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, published in 2018, say a scan could be justified for diagnosis and planning before surgery². They say the same of carrying the plan into the operation. The European Commission published guidelines on dental CBCT in 2012 ("the European guidelines" below). They say the first question is whether cross-sectional (3D) imaging is needed at all³. Neither source sets a rule for every implant: both leave the decision to the dentist, for each patient. How implants are planned at our clinic is explained on our dental implant treatment page.
• 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. Our clear aligner treatment page explains how.
• The look of new front teeth. Scans can also be used for digital smile design¹. A design on a screen shows what is planned, not the exact result.
• 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. Selection Criteria for Dental Radiography (2018) is a guide to choosing dental X-rays, written for dentists in the UK ("the selection guidance" below). It advises dentists to seek originals or copies of radiographs taken elsewhere⁵ when they are relevant. Bring recent ones, 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. The European guidelines say it should be used only when the question cannot be answered adequately by lower-dose conventional X-rays³. The scan should then cover the smallest area suited to the clinical situation³.
• 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. Your dentist will tell you whether your treatment will be planned this way, and with which software. They will also tell you whether a printed guide or navigation will be used. You can ask for this in writing.

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 notes that guides can be 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. Under Turkey's patient rights regulation, you can be told, on request, who is treating you, and their role and title¹⁰.

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

Turkey's patient rights regulation says what you are told before an intervention. It includes who will carry out the intervention, where and how, and the other options with their benefits and risks¹⁰. It also covers the possible complications and the consequences of refusing¹⁰. The information is given to you orally, by the professional who will carry out the intervention, in plain language¹⁰. For a digitally planned treatment, ask to be told:

• 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.

In private dental clinics, you are asked to sign a consent form for every intervention¹¹. Two copies of the form are signed, and one is given to you¹⁰. Ask for your copy. A signed form does not replace the discussion. Read the plan and the form before you sign, and ask about anything you do not understand. If either is not in a language you read well, ask for it in English or with a translation. Ask for your plan in writing, with copies 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 static guides, such as 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. The entry point is where the implant enters the bone; the tip is its deepest end. 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. They still 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 point¹². 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 guides¹². The comparison with printed guides combined laboratory studies and studies in patients. In the studies in patients, the review found no significant difference in angle between navigation and printed guides¹². Because deviations of more than 1 mm were observed¹², 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 combine¹³. It said firm recommendations could not yet be given¹³, and that the effects on time and cost were unclear¹³. The 2018 ITI consensus report drew on that review. It looked at pain and discomfort, costs, and complications during surgery. For these, it concluded that it cannot be stated⁹ that surgery with a printed guide is better than surgery without one. For jaws with no teeth, it added one point. 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. According to the selection guidance, 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. Scans can also record the position of implants in such jaws (a digital implant impression). For these, laboratory studies in the ITI report found that accuracy depended on the scanning protocol⁹.
• 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 in the studies 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 movements¹⁴. On average, the upper front teeth were pulled back 1.9 mm less than predicted¹⁴.

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. A printed guide steers the drill only along the planned path. If a position has to change, the guide cannot be used for that implant. If new teeth on the same day are planned, whether they can be fitted is confirmed only during surgery. Ask beforehand which of these changes your consent covers. Also ask what happens if same-day teeth cannot be fitted, or 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. If the plan changes, ask to be told at once and to receive the updated plan in writing.

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. Ask before treatment:

• which of these files are kept in your dental record;
• 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 another dentist can open them.

A CBCT scan is a set of data files. The selection guidance notes that 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.

Under Turkish rules, private dental clinics record the diagnosis, the treatment and any X-rays in detail, with tooth numbers¹¹. You can examine your file and records and get a copy¹⁰. Ask whether your planning files are included, and ask for copies in writing. Data protection law is not explained on this page. Ask the clinic how it handles your personal data, and ask for its privacy notice.

What a digital plan cannot do

• Show everything. CBCT is designed for teeth and bone. Where soft tissues are likely to need assessing as part of the imaging, 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. Our dental implant treatment page explains those risks.
• Replace judgement. It does not replace the dentist's examination and judgement, or your own decision.

Before treatment, ask these questions, and ask for the answers in writing:

• whether your treatment will be planned digitally, and with which records;
• 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;
• who carries out the surgery;
• 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;
• what the cost covers: scans, planning, any guide, copies and possible changes during surgery;
• how to reach the clinic if a problem appears after surgery.

Keep 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. A dentist who sees you later will need them.

Your choice. Before you decide, you can ask for the opinion of other dentists¹⁰. You can say no, or ask to stop, at any stage, including before any surgery.