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

Dr. Kamel, how has X-Guide® changed your 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 systems are less predictable, while the advanced design of X-Guide gives me the real assurance in ideal bone positioning, so that every patient receives the best possible treatment. Furthermore, it gives us the chance to accept referrals from other providers in our area because they lack the level of precision we can provide with X-Guide. Freehand surgery with real-time 3D guidance of your drills and implants with X-Mark turns your diagnostic scan into a navigated plan. X-Guide is 3-4 times more accurate than other dynamic systems tested.1 “X-Guide® has made the full-arch treatment very precise and predictable.”

Have you seen any differences in clinical outcomes since adopting dynamic navigation?

We now are having fewer problems with the implant integration and have patients seeking our office services after being sent away by other clinics.

What do you want your patients to know about the technologies you choose to use for their treatment

That we can provide them with surgeries that are less traumatic due to no incision and no sutures, less swelling, and more precision using computer programing systems. They know that they are getting the best treatment option for the same price of regular implant placement with but with a lower risk of complication.

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

Ms. Lank, 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 synergy 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.

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. Like any new technology, there is a learning curve.

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.

With X-Guide, you have predictability and start with the end results in mind.

Dr. Kamel, what was your learning curve to fully adopting navigation?

Learning and adapting to the technology was quite straightforward. It may take a bit of time to get used to looking at the screen instead of looking inside the mouth, however this has been very ergonomic for me as I am not bent over all the time. Today, we use X-Guide for every case – even with immediate implant after extraction – because we measure twice and cut only once.

What would you tell someone who doesn’t know about X-Guide navigated surgery yet?

With X-Guide, you have predictability and start with the end results in mind.

You offer a training center for other surgeons to learn about digital techniques for implant surgery.

Yes. At the Smile Rescue Academy we teach the step-by-step technique of using X-Guide for full-arch treatment to dentists from all over the world. We also show them the restorative option of using digital workflows on designing the restoration and delivering it the same day.

When using X-Guide, what is the benefit to the restorative part of implant treatment?

Pre-planning of the restoration, especially on the single implant cases in the anterior, provides us with guidance on which Multi-unit Abutment to use as well as the difference between the bone available versus the tooth position, so we do not end up with an implant that cannot be restored, which we have seen at some other clinics.

Where do you see this technology going in the next 3-5 years?

I think X-Guide could be used for more dental procedures. We even started implementing it in bone reduction, bone expansion and bone block manifestation.