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Pimkhaokham A, Chow J, Pozzi A, Arunjaroensuk S, Subbalehka K, Mattheos N. Computer-assisted and robotic implant surgery: Assessing the outcome measures of accuracy and educational implications. Clin Oral Implants Res 2024; 35:939-953. [PMID: 37994685 DOI: 10.1111/clr.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. METHODS A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. RESULTS Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta-analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. CONCLUSION Meta-analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.
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Affiliation(s)
- Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - James Chow
- Brånnemark Osseointegration Centre, Hong Kong SAR, China
| | - Alessandro Pozzi
- Goldstein Center for Esthetic and Implant Dentistry, Augusta University, Dental College of Georgia, Augusta, Georgia, USA
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keskanya Subbalehka
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Wang W, Zhuang M, Tao B, Wang F, Wu Y. Learning curve of dynamic navigation-assisted zygomatic implant surgery: An in vitro study. J Prosthet Dent 2024; 132:178.e1-178.e12. [PMID: 38609763 DOI: 10.1016/j.prosdent.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
STATEMENT OF PROBLEM Dynamic computer-assisted zygomatic implant surgery (dCAZIS) has been reported to provide clinical efficacy with high accuracy and low risk of complications. However, the learning curve before performing dCAZIS effectively is unknown. PURPOSE The purpose of this in vitro study was to explore the learning curve of dCAZIS in dentists with different levels of experience in implant dentistry and navigation surgery. MATERIAL AND METHODS Six senior dental students were randomly divided into 3 groups for initial training (FH-CI group: pretraining on freehand conventional implant surgery; FH-ZI group: pretraining on freehand ZI surgery; DN-CI group: pretraining on conventional implant surgery under dynamic navigation). Then, every operator conducted 6 repeated dCAZIS training sessions on edentulous 3-dimensional (3D) printed skull models and was asked to complete a self-report questionnaire after each training session. A total of 36 postoperative cone beam computed tomography (CBCT) scans with 144 ZI osteotomy site preparations were obtained and superimposed over the preoperative design for accuracy measurements. The operation time, 3D deviations, and results of the self-reports were recorded. Comparisons among groups were analyzed with independent-sample Kruskal-Wallis tests (α=.05), and correlations between study outcomes and the number of practices were calculated. RESULTS Operator experience and increased practice times did not significantly affect the accuracy of dCAZIS (P>.05). However, the operation time varied among groups (P<.001), and significantly shortened with more practice, reaching 11.51 ±1.68 minutes at the fifth attempt in the FH-CI group (P<.001 compared with the first practice), 14.48 ±3.07 minutes at the third attempt in the FH-ZI group (P=.038), and 8.68 ±0.58 minutes at the sixth attempt in the DN-CI group (P<.001). All groups reached their own learning curve plateau stage within 6 practice sessions. As the number of practice sessions increased, the results from the self-report questionnaires gradually improved. CONCLUSIONS Among dentists with different levels of experience in implant dentistry and navigation surgery, dCAZIS was found to have a learning curve with respect to operation time but not implant accuracy. Experience in ZI surgery had little impact on the learning curve of dCAZIS, but experience in navigation surgery was a key factor.
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Affiliation(s)
- Wenying Wang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Minjie Zhuang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Baoxin Tao
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Feng Wang
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Yiqun Wu
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China.
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Wang M, Liu F, Yu T, Zhan Y, Ma F, Rausch-Fan X. Accuracy of an autonomous dental implant robotic system in partial edentulism: A pilot clinical study. Clin Oral Investig 2024; 28:385. [PMID: 38890168 DOI: 10.1007/s00784-024-05780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Robots are increasingly being used for surgical procedures in various specialties. However, information about the accuracy of robot-assisted dental implant surgery is lacking. This pilot clinical study aimed to investigate the accuracy of an autonomous dental implant robotic (ADIR) system in partially edentulous cases. MATERIAL AND METHODS The ADIR system was used to place a total of 20 implants in 13 participants. Implant deviation from the planned positions was assessed to determine accuracy. The entry, apex, and angular deviations were described as means ± standard deviation. A two-sample t test was used to compare implant deviation between the flap and flapless groups and between maxillary and mandibular implants (α = .05). RESULTS The entry, apex, and angular deviations were 0.65 ± 0.32 mm, 0.66 ± 0.34 mm, and 1.52 ± 1.01°, respectively, with no statistically significant difference between the flap and flapless approaches (P > .05). No adverse events were encountered in any of the participants. CONCLUSIONS DIR accuracy in this clinical series was comparable to that reported for static and dynamic computer-assisted implant surgery. Robotic computer-assisted implant surgery may be useful for dental implant placement, potentially improving the quality and safety of the procedure. CLINICAL RELEVANCE The findings of this study showed that the ADIR system could be useful for dental implant surgery.
