Digital Treatment Planning

Digital planning helps where the answer depends on how the teeth, the bone and the planned restoration fit together in three dimensions. Examples:

• Where an implant can go. A CBCT scan shows the height and width of the bone, and where the nerve canal and the sinus lie. Recommendations on CBCT in implant dentistry (2018) say a scan could be justified for diagnosis and planning before surgery². They say the same of transferring the plan to the operation. Guidance does not call for a 3D scan before every implant. The European guidelines on dental CBCT say the first question is whether cross-sectional (3D) imaging is needed at all³. Our diagnostic imaging page explains when a CBCT scan may be justified, and our dental implants page explains the treatment.
• Designing a surgical guide. The combined model can be used to plan the position of the implants and to design one or more surgical guides¹. A guide helps to place the implants as planned.
• Implants for a whole jaw. Planning covers the bone along the whole jaw. Printed guides were more accurate in jaws with some teeth than in jaws with none⁴. Our All-on-4 page explains full-arch treatment on four implants.
• Orthodontics. A 2017 review calls scans a very useful tool in orthodontics for diagnosis and treatment planning¹. With aligners, the tooth movements are planned step by step on a computer, and the aligners are made to that plan.
• The look of new front teeth. Scans can also be used for digital smile design¹. Our digital smile design page explains what such a preview can and cannot show.
• Crowns and bridges. These are designed on a computer and then milled or printed. Our CAD/CAM page covers that.

Digital planning helps to answer where and how. Whether you need treatment at all, and which treatment, is decided from your history, an examination and a discussion with the dentist.

A plan is only as good as the records it is built from. The European guidelines say a CBCT scan must not be carried out³ without a history and an examination. Records commonly used include:

• Your medical and dental history, and an examination. These come first.
• X-rays you already have. UK guidance (Selection Criteria for Dental Radiography, 2018) advises dentists to seek originals or copies of radiographs taken elsewhere⁵ when they are relevant. Send recent ones from your UK dentist, with the date each was taken.
• A CBCT scan, where it is justified for you. It shows the teeth and jaws in three dimensions, usually at a higher radiation dose than ordinary dental X-rays³.
• A scan of the teeth and gums (an intraoral scan), which records surfaces with light. Our digital scanning page explains how it is taken and checked. A conventional impression or plaster model can also be scanned to give a digital file⁶.
• Photographs of your face and teeth, used mainly when the look of front teeth is being planned.
• Your bite, so that the plan fits the way your upper and lower teeth meet.

How the records are combined

In planning software, the scan of the teeth and gums can be superimposed onto the CBCT scan¹. The result is one 3D model. It shows the surfaces of the teeth and gums from the scan, and the bone from the CBCT scan. Each record has its own limits, and those limits carry into the plan (see "Accuracy and uncertainty" below).

The steps vary between clinics, software and treatments. The outline below is typical for implants. Whether your treatment will be planned this way, with which software, and whether a printed guide or navigation is available, is something to ask.

There are three main ways to carry an implant plan into surgery:

• A printed guide (static guided surgery). A guide is designed from the plan and fitted in the mouth during surgery, where it steers the drill along the planned path. A 2014 review says one 3D-printing method is routinely used to make resin surgical guides⁷ for implant placement. A 2021 review describes guides being printed once the treatment planning is completed⁶ in planning software.
• Navigation (dynamic guided surgery). A tracking system follows the drill during surgery and shows its position against the plan on a screen, in real time.
• Freehand placement. The dentist places the implants without a guide, using the scans and the plan as a reference.

A typical sequence:

The software and the guide do not decide anything. The dentist decides what to plan, checks the plan, and decides during surgery whether to follow it.

• The whole scan is read. The European guidelines call for a thorough clinical evaluation (‘radiological report’) of the entire image dataset³. That means the whole scan, not only the area where an implant is planned. Ask who will report your scan.
• Guided or freehand. A 2025 umbrella review found that freehand placement remained reliable with comparable long-term outcomes when performed by experienced clinicians⁸. It said the choice should consider treatment complexity, clinician expertise, and available resources⁸.
• An aid, not a replacement. The International Team for Implantology (ITI) published a consensus report in 2018. It looked at surgery with a printed guide (static guided surgery). It recommended that such surgery should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures⁹. It added that surgical experience and general comprehensive training are desirable⁹ for an accurate result.
• Margins near important structures. Some implants are planned close to important structures, such as the nerve in the lower jaw. For these, the European guidelines advise clinical judgement and a margin of safety³.
• Surgery without lifting the gum. Surgery with a printed guide is sometimes done without cutting and lifting a flap of gum (flapless). The 2018 consensus report warns that this can lead to implants being placed outside the firm gum (keratinised mucosa)⁹. It says the firm gum must be assessed before such surgery is planned⁹, and that flapless surgery must be done with utmost care.

