a 3D-image-guided approach can save time in the operating room, but it increases fees and possibly poses additional risks, as some studies have reported a lack of accuracy6,9 and higher complication rates7,10 (as discussed earlier in this article). It is important to note that image-guided implant surgery has developed significantly in the last 10 years and this explains the wide variation of outcomes in the literature. More outcome data on the various approaches to image-guided surgery are needed before its indications and contraindications are clear. CONCLUSION This review of the evidence clearly supports the use of CBCT as a diag- nostic aid to facilitate communication about surgical and restorative options and restrictions. The next level of using CBCT to guide the posi- tion of implants is more controversial, however, and there are conflicting reports in the literature. The use of guides in implant dentistry has evolved rapidly and has been promoted by the industry before there are reliable outcome data in terms of accuracy of placement and implant survival. While the positive studies outweigh the negative reports, this variation in outcomes is cause for concern. Further research is needed to improve this technology and explain the variation currently reported. In addition, there are relatively little data regarding partially guided versus fully guided surgery, or possible difference between laboratory- fabricated guides and in-office printed guides. Ultimately, while the literature supports the use of 3D image guid- ance when placing implants, it is critical to note this technique is not for the inexperienced. Although image-guided implant placement may appear easy, it can quickly become complicated and it takes an expe- rienced implant surgeon to use these guides effectively. D REFERENCES 1. Jansen CE. CBCT technology for diagnosis and treatment planning: what general practitioners should consider. Compend Contin Educ Dent. 2014;35:749–753. 2. van Steenberghe D, Glauser R, Blombäck U, et al. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res. 2005;7 (Suppl 1):S111–S120. 3. Merli M, Bernardelli F, Esposito M. Computer-guided flapless placement of immediately loaded dental implants in the edentulous maxilla: a pilot prospective case series. Eur J Oral Implantol. 2008;1:61–69. 4. Orentlicher G, Horowitz A, Goldsmith D, Delgado-Ruiz R, Abboud M. Cumulative survival rate of implants placed “fully guided” using CT-guided surgery: a 7-year retrospective study. Compend Contin Educ Dent. 2014;35:590–598,600. 5. Vasak C, Kohal RJ, Lettner S, Rohner D, Zechner W. Clinical and radiological evaluation of a template-guided (NobelGuide) treatment concept. Clin Oral Implants Res. September 18, 2012. Epub ahead of print. 6. Komiyama A, Klinge B, Hultin M. Treatment outcome of immediately loaded implants installed in edentulous jaws following computer-assisted virtual treatment planning and flapless surgery. Clin Oral Implants Res. 2008;19:677–685. 7. Ozan O, Turkyilmaz I, Ersoy AE, McGlumphy EA, Rosenstiel SF. Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement. J Oral Maxillofac Surg. 2009;67:394–401. 8. Arisan V, Karabuda ZC, Ozdemir T. Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study. J Periodontol. 2010;81:43–51. 9. Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29 (Suppl):25–42. 10. Behneke A, Burwinkel M, Behneke N. Factors influencing transfer accuracy of cone beam CT-derived template-based implant placement. Clin Oral Implants Res. 2012;23:416–423. 11. Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clin Oral Implants Res. 2009;20 (Suppl 4):73–86. 12. Abboud M, Wahl G, Guirado JL, Orentlicher G. Application and success of two stereolithographic surgical guide systems for implant placement with immediate loading. Int J Oral Maxillofac Implants. 2012;27:634–643. 13. D’haese J, Vervaeke S, Verbanck N, De Bruyn H. Clinical and radiographic outcome of implants placed using stereolithographic guided surgery: a prospective monocenter study. Int J Oral Maxillofac Implants. 2013;28:205–215. DecisionsInDentistry.com The Future of Dental X-rays! 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