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Affiliation(s)
- MiaoZhen Wang
- First Clinical Division, Peking University School and Hospital for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology for Stomatology & Beijing Key Laboratory for Digital Stomatology, Beijing, PR China
| | - Feng Liu
- First Clinical Division, Peking University School and Hospital for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology for Stomatology & Beijing Key Laboratory for Digital Stomatology, Beijing, PR China.
| | - Tao Yu
- First Clinical Division, Peking University School and Hospital for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology for Stomatology & Beijing Key Laboratory for Digital Stomatology, Beijing, PR China
| | - Yalin Zhan
- First Clinical Division, Peking University School and Hospital for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology for Stomatology & Beijing Key Laboratory for Digital Stomatology, Beijing, PR China
| | - Feifei Ma
- First Clinical Division, Peking University School and Hospital for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology for Stomatology & Beijing Key Laboratory for Digital Stomatology, Beijing, PR China
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, Center of Clinical Research, Dental School, Medical University of Vienna, Vienna, Austria
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Yan Q, Wu X, Shi J, Shi B. Does dynamic navigation assisted student training improve the accuracy of dental implant placement by postgraduate dental students: an in vitro study. BMC Oral Health 2024; 24:600. [PMID: 38778313 PMCID: PMC11112919 DOI: 10.1186/s12903-024-04324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training. METHODS Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire. RESULTS A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training. CONCLUSIONS Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.
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Affiliation(s)
- Qi Yan
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xinyu Wu
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Junyu Shi
- Department of Oral and Maxillo-Facial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Bin Shi
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Delarue M, Perez C, Lucidarme Q, Bornert F. Management of a solitary bone cyst using a custom-made surgical guide for a minimally invasive approach: technical note and case report. BMC Oral Health 2024; 24:560. [PMID: 38745168 PMCID: PMC11092003 DOI: 10.1186/s12903-024-04308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Solitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw. The article explores the use of a static 3D-printed surgical guide to treat mandibular SBC, emphasizing a minimally surgical approach for this lesion. CASE PRESENTATION A 20-year-old woman was referred for a persistent mandibular SBC lacuna, without specific complaints. Her medical history included a previous bone trepanation for a SBC in the same area, radiologically and surgically confirmed. X-ray assessment showed a well-defined unilocular radiolucency surrounding the root of the first left lower molar (tooth #36), measuring 10 × 10 mm. Pulp sensitivity was normal. CBCT data and STL files of dental cast were obtained preoperatively and registered. A 3D-printed surgical guide was used for minimally invasive trepanation of the buccal cortical. The simulation used a targeted endodontic microsurgery approach in order to determine axis and diameter of the trephine. Surgery was performed under local anesthesia. The guide was tooth supported integrating tubes and a fork for guiding precise trepanation. A 3.5 mm round bone window was created, leaving an empty cavity confirming SBC diagnosis and permitting bone curettage. A blood clot was obtained to promote bone healing. Complete reossification was observed after 6 months. The follow-up at 2 years confirmed a complete bone healing with normal pulp sensitivity. DISCUSSION The 3D-printed windowed surgical guide with dental support offers big advantages, including improved visibility and reduced errors. Compared to traditional guides, it eliminates visual hindrance and allows easier and quick access to confined areas as well as an improved irrigation during drilling process. The article also highlights the importance of preoperative planning while acknowledging potential limitations and errors and surgical complications. CONCLUSION The use of the 3D-printed surgical guide could be used in routine for minimally invasive intervention of SBC. This case also demonstrates the potential utility of this approach in various procedures in oral and maxillofacial surgery. The technique provides precise localization, reducing complications and enhances operative efficiency.
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Affiliation(s)
- Maxime Delarue
- Faculty of Dental Surgery, University of Strasbourg, 8 Rue de Sainte Elisabeth, Strasbourg, 67000, France.
