X Marks the Spot: X-Guide Facilitates Just-in-Time Treatment Planning

by Lou Shuman, DMD, CAGS, CEO and Founder of Cellerant Consulting

Reading the description of X-Guide powered by DTX Studio reads like something from a sci-fi novel:

“X-Guide is a dynamic 3D-navigation system that can become part of a streamlined workflow for same-day guided surgery. On the day of treatment, the clinician carries out the 3D (CB)CT scan, intraoral surface scans, creates the treatment plan in DTX Studio Implant, and immediately exports it with all the planning components to X-Guide. The practice can be ready to perform 3D navigated dental implant surgery on the very same day.

X-Guide guides the clinician through their treatment plan, providing a 360-degree, real-time view of the drill and anatomy during osteotomy and implant insertion. The ability to oversee every movement of the handpiece helps achieve a more exact implant placement compared to freehand surgery. ”

This isn’t future-state or fantasy dentistry. This powerful tool is being put to good use in practices around the country, and I jumped at the chance to talk with Dr. William Scruggs of North Carolina Prosthodontic Specialists about why he chose X-Guide and how he’s using it to significantly improve clinical outcomes.

Lou Shuman: Why was X-Guide something you were willing to try? A need, or curiosity?

William Scruggs: My dad and I are both prosthodontists, and he started the practice that I now own. When I finished residency in 2015, he already had a Nobel Guide, which was the company’s guided surgery solution at the time. My dad was not part of the “technology generation,” so when I came in, we decided that we needed to amp up that aspect of our technology picture because when dealing with implants, accuracy is essential.

In 2017, our Nobel Biocare regional manager, Henry Netter, came to me and said, “You guys would be the perfect practice for this.” I’d seen the product and thought it was cool, but a little gimmicky. I wasn’t sure how it would fit into a practice; I worried it might take too long to get everything calibrated and set up. But Henry pushed me a little bit. Today, we place 99% of implants in our practice using X-Guide.

LS: Can you pinpoint when it was that you became a true believer in X-Guide?

WS: It’s funny; I still show my fourth case ever with the X-Guide. The patient was missing teeth on the lower left. When I was doing the consult, the patient opened their mouth and even with a mouth mirror, I couldn’t really see the ridge because the tongue was over the lingual side and the cheek was over the buccal side. I completed that case with three single unit screw-retained crowns, and I didn’t even look in the patient’s mouth to place the implants. That case is pretty much impossible to execute without X-Guide.

LS: Tell me about the system X-Guide integrates with the DTX software. What are the benefits?

WS: DTX Studio Implant is the implant planning software from Envista and is part of the DTX Studio suite of software. It is an open software with multiple AI features. It integrates with a growing list of brands such as DEXIS, OP3D, i-CAT, 3Shape and Medit. I can plan a case in the software, in my office, push it to X-Guide, push continue and export. With three clicks, it sends it directly through my server to the machine in the operatory with the plan up on the screen. I can literally plan a case with imported intraoral scans and the CT images in my office, five minutes before the surgery.

LS: You have made a strong case for X-Guide. Are there no drawbacks at all?

WS: It does take the work of setting up systems and calibrations to make it as efficient as it is for us today. To make it seamless, you have to have a team that is trained and able to understand the process from the beginning.

I’ve also had people argue that since they were going to place the implant anyway. But you know, going into every single surgery, that the implant is going where you planned it. You’re not going to have remakes, where you would lose money on the restorative side. I get direct referrals because of the equipment. If I actually took the time to calculate it, I’ve certainly placed more implants because of the machine. That’s how I measure ROI.

About the Author

Lou Shuman, is the CEO of Cellerant Consulting Group, dentistry’s leading corporate incubator and accelerator. He is a venturer in-residence at Harvard’s i-Lab, chairman of the technology advisory board at WEO Media, a member of the Oral Healthadvisory board, and founder of the Cellerant Best of Class Technology Awards.