Abstract: Drilling of an implant shaft is carried out with a handpiece tool whose location and angular orientation with respect to a radiographic working guide is updated in real time with respect to the radiographic working guide and anatomical structures of the patient, free of viewing obstructions. Prior to the drilling, the radiographic working guide is fitted to a particular patient. Real-time imaging support is provided on a display of a computer, wherein the radiographic workpiece guide includes a plurality of fiducial markers that define a substantially planar reference surface of the radiographic workpiece guide. The radiographic workpiece guide also includes an alignment structure located a predetermined distance from a pilot hole proximate the work site. The image is updated based on an initial radiographic scan and updated position information from the handpiece tool as to location and angular orientation of the handpiece tool relative to the workpiece guide.