- Oral Surgery, UF8601, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg, 67000, France.
| | - Cyril Perez
- Faculty of Dental Surgery, University of Strasbourg, 8 Rue de Sainte Elisabeth, Strasbourg, 67000, France
- Oral Surgery, UF8601, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg, 67000, France
| | - Quentin Lucidarme
- Faculty of Dental Surgery, University of Strasbourg, 8 Rue de Sainte Elisabeth, Strasbourg, 67000, France
- Oral Surgery, UF8601, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg, 67000, France
| | - Fabien Bornert
- Faculty of Dental Surgery, University of Strasbourg, 8 Rue de Sainte Elisabeth, Strasbourg, 67000, France
- Dental Care Unit, UF8611, University Hospital of Strasbourg, Hôpital de Hautepierre, 1 Avenue Molière, Strasbourg, 67098, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, CRBS, 1 Rue Eugène Boeckel, Strasbourg, 67000, France
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Zhong X, Xing Y, Yan J, Chen J, Chen Z, Liu Q. Surgical performance of dental students using computer-assisted dynamic navigation and freehand approaches. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:504-510. [PMID: 37941129 DOI: 10.1111/eje.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/13/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Nowadays, the training of implant placement has shifted from once entirely instructor-student teaching to the increasing use of computer-assisted simulation. Based on computerized virtual planning, dynamic navigation has been used for implant placement with higher accuracy than the traditional freehand protocol. However, whether dynamic navigation benefits to the training of dental students in implant placement remains controversial. This study aimed to compare the surgical performance of dental students in implant placement using computer-assisted dynamic navigation and freehand approaches. MATERIALS AND METHODS A total of 20 dental students (6 males, 14 females, age: 25.6 ± 0.5 years) were enrolled in this study. With the traditional freehand approach (training 1) as the control protocol, computer-assisted dynamic navigation (training 2) was used in the training of dental students in implant placement. For each training, both the operating time (OT) of students and placement accuracy represented by the linear (at the implant platform, Dpl, and apex, Dap) and angular (Dan) deviations between the virtually planned and placed implants were recorded. Statistical comparisons were made between the two training protocols as well as male and female surgeons. RESULTS OT2 was around twice of OT1 (p < .0001), whereas Dan1 was almost three times of Dan2 (p < .0001). Dap1 and Dpl1 were significantly higher than Dap2 (p = .014) and Dpl2 (p = .033) respectively. Besides, male students showed statistically higher Dpl1 (p = .033) and Dan1 (p = .002) than females. No significant difference was found between male and female students in OT1, OT2, Dpl2, Dap1, Dap2 and Dan2. CONCLUSIONS Within the limitations of this study, the use of computer-assisted dynamic navigation in the preclinical training could improve the surgical performance of the dental students in implant placement. The combination of dynamic navigation with the traditional preclinical surgical training may benefit to dental students and could be applied in dental education.
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Affiliation(s)
- Xinyi Zhong
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yihan Xing
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Juan Yan
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jieyin Chen
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Zhuofan Chen
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Quan Liu
- Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
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Spille J, Bube N, Wagner J, Spille D, Birkenfeld F, Kübel P, Wiltfang J, Gülses A. Navigational exploration of bony defect mimicking a solid lesion of the mandible compared to conventional surgery by young professionals. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101588. [PMID: 37543209 DOI: 10.1016/j.jormas.2023.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION The aim of the current study was to evaluate the accuracy of resection a solid lesion in an acrylic lower jaw by young professionals using a dynamic computer-assisted surgical system comparted to conventional surgery technique. MATERIAL AND METHODS Twenty students performed the removal of the lesion conventionally and twenty students did the operation with a dynamic computer-assisted surgical system. Both groups were compared regarding the defect size, operation time, and surgical complications. RESULTS The defect size in the jaw was significant smaller with the navigated surgery (p < 0.001). Operation time was shorter without navigation system, but no significance was found (p = 0.137). Without navigation system three young professionals perforated the lingual cortex. DISCUSSION Navigated surgery can immediately be used by young professionals and support young surgeons in everyday clinical practice, especially in operations with difficult anatomic situations.
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Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany.
