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Mittal S, Kaurani P, Goyal R. Comparison of accuracy between single posterior immediate and delayed implants placed using computer guided implant surgery and a digital laser printed surgical guide: A clinical investigation. J Prosthet Dent 2024:S0022-3913(23)00816-8. [PMID: 38218708 DOI: 10.1016/j.prosdent.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/15/2024]
Abstract
STATEMENT OF PROBLEM The congruence of surgical implant placement with the preplanned position is important for anatomic and prosthetic precision, minimal complications, and increased longevity. The influence of implant placement timing on the surgical deviations in single posterior implants is unclear. PURPOSE The purpose of this clinical study was to compare deviations between preplanned and single posterior immediate and delayed implants placed using computer-guided digital light processing (DLP) surgical guides fabricated using intraoral scanning and cone beam computed tomography (CBCT). MATERIAL AND METHODS Implant surgery was performed on 24 participants requiring single immediate or delayed implants in the posterior maxillary and mandibular regions, for which the surgical site data were obtained from CBCT and intraoral scanning. Subsequently, virtual implant planning and DLP surgical guides were fabricated. Preimplant and postimplant placement CBCT scans were overlapped, and mean deviations for the immediate and delayed implant groups were calculated. The groups were compared with unpaired t tests (α=.05). RESULTS A total of 24 implants were placed, 12 in each group. In participants who received immediate implant placement, the mean ±standard deviation angular deviation, linear deviation at shoulder, linear deviation at apex, and vertical deviation were 1.03 ±0.70 degrees, 0.26 ±0.30 mm, 0.23 ±0.24 mm, and 0.39 ± 0.34 mm, respectively. In participants who received delayed implant treatment, the deviations were 0.53 ±0.60 degrees, 0.15 ±0.18 mm, 0.25 ±0.33 mm, and 0.17 ±0.10 mm, respectively. Significant differences between the 2 groups were found in the vertical deviation (P<.05). CONCLUSIONS The timing of the single posterior placement was associated with different deviations in the vertical direction. All deviations obtained were below the recommended values. DLP surgical guides fabricated from intraoral and CBCT scans provided accurate implant placement in immediate and delayed single posterior implants.
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Affiliation(s)
- Sankalp Mittal
- Head of Department, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Jaipur, India.
| | - Pragati Kaurani
- Professor, Department of Prosthodontics Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Jaipur, India
| | - Ritika Goyal
- Postgraduate student, Department of Prosthodontics Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Jaipur, India
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Luo T, Xie C, Wu J, Zhu J, Yu H. A digital strategy for intraoperative acquisition of actual drill position and rapid assessment of bony preparation accuracy using an intraoral scanner. Heliyon 2023; 9:e18004. [PMID: 37483804 PMCID: PMC10362229 DOI: 10.1016/j.heliyon.2023.e18004] [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: 12/03/2022] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
A digital workflow to acquire actual position of the drill and assess bony preparation accuracy intraoperatively was described. Based on the widely used intraoral scanner, this digital workflow was a relatively practical and economical option for digital intraoperative measurement. As a result, it could help the clinician in accurate verification and immediate correction of the drill position and consequently facilitating the accurate implant placement in implant surgery.
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Affiliation(s)
- Tian Luo
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chenyang Xie
- Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiacheng Wu
- Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiakang Zhu
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haiyang Yu
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Schulz MC, Tokarski M, Jacoby J, Naros A, Weise C, Tausche E, Lauer G, Haim D. Accuracy of full-guided vs. pilot-guided implant insertion - A prospective laboratory study in fifth-year dental students. Ann Anat 2023; 248:152082. [PMID: 36913983 DOI: 10.1016/j.aanat.2023.152082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/12/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Education of undergraduates in implant dentistry has been extended. In order to assess the correct implant position, the accuracy of implant insertion using templates for pilot-drill guided and full-guided implant insertion was examined in a laboratory set-up in a cohort of undergraduates. METHODS After three-dimensional planning of the implant position in partially edentulous mandibular models, individual templates for the pilot-drill guided or full-guided implant insertion in the region of the first premolar were produced. A total of 108 dental implants were inserted. The results of the radiographic evaluation of the three-dimensional accuracy were statistically analyzed. Furthermore, the participants completed a questionnaire. RESULTS The deviation of the three-dimensional angle of the implants inserted fully guided was 2.74 ± 1.49 degrees compared to 4.59 ± 2.70 degrees for pilot-drill guided. The difference was statistically significant (p < 0.01). The returned questionnaires revealed a high interest in oral implantology and a positive evaluation of the hands-on course. CONCLUSIONS In this study, the undergraduates benefited from applying full-guided implant insertion considering the accuracy in this laboratory examination. However, the clinical effects are not clear as the differences are within a small range. Based on the returned questionnaires, the implementation of practical courses in the undergraduate curriculum should be encouraged.
