Guided implant surgery Periodontal treatment

Step by step

1. A CBCT scan of the jaw and a scan or impression of the teeth.
2. Planning software places a virtual implant clear of nerves, roots and the sinus.
3. The plan becomes a printed surgical guide, a navigation plan or a robot plan.
4. At surgery, the guide, the tracking camera or the robot arm keeps the drill on the planned path.
5. The implant is placed, often through a small opening with no gum flap.
6. An X-ray checks the final implant position.

What is guided implant surgery?

Guided implant surgery transfers a computer plan of each implant's position, angle and depth to the mouth. The plan is built on a CBCT scan, which the American Academy of Oral and Maxillofacial Radiology names the imaging method of choice for implant sites. The FDA summary for one guidance system describes placing a virtual implant on the scan so the surgeon can avoid critical anatomical structures.

The plan reaches the mouth by static, dynamic or robot-assisted guidance. A static guide is a printed template that steers the drill. A dynamic navigation system tracks the drill and the patient and shows the drill on the CT scan in real time. A robotic system adds an arm that holds the drill and constrains it to the plan. A review of CBCT in implant dentistry notes that the same 3D data can be transferred to surgery by 3D printing or navigation. Planning happens during the implant process before surgery day.

How accurate are surgical guides for implants?

Static surgical guides place implants close to the plan, with small average errors. A meta-analysis of clinical studies found a mean error of 1.2 mm at the entry point. The mean error at the implant tip was 1.4 mm. The mean angle error was 3.5 degrees. Guides were more accurate in partially edentulous jaws than in fully edentulous jaws. The authors judged static guides within the clinically acceptable range in most situations and advised a safety margin of at least 2 mm.

Randomized trials compared flapless guided surgery with freehand surgery through a gum flap. Angular deviation was lower with the guide by a mean 3.88 degrees. Even guided implants still deviated from the plan, so the safety margin applies to every method. Guided flapless placement is also combined with immediate loading of full arches. Implant survival in those studies ranged from 90% to 99.4%. The same planning supports immediate implants.

What is dynamic navigation in implant surgery?

Dynamic navigation tracks the drill and the patient with a camera system and shows the drill's position on the CT scan in real time. The FDA 510(k) database lists the X-Guide Surgical Navigation System from X-Nav Technologies under number K150222. FDA found it substantially equivalent in October 2015. The FDA summary for a later robotic system notes that X-Guide uses LED camera tracking and gives visual feedback only.

A meta-analysis of dynamic systems in clinical studies found a mean angle error of 3.68 degrees. Mean entry error was 1.03 mm. Dynamic systems were more accurate than freehand placement by a mean 4.33 degrees. They were also slightly more accurate than static guides. The authors still advise a 2 mm safety margin. Laboratory studies reported lower deviations than clinical ones, with a mean angle error of 2.01 degrees. Lasers, regeneration and digital planning are compared in modern periodontal techniques.

What is Yomi robotic dental implant surgery?

Yomi is a robotic guidance system for dental implant surgery made by Neocis, Inc. of Miami, Florida. Neocis obtained FDA clearance for the system's guidance arm as the Neocis Guidance System, 510(k) K161399. FDA found it substantially equivalent on December 22, 2016. A 2020 clearance paired the Neocis Guidance System with Yomi Plan software. The FDA summary for K161399 describes a guidance arm that holds a standard dental drill and constrains drilling to the planned path, with the surgeon in control of the drill. The arm does not move unless the surgeon applies force to the drill.

A later clearance, K231018, covers the Yomi Robotic System for partially and fully edentulous adult patients, which includes full-arch cases. It also covers planning and performing guided bone reduction of the jaws. In a meta-analysis of robotic systems in clinical studies, the mean angle error was 1.62 degrees. Mean deviation at the implant platform was 0.69 mm. The same review called for large randomized trials comparing robots with other techniques.

Is guided implant surgery less painful?

Flapless guided surgery caused less pain after surgery than freehand surgery with a gum flap in randomized trials. The mean difference was 17.09 mm on a visual analogue pain scale. The certainty of that pain evidence was low. Swelling showed a smaller difference, with very low certainty.

Guided surgery has limits. Flapless static guided surgery had a 12% intraoperative complication rate in those trials. The protocol could not be completed in 7% of cases. Evidence on implant survival, long-term prognosis and cost with flapless guided surgery is still scarce, according to the same review. The authors suggest flapless guided placement when the aim is minimal invasiveness, with careful case selection and a safety margin. Aftercare is the same as for any implant, as described in implant recovery, and does gum surgery hurt covers pain control.

Sources

1. Tyndall DA et al. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012
2. FDA 510(k) K161399, Neocis Guidance System, Neocis Inc., decided 2016-12-22
3. FDA 510(k) summary K161399, Neocis Guidance System
4. FDA 510(k) summary K202100, Neocis Guidance System with Clamped Chairside Patient Splint, 2020
5. FDA 510(k) K202264, Neocis Guidance System (NGS) with Yomi Plan v2.0, decided 2020-12-04
6. FDA 510(k) K231018, Yomi Robotic System, Neocis Inc., decided 2023-08-14
7. FDA 510(k) summary K231018, Yomi Robotic System, 2023
8. FDA 510(k) K150222, X-Guide Surgical Navigation System, X-Nav Technologies, decided 2015-10-08
9. Jacobs R et al. Cone beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health 2018
10. Tahmaseb A et al. The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis. Clin Oral Implants Res 2018
11. Romandini M et al. Minimal invasiveness at dental implant placement: a systematic review with meta-analyses on flapless fully guided surgery. Periodontol 2000 2023
12. Jorba-Garcia A et al. Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis. Clin Oral Investig 2021
13. Khaohoen A et al. Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials. BMC Oral Health 2024
14. Luo Z et al. Accuracy of robotic computer-assisted implant surgery in clinical studies: a systematic review and meta-analysis. BMC Oral Health 2025
15. Papaspyridakos P et al. Implant loading protocols for edentulous patients with fixed prostheses: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2014

Reviewed by Steve Schadt, Director of IT and Medical Compliance: 25 years in dentistry, medicine and HIPAA compliance. Updated 2026-10-02. Checked against the sources listed. General information, not medical advice.