| | - Nele Bube
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Juliane Wagner
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Dorothee Spille
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Falk Birkenfeld
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Paul Kübel
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
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Pei X, Weng J, Sun F, Ma Y, Iao S, Liu X. Accuracy and efficiency of a calibration approach in dynamic navigation for implant placement: An in vitro study. J Dent Sci 2024; 19:51-57. [PMID: 38303864 PMCID: PMC10829622 DOI: 10.1016/j.jds.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/02/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Computer-assisted dynamic navigation surgery could provide accurate implant placement. However, its low efficiency was always criticized by dental surgeons. The purpose of this study was to evaluate the accuracy and efficiency of a calibration approach with reflective wafers in dynamic navigation for implant placement. Materials and methods Eighty implants were placed in the standardized polyurethane mandibular models under dynamic navigation and divided into 2 groups according to the calibration methods (n = 40). The U-shaped tube (UT) group used a prefabricated U-shaped tube embedded with radiopaque markers. The reflective wafers (RW) group used a fixation with 3 round reflective wafers as markers. Postoperative cone beam computed tomography images were obtained for implants deviation analyses. The calibration time was used to evaluate the efficiency of the 2 methods. Results Significant differences were found in the trueness and efficiency between the 2 groups (P < 0.05). The 3D deviations at the implant platform and apex were smaller in UT group (0.89 ± 0.28 and 0.79 ± 0.30 mm, respectively) than in the RW group (0.99 ± 0.28 and 0.98 ± 0.30 mm, respectively). The angular deviation was larger in the UT group (2.16 ± 1.12°) than in the RW group (1.53 ± 0.88°). The calibration approach of RW group was more efficient than the UT group (2.05 ± 0.55 and 7.50 ± 0.71 min, respectively). Conclusion The calibration method of RW improved the efficiency significantly and achieved equivalent trueness with UT for dynamic navigation during implant placement.
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Affiliation(s)
- Xiyan Pei
- First Clinic Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jinlong Weng
- First Clinic Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Feng Sun
- First Clinic Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yu Ma
- First Clinic Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Siniong Iao
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoqiang Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Takács A, Hardi E, Cavalcante BGN, Szabó B, Kispélyi B, Joób-Fancsaly Á, Mikulás K, Varga G, Hegyi P, Kivovics M. Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods. J Dent 2023; 139:104748. [PMID: 37863173 DOI: 10.1016/j.jdent.2023.104748] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. DATA In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. SOURCES A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. RESULTS A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. CONCLUSIONS Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. CLINICAL SIGNIFICANCE To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.
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Affiliation(s)
- Anna Takács
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary
| | - Eszter Hardi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária utca 52. 1085 Budapest, Hungary
| | - Bianca Golzio Navarro Cavalcante
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oral Biology, Semmelweis University, Nagyvárad tér 4. 1089 Budapest, Hungary
| | - Bence Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary
| | - Barbara Kispélyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Szentkirályi utca 47. 1088 Budapest, Hungary
| | - Árpád Joób-Fancsaly
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária utca 52. 1085 Budapest, Hungary
| | - Krisztina Mikulás
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Szentkirályi utca 47. 1088 Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Department of Oral Biology, Semmelweis University, Nagyvárad tér 4. 1089 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12. 7624 Pécs, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Városmajor utca 68. 1122 Budapest, Hungary
| | - Márton Kivovics
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Üllői út 26. 1085 Budapest, Hungary.
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Ma L, Ye M, Wu M, Chen X, Shen S. A retrospective study of dynamic navigation system-assisted implant placement. BMC Oral Health 2023; 23:759. [PMID: 37838655 PMCID: PMC10576318 DOI: 10.1186/s12903-023-03481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND To evaluate the accuracy of implant placement assisted by a dynamic navigation system, as well as its influencing factors and learning curve. METHODS At Macao We Care Dental Center, 55 cases of implant placement using dynamic navigation were retrospectively evaluated. To evaluate their accuracy, the apex, tip, and angle deviations of preoperatively planned and postoperatively placed implants were measured. The effects of the upper and lower jaws, different sites or lateral locations of dental implants, and the length and diameter of the implants on accuracy were analyzed, as well as the variation in accuracy with the increase in the number of surgical procedures performed by dentists. RESULTS The implant had an apex deviation of 1.60 ± 0.94 mm, a tip deviation of 1.83 ± 1.03 mm, and an angle deviation of 3.80 ± 2.09 mm. Statistical differences were observed in the tip deviation of implants at different positions based on three factors: jaw position, lateral location, and tooth position (P < 0.05). The tip deviation of the anterior teeth area was significantly greater than those of the premolar and molar areas. There were no statistically significant differences in apex deviation, tip deviation, or angle deviation between the implants of different diameters and lengths (P > 0.05). There were significant differences in the angle deviation between the final 27 implants and the first 28 implants. Learning curve analysis revealed that angle deviation was negatively correlated with the number of surgical procedures, whereas the regression of apex deviation and tip deviation did not differ statistically. CONCLUSIONS The accuracy of dynamic navigation-assisted dental implants meets the clinical needs and is higher than that of traditional implants. Different jaw positions, lateral locations, and implant diameters and lengths had no effect on the accuracy of the dental implants guided by the dynamic navigation system. The anterior teeth area had a larger tip deviation than the posterior teeth area did. As the number of dynamic implantation procedures performed by the same implant doctor increased, the angle deviation gradually decreased.
