# Digital Planning Technique for Surgical Guides for Prosthetic Implants before Orthodontic Treatment
## 4 Discussion  
Conventional orthodontic methods have been associated with a general compromise in facial appearance, raising a major concern among patients seeking orthodontic treatment [8]. Thus, esthetic materials and techniques have been introduced in clinical practice aiming to overcome these limitations; clear aligners, considering their chemical and physical properties, represent a common solution for adult orthodontic treatment [9; 10]. Furthermore, the use of auxiliaries and attachments increase the possibility to treat complex cases in both adults and children [11; 12; 13; 14]. Furthermore, the great variability of the available materials increases the possibilities to customize the treatment planning [15; 16; 17]. Adult patients present well-defined expectations concerning treatment, requesting a shorter treatment time to resolve their complaints [4]. However, a great deal of adult patients is the presence of tooth loss, which complicates orthodontic treatment and extends treatment time. In the literature, it is always preferable in aesthetic cases to complete the orthodontic care prior to implant placement [6]. Only in cases of missing posterior teeth can provisional interim implants be placed in order to help the orthodonticst establish anchorage [6]. The use of implants for orthodontic anchorage can produce superior preprosthetic tooth movements for partially edentulous patients [18; 19]. Interdisciplinary planning can contribute to a successful use of the implants [18]. However, the three-dimensional planning of the implant location site is necessary in order not to compromise orthodontic movement or subsequent prosthetic treatment [18]. There are advantages with the implant treatment modality, e.g., implants replacing premolars for functional aspects and implants replacing incisors for aesthetic reasons [20]. Moreover, implants--as a means of enhancing orthodontic anchorage--are gaining increased importance in orthodontic treatment because of the limitations and acceptance problems of conventional intraoral or extraoral anchorage aids or miniscrews, especially in very complex cases [21; 22]. Some studies have shown that dental implants placed in the alveolar bone are resistant to orthodontic force [23; 24; 25]; therefore, implants help orthodontic biomechanics as skeletal anchorage. Furthermore, having a digital setup prepared using a CBCT scan is extremely helpful for the surgeon because orthodontic treatments move teeth to find the best position for the implants, and in some cases even help to create bone. This is crucial for the avoidance of surgical complications such as damage and/or perforation into important anatomical structures like the maxillary sinus in the maxilla and the inferior alveolar canal and submandibular fossa in the mandible [26]. Additionally, studies report that using a 3D surgical guide makes precise implant placement possible in partially and completely edentulous patients even with a flapless approach, thereby reducing chaniskide surgical time, increasing patient comfort post-surgery, and allowing simultaneous implant placement in complex cases [27; 28]. Furthermore, implant placement is a technically demanding procedure and, if not performed properly, can lead to various complications such as poor esthetics, damage to anatomically important structures, infections, and implant failure [27]. Therefore, guided implant placement can prevent these complications by the fabrication of surgical guides with the help of 3D printing [27; 29]. Despite the advantages, surgeons should not become overly reliant upon 3D-printed guides for surgical safety, and caution should be taken [30; 31]. Furthermore, cost is a factor when using 3D-printed templates, but studies have reported it to be justified [27; 30]. Nevertheless, it should be noted that even if the space before orthodontic treatment seems sufficient and correct for an implant to be inserted, it might not in the correct position after orthodontic treatment when all of the teeth have moved into their planned places.