“X-Guide® has made the full-arch treatment very precise and predictable.”

How has X-Guide® changed the All-on-4® treatment concept workflow?

With the truly 100% digital workflow, X-Guide has made the full-arch treatment very precise and predictable.^1,3 In a very resorbed ridge, a freehand technique or static guided system is less predictable, while the advanced design of X-Guide gives clinicians the real assurance in ideal bone positioning, so that every patient receives the best possible treatment. Furthermore, it helps in referral networks because clinicians can offer a technology to their patients that their competition may not.

What do you think patients should know about the technologies their dentists use for their treatment?

Technologies such as X-Guide allow dentists to perform surgeries that are less traumatic due to no incision and no sutures, less swelling, and more precision. Patients can feel assured that they are getting a treatment option with fewer risks of complications.

You are a biomedical engineer and worked on verification and validation of X-Guide before joining Nobel Biocare. In simple terms, how does the system work?

X-Guide offers interactive, turn-by-turn guidance during surgery for more exact implant placement – like GPS for your drill. It does this by tracking the position of both the surgical handpiece and the patient in real-time via two cameras that are positioned 60-80 cm above the patient. There is no need for a surgical template. Using the treatment plan on the patient’s cone beam CT, X-Guide can help dentists confidently place implants where they planned them. It’s amazing to see how the product has evolved since I left X-Nav Technologies back in 2016. X-Nav’s leadership team includes part of the original team that disrupted dentistry with the i-CAT® cone beam CT. I think it’s safe to say that they are in the midst of disrupting the market once again, which isn’t easy to do.

X-Guide offers interactive, turn-by-turn guidance during surgery for more exact implant placement – like GPS for your drill.

What do scientific studies tell us about the accuracy of navigated dental surgery?

Several studies show the improved accuracy of navigated surgery compared to freehand surgery, including some meta-analyses.

One notable study was a prospective clinical study with over 714 implants, of which 592 were guided, and 122 freehand.4 It showed that the accuracy of X-Guide is similar to static CT-generated guides, and that there is a statistically significant improvement in accuracy compared to freehand implant placement. The accuracy improvement is most significant for angular accuracy, with navigated surgery being 11 times more accurate than freehand surgery. Overall, accuracy of navigated surgery is five times more accurate than freehand.

This was also documented in a clinical study that compared accuracy results from three experienced surgeons over time.³ After 20 implants, all three surgeons showed comparable accuracy results using navigation.

What is the learning curve to fully adopt navigation in daily practice?

It can take some time to get used to looking at the screen instead of looking inside the mouth. However, we actually studied the learning curve for this technology. The clinician is immediately more accurate from the very first implant placed with navigation, but we saw improvements in accuracy and speed of treatment up to 30 cases.⁴ In fact, a recent study showed that even for novice surgeons dynamic computer-assisted implant surgery improves accuracy of implant placement, compared to the conventional freehand approach, without extending the surgical time.⁵

Navigate beyond surgery with FastMap® photogrammetry for X-Guide®

What would you tell someone who doesn't know about X-Guide with FastMap® navigated photogrammetry yet?

FastMap is a new feature on the X-Guide that opens the door to a new dimension of prosthetic design of implant-borne restorations.

It allows you to capture the true position of the physical implants / abutments placed with X-Guide relative to the pre-operative prosthetic plan. Maintaining this relationship is possible using navigation because the X-Guide tracks the patient during both implant placement and final implant / abutment position capture thanks to the registered patient tracker which remains in position for both steps.

FastMap allows for the creation of a printed or milled passive-fit provisional directly onto abutments for a same-day full arch restoration.

What excites you about X-Guide in the next couple of years?

There is still so much potential for this technology to bring further benefits to clinicians. Navigating straight cuts for bone reduction, compatibility with augmented reality (AR) headsets for improved user experience...the sky’s the limit. It's also exciting to know that more and more patients are being treated with this technology each year. Over 375,000 implants have been placed with X-Guide. X-Guide has touched so many patients' lives! It's a privilege to say I've had some part to play in that.