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Affiliation(s)
- Lijuan Ma
- Department of Stomatology, Affiliated Stomatological Hospital of Jinan University (Daliang Hospital Shunde District Foshan City), Foshan City, 528399, Guangdong Province, China
| | - Mingjun Ye
- School of Stomatology, Jinan University, Guangzhou City, 510620, Guangdong Province, China
| | - Mingle Wu
- Department of Stomatology, Affiliated Stomatological Hospital of Jinan University (Daliang Hospital Shunde District Foshan City), Foshan City, 528399, Guangdong Province, China
| | - Xiaolei Chen
- School of Stomatology, Jinan University, Guangzhou City, 510620, Guangdong Province, China
| | - Shan Shen
- Department of Stomatology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, 510632, Guangdong Province, China.
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Ebeling M, Sakkas A, Schramm A, Wilde F, Scheurer M, Winter K, Pietzka S. Accuracy Analysis of Computer-Assisted and Guided Dental Implantology by Comparing 3D Planning Data and Actual Implant Placement in a Mandibular Training Model: A Monocentric Comparison between Dental Students and Trained Implantologists. J Pers Med 2023; 13:1037. [PMID: 37511650 PMCID: PMC10381824 DOI: 10.3390/jpm13071037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided.
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Affiliation(s)
- Marcel Ebeling
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Alexander Schramm
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Mario Scheurer
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04109 Leipzig, Germany
| | - Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
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12
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Ardila CM, González-Arroyave D. Efficacy of CAD/CAM technology in dental procedures performed by students: A systematic scoping review of randomized clinical trials. Heliyon 2023; 9:e15322. [PMID: 37123905 PMCID: PMC10130864 DOI: 10.1016/j.heliyon.2023.e15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/10/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
To assess the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) in dental procedures performed by dental students. METHODS A systematic scoping review was performed. MeSH terms and keywords were specified to assess randomized clinical trials (RCTs) in all idioms. RESULTS Nine RCTs that include 520 students were selected. Two RCTs studied implant placement, and the rest of the trials explored implant impressions, intraoral scans, canal obturation, head positioning errors in panoramic images, deep caries and pulp exposure, diagnosis of temporomandibular disorders, and a tooth for restorations. Considering efficacy, variable results were found. The RCTs that explored implant impressions, deep caries and pulp exposure, and diagnosis of temporomandibular disorders showed better results when CAD/CAM technology was performed by students. Two RCTs that investigated implant placement presented contradictory outcomes; one showed better results when CAD/CAM systems were used while the other described similar results to conventional methods. The remaining RCTs did not find differences with conventional procedures. Considering the time spent during the procedures, two studies showed no differences between groups, while another indicated that the time spent was less for digital impressions (p < 0.001). A continuous decrease in scanning time was also perceived for all groups as skills in intraoral scanning augmented (p = 0.0005). Students indicated an interest in utilizing the CAD/CAM systems and recognized that their abilities were enhanced. CONCLUSIONS Considering the limitations of this review and the limited number of RCTs evaluated, students recognized that their skills improved using CAD/CAM systems; however, only in some specific procedures greater efficacy and less time spent were observed when this technology was used. Dental students also showed great interest in using these techniques.
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Affiliation(s)
- Carlos M. Ardila
- Basic Studies Department, Faculty of Dentistry, University of Antioquia, UdeA, 050010 Medellín, Colombia
- Corresponding author.
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Wu F, Liu L, Zhao Y, Wu G, Chen L, Wang J. Influence of different education approaches on the implantation performance of dental practitioners in aesthetic zone. J Dent Educ 2023; 87:415-423. [PMID: 36377034 DOI: 10.1002/jdd.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the influence of different education approaches on the implantation performance (operation time, three-dimensional deviation) of inexperienced operators. METHODS Eighteen students who met the inclusion criteria were randomly assigned to traditional training group or digital training group. After training, the average operation time and implant deviation (platform deviation, apex deviation, and angle deviation) of the two groups were calculated by Student's t-test. A self-developed questionnaire was used to evaluate the students' grasp of clinical knowledge and skill. RESULT Compared with the traditional training group, the duration of implant installation and temporary prosthesis placement of the digital training group decreased significantly (p < 0.05). The implant deviation of the digital training group was lower than that of the traditional training group. The apex deviation (p = 0.015) and angle deviation (p = 0.015) significantly improved with digital training, but differences in platform deviation (p = 0.065) were not statistically significant. The questionnaire survey showed that the overall perception of the inexperienced operators in the digital training group was better than that in the traditional training group. CONCLUSION In the hands of inexperienced operators, digital training reduced the operation time and improved the implant accuracy in comparison with traditional training.
