Vertical space requirements for using dental implant surgical guides

A tube-based surgical guide requires the drill be stacked above the tube, in line with the tube, adding 7-9 mm of height requirement to a case. A recent research article in the Journal of Prosthetic Dentistry stated that a lack of interocclusal distance is one of the most common challenges of using surgical guides. Unfortunately, most of us don’t consistently measure the maximum inner incisal opening of our patients as part of our pre-surgical plan. And how many of us have had situations where this issue is not appreciated until the surgical appointment, in which case the tube guide is discarded?

We advocate measuring the patient’s vertical opening as part of the pre-surgical workup because this dictates whether or not surgery can be done. If it can be done, this dictates the length of your drill and the maximum length of the implant that you can use, which varies with different drill systems and the size of your hand piece. We have constructed a chart you can use to see whether your drills and hand piece can be used in the case.

Our ThinLayer® Guide addresses these issues by its design. For every case we provide a set of disposable drill stops, custom made for any drill in the sequence. The first step is to use an insert with an endo file, lance/spear, or starter drill to create a bleeding point in the planned ideal insertion location. After verifying the position, the drill is inserted through the surgical guide further to create a pilot hole. Inserting the drill through the surgical guide hole at an angle does not require any more vertical clearance than freehand drilling. If the drill and hand piece fit in the mouth without a surgical guide, then it will fit with the ThinLayer® Guide. Drag the tip of the drill along the gingiva, insert it into the pilot hole, and drill to depth. This procedure is then repeated with drills of increasingly large diameters.

A sample chart to determine minimum vertical clearance for your drills and hand piece can be found here.

About Guided Surgery Solutions, LLC
Guided Surgery Solutions, LLC designs, manufactures, and sells 3D image-based surgical guides for dental implant surgery. The ThinLayer® Drill Guide System was developed in the founder’s clinical practice, in response to design limitations found in existing products. The solution makes guided surgery technically and economically feasible for all implant surgeons, allowing them to provide better treatment to more patients. Please visit for more information.