A surgeon’s perspective: 3 must-haves when adopting a guided dental implant technology

Over the last few years, Neocis has had the privilege to partner with leading oral and maxillofacial surgeon Donald Nikchevich Jr., DDS. Dr. Nikchevich has been practicing in the Los Angeles area for more than three decades, focusing exclusively on implantology for the last 20 years. While experienced in all forms of oral surgery, he specializes in advanced implant techniques including distraction osteogenesis, full-mouth reconstruction, advanced bone grafting, all-on-four, and sinus lift procedures. A significant percentage of his cases involve the placement of immediate or emergency implants.

Dr. Nikchevich has always been interested in learning about and using the dental industry’s most cutting-edge technologies. That’s why, several years ago, he began exploring guided implant placement methodologies that could help him augment his practice and give his clinical team a high level of confidence while performing complex cases. Below are the three non-negotiables Dr. Nikchevich wanted in a guided surgical system – and the reasons why he ultimately decided to incorporate a robotic platform into his practice, which he has used regularly for the last three years. In short, he needed a system that would provide:

• An unencumbered surgical site for both visualization and palpation
• Flexibility to change instrumentation and implants, and make treatment adjustments intraoperatively
• The ability to carefully plan implants and then execute said plan with accuracy and efficiency

1. The ability to visualize and palpate the full surgical site without restriction

As a doctor who has placed thousands of implants freehand, Dr. Nikchevich is used to having excellent visibility throughout a case. Because static surgical guides can significantly obscure parts of the mouth, he felt a robotic platform would be a better fit for him. With Yomi®, the first and only FDA-cleared robotic dental surgery system, the user can maintain direct visualization of the entire surgical site while using haptic guidance to ensure accurate placement in terms of angulation, position, and depth.

Years of freehand implant placement has given Dr. Nikchevich a keen appreciation for just how much a surgeon can gather through touch. Being able to freely palpate hard and soft tissue and get a true feel for the vibration and torque of a drill can help clinicians verify the surgical site, especially when an osteotomy is in the posterior. Not only does robotic assistance provide a clear field of view, it also facilitates a level of pure tactile feedback one doesn’t have when using static guides. While Dr. Nikchevich can count on Yomi’s software to generate a precise surgical plan, he also gets the peace of mind that comes from being able to feel the surgical site for himself.

2. The flexibility to make intraoperative treatment adjustments in real time

Seemingly common cases at the outset can call for changes on the fly as new information comes to light. The more difficult the case, the more likely intraoperative corrections may need to be made. Perhaps a patient’s bone isn’t as dense as expected, and an implant with a different thread pattern is called for. Or the location of an osteotomy needs to be shifted just a few millimeters. Whatever the situation, having the latitude to change course once a procedure is underway is crucial. Dr. Nikchevich appreciates that robot-assisted surgery allows for seamless adaptation when needed.

Being able to change implant length or diameter – or switch to a different manufacturer altogether – in the middle of a procedure is a huge benefit to both doctor and patient. With Yomi’s intuitive software, a clinical assistant can easily input different implant types and sizes, and the surgical plan will adjust accordingly in real time. Additionally, unlike static surgical guides, when a case calls for a different drill or drill type, such as when accessing a tight interocclusal area in the posterior, robotic surgery allows one to maintain the same level of accuracy thanks to haptic guidance.

Having the flexibility to quickly change implants, drill bits, and the overall treatment plan mid-procedure is one of the biggest advantages of a robot-assisted surgical approach.

3. The ability to plan implants with a high degree of detail – and then execute said plan accurately and efficiently

Performing emergency extraction, implant placement, and temporization in a single visit is possible without robotics, but Dr. Nikchevich feels more confident planning and executing these cases when using Yomi. The same goes for complicated full-arch cases. This assurance he feels in the operatory largely stems from the stability and control haptic guidance provides throughout a procedure, but equally important is the detailed CT-based planning that’s central to this treatment modality.

Yomi’s software enables Dr. Nikchevich to easily build precise, restorative-driven surgical plans. Because he’s able to map critical anatomy and analyze bone density before a procedure ever gets underway, Dr. Nikchevich doesn’t have to worry about the position, angulation, or depth of an osteotomy. Not only does virtual planning give him added peace of mind going into a procedure, it has also helped his team streamline preoperative processes dramatically. Because robot-assisted surgery doesn’t require the production of surgical guides, Dr. Nikchevich and his team can go from the planning phase to surgery without any wait time. In fact, they can plan a partially edentulous case in about 20 minutes and a full-arch procedure in less than 30 minutes.

Wrap-up

As you can see, it was largely two factors that drew Dr. Nikchevich to Yomi: Strong similarities to the free-handed technique he was used to, combined with being able to avoid common pain points associated with static guides. Want to hear more from Dr. Nikchevich himself? Watch his recent on-demand webinar.

If your current technology doesn’t allow you to do all, or even some, of the things above, it’s time to take a closer look at Yomi. Whether you’re interested in adding more complex procedures (All-on-4®, Trefoil™, immediate implants) to your service offerings or simply want to grow your implant practice, robotic guidance may be right for you. If you’d like to learn more about the Yomi system, schedule a hands-on demo right at your practice.

All-on-4® and Trefoil™ are trademarks of Nobel Biocare