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How is a GuidedSMILE Natural case planned (implants, sites, and esthetic measurements)?

Correct implant planning establishes the foundation for MUA placement, bone maintenance, soft tissue contour, and esthetics. ROE and the GuidedSMILE design team optimize placement so the case can also transition to FP3 in the future without changing implants. Three priorities govern position:

Priority Principle Rationale
1 Prioritize straight implants Straight MUAs are narrower and easier to manage, allow more tissue development, and eliminate bone profiling.
2 Avoid angled implants in the esthetic zone Risk of visible hardware with a high lip line and angled anterior MUAs.
3 Exhaust alternatives before angling Bone grafting with a staged approach is preferable to compromised angulation.

Implant site hierarchy (a guiding principle is "the tissue is the issue," maximizing tissue around the prosthesis):

Priority Sites Rationale
Ideal anterior #8, #9 Wider teeth accommodate components well
Ideal middle #6, #11 Good bone and emergence, esthetically forgiving
Ideal premolar #5, #12 Adequate width, good prosthetic position
Ideal first molar #3, #14 Posterior support, less esthetic demand
Avoid laterals #7, #10 Narrow teeth give the most difficult emergence esthetics

Implant configuration targets: ideal 5 to 6 implants (minimum 4 if anatomically constrained), no more than 2 pontics between implants, and a maximum of a one-tooth distal cantilever. The Handbook favors narrow and slightly longer implants over wide and short ones, following a "less implant, more bone" philosophy.

The MUA-to-Gingival-Zenith rule drives esthetics. In the anterior maxilla, an MUA is placed about 3 mm apical to the planned esthetic gingival zenith and 2 mm palatal to the proposed facial surface of the crown. Implant depth is read against the gingival zenith:

Measurement Action
5 to 6 mm anterior implant Accept the position and move to the next site
Less than 5 mm at any site Place the implant deeper, switch to a shorter implant if needed, and warn of a longer clinical crown
More than 6 mm at any site May need to adjust bone to reach 5 to 6 mm, and warn of a possible longer clinical crown

Important: Failure to design for these measurements, or modifying them on the day of surgery, can cause the temporary prosthesis to compromise soft tissue conditioning and the final outcome.

 

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