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Affiliation(s)
- Matthias C Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstr. 2-8, D-72076 Tübingen, Germany; Department of Oral and Maxillofacial Surgery Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
| | - Marc Tokarski
- Department of Oral and Maxillofacial Surgery Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Johann Jacoby
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Silcherstr. 5, D-72076 Tübingen, Germany
| | - Andreas Naros
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstr. 2-8, D-72076 Tübingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstr. 2-8, D-72076 Tübingen, Germany
| | - Eve Tausche
- Orthodontic Office for Children and Adults, Beilstr. 13, D-01277 Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Dominik Haim
- Department of Oral and Maxillofacial Surgery Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
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Liu L, Wang X, Guan M, Fan Y, Yang Z, Li D, Bai Y, Li H. A mixed reality-based navigation method for dental implant navigation method: A pilot study. Comput Biol Med 2023; 154:106568. [PMID: 36739818 DOI: 10.1016/j.compbiomed.2023.106568] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
This in vitro study aimed to put forward the development and investigation of a novel Mixed Reality (MR)-based dental implant navigation method and evaluate implant accuracy. Data were collected using 3D-cone beam computed tomography. The MR-based navigation system included a Hololens headset, an NDI (Northern Digital Inc.) Polaris optical tracking system, and a computer. A software system was developed. Resin models of dentition defects were created for a randomized comparison study with the MR-based navigation implantation system (MR group, n = 25) and the conventional free-hand approach (FH group, n = 25). Implant surgery on the models was completed by an oral surgeon. The precision and feasibility of the MR-based navigation method in dental implant surgery were assessed and evaluated by calculating the entry deviation, middle deviation, apex deviation, and angular deviation values of the implant. The system, including both the hardware and software, for the MR-based dental implant navigation method were successfully developed and a workflow of the method was established. Three-Dimensional (3D) reconstruction and visualization of the surgical instruments, dentition, and jawbone were achieved. Real-time tracking of implant tools and jaw model, holographic display via the MR headset, surgical guidance, and visualization of the intraoperative implant trajectory deviation from the planned trajectory were captured by our system. The MR-based navigation system was with better precise than the free-hand approach for entry deviation (MR: 0.6914 ± 0.2507 mm, FH: 1.571 ± 0.5004 mm, P = 0.000), middle deviation (MR: 0.7156 ± 0.2127 mm, FH: 1.170 ± 0.3448 mm, P = 0.000), apex deviation (MR: 0.7869 ± 0.2298 mm, FH: 0.9190 ± 0.3319 mm, P = 0.1082), and angular deviation (MR: 1.849 ± 0.6120°, FH: 4.933 ± 1.650°, P = 0.000).
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Affiliation(s)
- Lin Liu
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Xiaoyu Wang
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China; Department of Stomatology, PLA Strategic Support Force Special Medical Center, Beijing, 100101, China
| | - Miaosheng Guan
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China; PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Yiping Fan
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Zhongliang Yang
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Deyu Li
- Beijing Visual 3D Medical Science and Technology Development Co., LTD., Beijing, 100000, China.
| | - Yuming Bai
- Beijing Visual 3D Medical Science and Technology Development Co., LTD., Beijing, 100000, China
| | - Hongbo Li
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
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Deeb JG, Kanduti D, Skrjanc L, Carrico CK, Deeb G. Comparison of Accuracy and Time for Four Implant Placement Techniques Supporting Fixed-Partial Denture. J ORAL IMPLANTOL 2022; 48:562-572. [PMID: 35503961 DOI: 10.1563/aaid-joi-d-20-00415] [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: 04/04/2021] [Revised: 01/07/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022]
Abstract
Various guiding methods are used to place implants. This ex vivo pilot study used a convenience sample to examine time and accuracy for placement of 2 dental implants supporting a 3-unit fixed prosthesis on a simulation model using freehand and 3 guided placement techniques. Four operators with no prior implant placement experiences were randomly assigned placement of 2 maxillary or mandibular implants for a fixed prosthesis. Techniques included dynamic navigation (DN), static guide (SG), template-based guide (TBG), and freehand placement (FH). Preoperative and operative times were recorded. Discrepancies between the planned and placed implant positions were assessed by superimposing preoperative and postoperative cone beam computerized tomography scans. Data were analyzed with repeated-measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). Dynamic navigation was associated with the longest operative time (13.5 minutes vs 5-10.2, P = .0001) but overall fastest when incorporating preoperative time (32.1 minutes vs 143-181.5, P < .0001). All deviation measures were significantly associated with the placement method (P < .05) except apex vertical deviation (P = .3925). Implants placed by SG had significantly lower entry 2-dimensional deviation than the other methods, particularly on the mandible. The DN and SG methods had significantly lower Apex 3D and overall angle deviations, again particularly on the mandible. The mandible had significantly higher deviations than maxilla. Within limitations of this study, implant placement by novice operators is more accurate when using dynamic and static guidance compared to freehand and template-based techniques.
