academy of Periodontists, and the American Academy of Esthetic Dentistry (AAED). She co-mentors the Vancouver Implant Periodontal and Prosthetic Study Group (VIP), which focuses on total treatment solutions from diagnosis to final restoration. Dr. Leziy is the VP of Clinical Affairs for the Seattle Study Club. She is a member of the editorial boards of the journals Spectrum Dialogue, the Journal of Esthetic and Restorative Dentistry, the International Journal of Perio and Restorative Dentistry, and section editor for Aegis’ Inside Dentistry. She maintains a Clinical Associate position at the University of British Columbia. Dr. Leziy has been recognized among the top clinicians in CE in North America by Dentistry Today for more than a decade. She has published extensively on implant esthetics and lectures nationally and internationally on the subject of implants and advanced esthetics/periodontal plastic surgery. Dr. Leziy maintains a full-time interdisciplinary private practice in Vancouver, Canada.
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