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Affiliation(s)
- Fan Wu
- Department of Oral Implants, School of Stomatology, National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lipeng Liu
- Department of Pediatric Dentistry, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yuqing Zhao
- Department of Oral Implants, School of Stomatology, National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Gaoyi Wu
- School of Stomatology, Heilongjiang Key Lab of Oral Biomedicine Materials and Clinical Application, Experimental Center for Stomatology Engineering, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Lei Chen
- Department of Orthodontics, School of Stomatology, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong, China
| | - Jing Wang
- Department of Oral Implants, School of Stomatology, National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
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14
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Wu BZ, Xue F, Ma Y, Sun F. Accuracy of automatic and manual dynamic navigation registration techniques for dental implant surgery in posterior sites missing a single tooth: A retrospective clinical analysis. Clin Oral Implants Res 2023; 34:221-232. [PMID: 36691811 DOI: 10.1111/clr.14034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the relative accuracy of manual (U-shaped tube) and automatic (two-in-one) dynamic navigation registration techniques for implant surgery performed in posterior sites missing one tooth. MATERIALS AND METHODS This study included 58 partially edentulous patients with 58 implants, including 31 and 27 in the manual and automatic groups. Deviations between the planned and actual implant placement were assessed. RESULTS The angular deviation in the overall study cohort was 2.54 ± 1.21°, while the 3D deviations at the implant platform and apex were 0.90 ± 0.46 mm and 1.04 ± 0.47 mm, respectively. The respective angular deviations in the manual and automatic groups were 2.82 ± 1.17° and 2.21 ± 1.19° (p > .05), while platform deviations were 0.89 ± 0.48 mm and 0.91 ± 0.45 mm (p > .05), and apex deviations were 0.99 ± 0.48 mm and 1.11 ± 0.46 mm (p > .05). No significant differences in absolute buccolingual, mesiodistal, or apicocoronal deviations were detected between these groups at either level (p > .05) nor were did deviation distributions differ in the buccolingual, mesiodistal, or apicocoronal directions at the platform or apex levels (p > .05). CONCLUSIONS Manual and automatic dynamic navigation registration techniques can achieve excellent accuracy when placing implants in posterior sites missing a single tooth. The two-in-one automatic registration technique can reduce the amount of time and intraoperative steps necessary to complete the registration process relative to the manual U-shaped tube registration technique. Further follow-up studies are necessary to expand on these results.
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Affiliation(s)
- Bin-Zhang Wu
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Fei Xue
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yu Ma
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Feng Sun
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Wang X, Shujaat S, Meeus J, Shaheen E, Legrand P, Lahoud P, Gerhardt MDN, Jacobs R. Performance of novice versus experienced surgeons for dental implant placement with freehand, static guided and dynamic navigation approaches. Sci Rep 2023; 13:2598. [PMID: 36788333 PMCID: PMC9929278 DOI: 10.1038/s41598-023-29633-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Lack of evidence exists related to the investigation of the accuracy and efficacy of novice versus experienced practitioners for dental implant placement. Hence, the following in vitro study was conducted to assess the accuracy of implant positioning and self-efficacy of novice compared to experienced surgeons for placing implant using freehand (FH), pilot drill-based partial guidance (PPG) and dynamic navigation (DN) approaches. The findings revealed that DN significantly improved the angular accuracy of implant placement compared with FH (P < 0.001) and PPG approaches (P < 0.001). The time required with DN was significantly longer than FH and PPG (P < 0.001), however, it was similar for both novice and experienced practitioners. The surgeon's self-confidence questionnaire suggested that novice practitioners scored higher with both guided approaches, whereas experienced practitioners achieved higher scoring with PPG and FH compared to DN. In conclusion, implant placement executed under the guidance of DN showed high accuracy irrespective of the practitioner's experience. The application of DN could be regarded as a beneficial tool for novices who offered high confidence of using the navigation system with the same level of accuracy and surgical time as that of experienced practitioners.