Ask who makes your plan, who checks it, and who carries out the surgery.

A 3D model on a screen can make a plan easier to follow. A 2017 review notes that when patients see scans of their mouth, they can feel more involved in their treatment¹. Ask the dentist to show you your plan and explain it.

A simulation shows what is planned, not what will happen. On the screen, the position of an implant, the movement of a tooth or the look of new teeth is a plan. It is not an exact preview of the result.

What to be told before you agree

• what the plan is for, and what it shows;
• the benefits and risks of the treatment proposed for you, and what is known about how long such treatment lasts;
• whether a printed guide, navigation or freehand placement is planned, and why;
• what could change during surgery, and what would happen then;
• the other options, including having no treatment;
• what the cost covers, including scans, any guide and possible changes.

A signed form does not replace this discussion. Ask for the plan and the consent form in English, or with a translation.

In Turkey, patients are entitled to information on other options, with their benefits and risks, and the consequences of refusing¹⁰. In Turkish dental facilities, a consent form is required for every intervention¹¹. In the UK, the General Dental Council's standards say dentists must give patients a written treatment plan before their treatment starts¹². Those standards bind dentists on the UK register, not a clinic in Turkey, but they are a fair yardstick. Ask for a copy of your plan and of the images it is based on.

The figures below come from published studies, not from our own records. Accuracy here means how close an implant ends up to its planned position. It is not the same as how long an implant lasts.

Printed guides

A 2018 review pooled 20 clinical studies of implants placed with printed guides, covering 2,238 implants in 471 patients⁴. Only one of the studies was a randomised trial. On average, implants ended up 1.2 mm from the plan at the entry point, 1.4 mm at the tip and 3.5 degrees off in angle⁴. Accuracy was better in jaws with some teeth than in jaws with none. The authors judged accuracy within the clinically acceptable range in the majority of clinical situations⁴, but advised a safety margin of at least 2 mm⁴.

Navigation

A 2021 review of navigation covered 24 studies. In studies in patients, implants ended up on average 3.68 degrees off in angle and 1.03 mm from the plan at the entry point¹³. Laboratory studies gave smaller errors. Navigation reduced the angle error by about 4.3 degrees compared with freehand placement, and by about 0.9 degrees compared with printed guides¹³. Because deviations of more than 1 mm were observed¹³, the authors advised a 2 mm safety margin. The review did not measure complications.

Survival and complications

A 2025 umbrella review brought together 13 systematic reviews. Guided placement was more accurate than freehand placement. But implant survival and bone loss around the implants were comparable⁸, and complications were low with both. The lower complication rate with guided surgery was not statistically significant⁸. So the reviews we cite have not shown that guided implants last longer.

Pain, cost and time

A 2018 systematic review looked at pain and discomfort, costs and complications during guided surgery. It found few studies, too different to combine¹⁴. It said firm recommendations could not yet be given¹⁴, and that the effects on time and cost were unclear¹⁴. The 2018 ITI consensus report drew on that review. It concluded that it cannot be stated⁹ that surgery with a printed guide (static guided surgery) is better than surgery without a guide for pain and discomfort, costs or complications during surgery. In jaws with no teeth, it said, surgery with a printed guide and without lifting the gum may mean less pain after surgery⁹ than lifting it.

What limits accuracy

• The CBCT scan. Distances measured on CBCT are comparable in accuracy with CT⁵, but bone density values read from CBCT are not reproducible⁵. The 2018 ITI report found that CBCT distances can be over- or underestimated, and the range of error can exceed 1 mm in selected cases⁹. In patients, accuracy may be lower than in laboratory studies, because of small movements during the scan³.
• Metal in the mouth. Metal crowns, posts and fillings can cause streaks on a CBCT scan that profoundly reduce image quality⁵.
• Jaws with no teeth. Printed guides were less accurate there. For intraoral scans of such jaws, laboratory studies in the ITI report found that the results are dependent on the protocol that has been followed⁹.
• The step from plan to surgery. Each part of the chain has its own limits: the scans, the matching of the scans in software, and the guide or navigation. Even with a guide or navigation, implants did not end up exactly where they were planned (see above).

