Oral Surgery Technology

How Much Has Changed

Studio STL: Let’s talk about these advances in technology. How has that changed the landscape of what you are able to do for patients?

Dr. Heatrice: When it comes to technology with oral surgery, it has changed so much. From 3D imaging to 3D printing, we can now print things that are missing in people’s mouths. Laser dentistry is getting popular. There is also what is called photogrammetry, where we are able to pinpoint the accuracy of the implants and things like that. So oral surgery is becoming a very exciting part of medicine when it comes to technology. Even robotics. We have robotic arms now.

He covers a lot of ground quickly there, so it is worth separating what these things actually do. They fall into two groups: technologies that improve what the surgeon can see and plan before the procedure, and technologies that improve the accuracy of executing that plan during it.

What 3D Imaging Shows That an X-ray Cannot

Studio STL: Can you talk about the advantage of having 3D imaging right there in your office, as far as getting patients answers as soon as possible?

Dr. Heatrice: The good thing about 3D imaging is that it basically slices your face up. It starts from the top down, from side to side, and from front to back. Those slices allow us to identify bone levels and bone quality. We can find where nerves are located, and on top of all that it helps us identify pathology. With all that information, it can create all types of things: guides, implant placements, and things like that as well.

The distinction he is drawing is between a flat image and a volume. A traditional dental X-ray compresses three dimensions into two, which tells you a tooth is there but not how much bone surrounds it or what sits behind it. A three-dimensional scan captures the anatomy as a volume that can be viewed in cross-section from any angle.

Four things come out of that, and he lists all four:

Bone levels

How much bone is actually present at a potential implant site, measured rather than estimated. This is the difference between knowing whether an implant will fit and hoping it will.

Bone quality

Volume is not the whole story. Denser bone provides better initial stability for an implant, and knowing the quality in advance informs how the case is planned.

Nerve location

The inferior alveolar nerve runs through the lower jaw, and its exact path varies from person to person. Knowing where it is before surgery rather than working around an estimate is one of the more significant safety advances in implant dentistry.

Pathology

Cysts, lesions, and other findings sometimes appear on a scan taken for an entirely different reason. Having the scan in-office means these are identified during the same visit rather than after a referral elsewhere.

The point about having it in the office is also a practical one for patients. It means the evaluation, the imaging, and the conversation about what the imaging shows all happen at one appointment.

Learn more on our 3D imaging page. Findings that turn out to be pathology are addressed through our oral pathology services.

Guided Implant Placement, Stents, and Navigation

Studio STL: What about those guided implant placements you mentioned? What exactly does that mean?

Dr. Heatrice: Guided implant placement is not new. It has been out for a while. But what makes it great is that the technology around it has advanced. One of them is the robotic arm. Now we can use that 3D image to make a stent, and that robotic arm will follow exactly what you have planned to do. They have what we call navigation in implant dentistry now, where there is a machine that allows doctors to be guided to where they want to place the implant. So not only are we making stents as part of the surgical process now, we can also use technology to bring more precision to our surgical approaches.

Guided placement inverts the traditional sequence. Rather than deciding implant position during surgery based on what the surgeon sees in the moment, the position is determined beforehand using the scan data, and the surgery executes a plan that already exists.

Surgical stents

A stent, also called a surgical guide, is a custom-fabricated appliance that fits over the remaining teeth or the ridge. It has channels built into it that direct the drill to the planned position, at the planned angle, to the planned depth. It is produced from the scan data, which is where 3D printing enters the workflow.

Navigation

Navigation systems provide live positional feedback during the procedure, showing the surgeon in real time where the instrument sits relative to the plan. It is the same concept as a stent, achieved dynamically rather than with a physical guide.

Photogrammetry

Mentioned earlier in the segment, photogrammetry captures the precise three-dimensional relationship between implants once they are placed. Accurate position data is what allows a restoration to fit properly across multiple implants, which becomes more demanding as the number of implants increases.

Why this matters to a patient: implant position is not only a surgical question, it is a restorative one. An implant placed in bone that will hold it but at an angle that complicates the final crown or bridge creates a problem that has to be solved later. Planning position against both the anatomy and the final restoration at the same time is what guided placement is for.

See how implants are planned and placed on our overview of implant placement page.

3D Printing, Lasers, and Robotics

Dr. Heatrice also mentions three technologies in passing that are worth noting. 3D printing produces surgical guides, models, and provisional restorations from digital scan data, without the impressions and lab turnaround that used to be required. Laser applications are increasingly common across dentistry for soft tissue procedures. And robotic assistance in implant surgery, which he describes as a robotic arm following the plan, represents the current edge of guided placement.

What This Means If You’ve Been Putting Treatment Off

Studio STL: What do you say to those of us who have been putting off treatment, some of the patients you see who waited too long?

Dr. Heatrice: One of the things people have to understand is that with the level of technology and the expertise our surgeons are learning nowadays, there is really nothing that should limit someone from coming in. We are able to achieve a lot of goals by using technology and the expertise of a surgeon.

The two halves of that sentence carry equal weight. Technology expands what is possible, but it does not replace judgment about which approach fits a given patient. A scan produces data. Deciding what to do with it is the surgeon’s work.

For someone who has been delaying treatment, the practical takeaway is that an evaluation today produces better information than one performed years ago, and that better information sometimes produces a different answer.

Dr. Heatrice discusses what that means for patients previously told they were not candidates in a separate segment on complicated cases.