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Affiliation(s)
- Xiaotong Wang
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Meeus
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paul Legrand
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Maurício do Nascimento Gerhardt
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- School of Health Sciences, Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
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The effect of implant surgery experience on the learning curve of a dynamic navigation system: an in vitro study. BMC Oral Health 2023; 23:89. [PMID: 36782192 PMCID: PMC9926829 DOI: 10.1186/s12903-023-02792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Dynamic navigation systems have a broad application prospect in digital implanting field. This study aimed to explore and compare the dynamic navigation system learning curve of dentists with different implant surgery experience through dental models. METHODS The nine participants from the same hospital were divided equally into three groups. Group 1 (G1) and Group 2 (G2) were dentists who had more than 5 years of implant surgery experience. G1 also had more than 3 years of experience with dynamic navigation, while G2 had no experience with dynamic navigation. Group 3 (G3) consisted of dentists with no implant surgery experience and no experience with dynamic navigation. Each participant sequentially placed two implants (31 and 36) on dental models according to four practice courses (1-3, 4-6, 7-9, 10-12 exercises). Each dentist completed 1-3, 4-6 exercises in one day, and then 7-9 and 10-12 exercises 7 ± 1 days later. The preparation time, surgery time and related implant accuracy were analyzed. RESULTS Three groups placed 216 implants in four practice courses. The regressions for preparation time (F = 10.294, R2 = 0.284), coronal deviation (F = 4.117, R2 = 0.071), apical deviation (F = 13.016, R2 = 0.194) and axial deviation (F = 30.736, R2 = 0.363) were statistically significant in G2. The regressions for preparation time (F = 9.544, R2 = 0.269), surgery time (F = 45.032, R2 = 0.455), apical deviation (F = 4.295, R2 = 0.074) and axial deviation (F = 21.656, R2 = 0.286) were statistically significant in G3. Regarding preparation and surgery time, differences were found between G1 and G3, G2 and G3. Regarding implant accuracy, differences were found in the first two practice courses between G1 and G3. CONCLUSIONS The operation process of dynamic navigation system is relatively simple and easy to use. The linear regression analysis showed there is a dynamic navigation learning curve for dentists with or without implant experience and the learning curve of surgery time for dentists with implant experience fluctuates. However, dentists with implant experience learn more efficiently and have a shorter learning curve.
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Kang HG, Kang SH, Kim HK, Son YD. Target registration errors in navigation-assisted mandibular surgery according to the tracking methods and the type of markers: experiments using human dry mandibular bone. Oral Radiol 2023; 39:180-190. [PMID: 35578091 DOI: 10.1007/s11282-022-00619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible. METHODS Four different experiments were performed to obtain the TREs using two tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package. RESULTS The average TRE values obtained from the four experiments were as follows: (1) 0.85 mm (± 0.07) using invasive marker and Aurora, (2) 1.06 mm (± 0.12) using invasive marker and Polaris, (3) 1.43 mm (± 0.15) using noninvasive marker and Aurora, and (4) 1.57 mm (± 0.23) using noninvasive marker and Polaris. Comparisons between all the experimental results revealed statistically significant differences except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons. CONCLUSIONS This study demonstrates that irrespective of the tracking modality, using invasive marker is a better choice in terms of accuracy. When using noninvasive marker, it is important to consider the increased TREs. In this study, the noninvasive marker caused a maximum increment of TREs of 0.81 mm compared with the invasive marker. Furthermore, using an EM-based tracker with invasive marker may result in the best accuracy for navigation.
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Affiliation(s)
- Hee-Guen Kang
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea.
- Neuroscience Research Institute, Gachon University, Incheon, Korea.
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea.
| | - Young-Don Son
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
- Neuroscience Research Institute, Gachon University, Incheon, Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea
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Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches. Int J Implant Dent 2022; 8:42. [PMID: 36210395 PMCID: PMC9548458 DOI: 10.1186/s40729-022-00441-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches.
Methods
A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. Each practitioner inserted 4 implants per approach randomly with a 1-week gap to avoid memory bias (4 insertion sites × 3 approaches × 6 practitioners = 72 implants). The performance of practitioners was assessed by comparing actual implant deviation to the planned position, time required for implant placement and questionnaire-based self-confidence evaluation of practitioners on a scale of 1–30.
Results
The navigation approach significantly improved angular deviation compared with freehand (P < 0.001) and surgical guide (P < 0.001) irrespective of the experience. Surgical time with navigation was significantly longer compared to the freehand approach (P < 0.001), where experienced practitioners performed significantly faster compared to novice practitioners (P < 0.001). Overall, self-confidence was higher in favor of novice practitioners with both guided approaches. In addition, the confidence of novice practitioners (median score = 26) was comparable to that of experienced practitioners (median score = 27) for placing implants with the navigation approach.