Orthodontic plans

A 2026 review looked at aligner treatment in which premolars were taken out. It found significant discrepancies between predicted and achieved movements¹⁵. On average, the upper front teeth were pulled back 1.9 mm less than predicted¹⁵.

A plan is made at one point in time, from the records available then. It can change.

• After the examination. A plan made from photographs or X-rays you send is preliminary. The examination confirms or changes it.
• When your mouth changes. A scan records your mouth on the day it is taken. If a tooth is removed, a graft heals or teeth move, an older scan may no longer match, and new records may be needed. A CBCT scan should not be repeated ‘routinely’³ without a new assessment of its benefit and risk.
• During surgery. The bone found at surgery may differ from what the scan suggested. The dentist may then change the size or position of an implant, add a bone graft, or place the implant later. Whether new teeth can be fitted on the same day is also decided during surgery. Ask beforehand which of these changes your consent covers, and what happens if a larger change is needed.
• After surgery. The final position of each implant can differ from the plan. Recommendations say 2D intraoral X-rays are still the main tool² when a placed implant needs checking. So routine checks of a placed implant usually need only standard X-rays.

Ask before surgery what could change, and how you would be told. The UK dental regulator's standards say dentists must inform patients immediately if the treatment plan changes and give them an updated version in writing¹². Ask the clinic to do the same.

Your planning files

A digital plan produces several files. They include the CBCT data, the scans of your teeth, photographs and the plan itself. If a guide is made, its design is a file too. All of them are part of your dental record. Ask before treatment:

• where the files are stored, who can see them, and how long they are kept;
• whether any part of the planning, or the making of a guide, is done outside the clinic, and where;
• in which format you will receive copies, and whether your UK dentist can open them.

A CBCT scan is a set of data files. Most makers provide an export function with a simple imaging program⁵, so the data can be viewed elsewhere. If the plan file cannot be opened outside the software that made it, ask for a printed summary showing where each implant is planned.

In Turkey, patients may examine their file and records and obtain a copy¹⁰. The health tourism regulation also entitles international patients, on request, to free copies of the records of the materials used, the tests and the imaging¹⁶. Ask whether your plan files are included. Data protection law in the UK and in Turkey is not explained here; ask the clinic for its privacy notice.

What a digital plan cannot do

• Show everything. CBCT is designed for teeth and bone. Where soft tissues need assessing, the European guidelines advise conventional medical CT or MR, rather than CBCT³.
• Be exact. Planned and achieved positions differ, as the studies above show.
• Remove the risks of surgery. A scan shows where the nerve canal and the sinus lie, so treatment can be planned around them. It does not remove the risks of surgery.
• Replace judgement. It does not replace the dentist's examination and judgement, or your own decision.

Before treatment, ask in writing:

• whether your treatment will be planned digitally, with which records, and whether you need a CBCT scan, and why;
• whether a printed guide, navigation or freehand placement is planned, and why;
• who makes and checks the plan, and who makes any guide, and where;
• what could change during surgery, and how you would be told;
• what the written terms say if an implant cannot be placed as planned, or fails later;
• who pays for further treatment and any extra trip;
• how to reach the clinic if a problem appears after you return.

Bring home for your UK dentist copies of your X-rays, your CBCT data with a viewer and its report, and your scans. Add a summary of the plan, and the implant system, size, and part and lot (batch) numbers of each implant.

Aftercare. Problems after you return are usually first seen by your own dentist in the UK. If you do not have one, it helps to find one before you travel. The General Dental Council suggests speaking to your own dentist¹⁷ before you consider treatment abroad. The NHS website for England says the NHS is not liable for negligence or failure of treatment¹⁸ abroad. It also says most travel insurance policies will not cover you for planned treatment abroad¹⁸. Scotland, Wales and Northern Ireland run their own health services, with their own rules, which this page does not cover; if you live there, ask your dentist.

Your choice. Dentists in the UK also plan and place implants, with or without guides, and a UK opinion gives you something to compare. You can say no, or ask to stop, at any stage, including before any surgery.

Our dental implants page lists the questions the General Dental Council and the NHS suggest you ask before treatment abroad.