Conclusions
Dynamic navigation system could act as a viable tool for dental implant placement. Unlike freehand and static-guided approaches, novice practitioners showed comparable accuracy and self-confidence to that of experienced practitioners with the navigation approach.
Graphical Abstract
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Learning Curve and Comparison of Dynamic Implant Placement Accuracy Using a Navigation System in Young Professionals. Dent J (Basel) 2022; 10:dj10100187. [PMID: 36285997 PMCID: PMC9600962 DOI: 10.3390/dj10100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of the current study was to evaluate the learning curve and accuracy of implant placement by young professionals using a dynamic computer-assisted surgical system for dental implant placement. Ten students tried to place eight implants with a dynamic surgical system in predefined positions on two consecutive weekends, resulting in 160 implant placements in total. Postoperatively, the positions of the implants were scanned with an intraoral scanner and compared for deviations at the entry point, the apex, as well as angular deviations to the master model. The mean values of all measurements improved; statistical significance was found for the changes in the angle as well as for the position of the implants to the apex (p < 0.001). Furthermore, the young professionals indicated subjective improvement in handling the dynamic surgery system. Navigated surgical dental implant placement can be learned quickly and can support young professionals in everyday clinical practice, especially in difficult anatomic situations.
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Abduo J, Lau D. Duration, deviation and operator's perception of static computer assisted implant placements by inexperienced clinicians. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:477-487. [PMID: 34797018 DOI: 10.1111/eje.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This study measured the duration, deviation and operator's perception of implant placement by fully guided (FG), pilot-guided (PG) and freehand (FH) protocols by postgraduate students with minimal implant experience. MATERIALS AND METHODS Twenty postgraduate students participated in the study. Half of them placed single anterior (S-Ant) and single posterior (S-Post) implants, and the other half placed anterior (B-Ant) and posterior (B-Post) implants in a wide edentulous area. The PG placement involved surgical guides that only controlled pilot drilling, whilst the FG placement controlled all the drilling steps and implant placement. The duration of implant placement and the operator's perception (ease of drilling, ease of implant placement and operator's preference) were measured. The deviations of placed implants were quantified by measuring the trueness and angulation deviations in relation to the planned implants. RESULTS The PG placement was the quickest for inserting implants, followed by FG and FH placements, respectively (p < .05). The location of the implant had influenced the duration of implant placement only for the PG placement. In relation to ease of drilling, ease of implant placement and operator's preference, there was no significant difference amongst the different placement protocols or implant locations. The FG placement was associated with least deviations, followed by PG and FH placements, respectively (p < .05). CONCLUSIONS In the hands of postgraduate students with minimal implant experience, FG and PG placements reduced the implant placement duration in comparison with FH placement. The FG placement was consistently more accurate followed by PG placement.
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Affiliation(s)
- Jaafar Abduo
- Melbourne Dental School, Melbourne University, Melbourne, Victoria, Australia
| | - Douglas Lau
- Private Practice, Melbourne Dental School, Melbourne University, Melbourne, Victoria, Australia
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21
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Accuracy of Dynamic Navigation for Non-Surgical Endodontic Treatment: A Systematic Review. J Clin Med 2022; 11:jcm11123441. [PMID: 35743515 PMCID: PMC9225421 DOI: 10.3390/jcm11123441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 01/27/2023] Open
Abstract
In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data.
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Jorba-García A, González-Barnadas A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:2479-2494. [PMID: 33635397 DOI: 10.1007/s00784-021-03833-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement. MATERIALS AND METHODS An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model. RESULTS Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I2 = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I2 = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I2 = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I2 = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): -0.86°; 95% CI: -1.35 to -0.36) and freehand implant placement (MD: -4.33°; 95% CI: -5.40 to -3.25). CONCLUSION dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems. CLINICAL RELEVANCE The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.
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Affiliation(s)
- Adrià Jorba-García
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Albert González-Barnadas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,IDIBELL Institute, Barcelona, Spain
| | - Octavi Camps-Font
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,IDIBELL Institute, Barcelona, Spain
| | - Rui Figueiredo
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. .,IDIBELL Institute, Barcelona, Spain. .,Facultat de Medicina i Ciències de la Salut, Campus de Bellvitge, Universitat de Barcelona (UB), Pavelló de Govern, 2a Planta, Despatx 2.9, C/Feixa Llarga s/n, E-08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eduard Valmaseda-Castellón
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,IDIBELL Institute, Barcelona, Spain
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