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Affiliation(s)
- Janina Golob Deeb
- Virginia Commonwealth University, School of Dentistry, Department of Periodontics, Richmond, Virginia, USA
| | - Domen Kanduti
- University of Ljubljana, Medical Faculty, Division of Dental Medicine, Department of Periodontics, Ljubljana, Slovenia, EU
| | - Lenart Skrjanc
- University of Ljubljana, Medical Faculty, Division of Dental Medicine, Ljubljana, Slovenia, EU
| | - Caroline K Carrico
- Oral Health Promotion and Community Outreach, Oral Health Research Core, Virginia Commonwealth University, Richmond, VA, USA
| | - George Deeb
- Virginia Commonwealth University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Richmond, Virginia, USA
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Choi YS, Oh JW, Lee Y, Lee DW. Thermal changes during implant site preparation with a digital surgical guide and slot design drill: an ex vivo study using a bovine rib model. J Periodontal Implant Sci 2022; 52:411-421. [PMID: 36302647 PMCID: PMC9614178 DOI: 10.5051/jpis.2106040302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 10/29/2023] Open
Abstract
PURPOSE In this study, we aimed to evaluate the degree of heat generation when a novel drill design with an irrigation slot was used with metal sleeve-free (MF) and metal sleeve-incorporated (MI) surgical guides in an environment similar to that of the actual oral cavity. METHODS A typodont with a missing mandibular right first molar and 21 bovine rib blocks were used. Three-dimensional-printed MF and MI surgical guides, designed for the placement of internal tapered implant fixtures, were used with slot and non-slot drills. The following groups were compared: group 1, MI surgical guide with slot drill; group 2, MI surgical guide with a non-slot drill; and group 3, MF surgical guide with a slot drill. A constant-temperature water bath at 36°C was used. The drilling was performed in 6 stages, and the initial, highest, and lowest temperatures of the cortical bone were measured at each stage using a non-contact infrared thermometer. RESULTS There were no temperature increases above the initial temperature in any drilling procedure. The only significant difference between the non-slot and slot groups was observed with the use of the first drill in the MI group, with a higher temperature in the non-slot group (P=0.012). When the heat generation during the first and the second drilling was compared in the non-slot group, the heat generation during the first drilling was significantly higher (P<0.001), and there was no significant difference in heat generation between the drills in the slot group. CONCLUSIONS Within the limitations of this study, implant-site preparation with the surgical guide showed no critical increase in the temperature of the cortical bone, regardless of whether there was a slot in the drill. In particular, the slotted drill had a cooling effect during the initial drilling.
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Affiliation(s)
- Yoon-Sil Choi
- Department of Periodontology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae-Woon Oh
- Department of Periodontology, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong-Woon Lee
- Department of Periodontology, Veterans Health Service Medical Center, Seoul, Korea
- Department of Periodontology, Dental Hospital, Wonkwang University College of Dentistry, Iksan, Korea.
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A novel guided zygomatic implant surgery system compared to free hand: a human cadaver study on accuracy. J Dent 2021; 119:103942. [PMID: 34974136 DOI: 10.1016/j.jdent.2021.103942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used. METHODS Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol(Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative Ct scan (with the final position of the achieved implants)with the pre-operative CT scan (with the planned implants). RESULTS The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71° p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm p<0.001)and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm p<0.001). CONCLUSIONS The proposed surgical guided system exhibited a higher accuracy for all the investigated variables compared to the free hand technique.
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8
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Mistry A, Ucer C, Thompson JD, Khan RS, Karahmet E, Sher F. 3D Guided Dental Implant Placement: Impact on Surgical Accuracy and Collateral Damage to the Inferior Alveolar Nerve. Dent J (Basel) 2021; 9:dj9090099. [PMID: 34562973 PMCID: PMC8470513 DOI: 10.3390/dj9090099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 01/26/2023] Open
Abstract
An increase in the number of implants placed has led to a corresponding increase in the number of complications reported. The complications can vary from restorative complications due to poor placement to damage to collateral structures such as nerves and adjacent teeth. A large majority of these complications can be avoided if the implant has been placed accurately in the optimal position. Therefore, the aim of this in vitro pilot study was to investigate the effect of freehand (FH) and fully guided (FG) surgery on the accuracy of implants placed in close proximity to vital structures such as the inferior alveolar nerve (IAN). Cone-beam computed tomography (CBCT) and intraoral scans of six patients who have had previous dental implants in the posterior mandible were used in this study. The ideal implant position was planned. FG surgical guides were manufactured for each case. In this study, the three-dimensional 3D printed resin models of each of the cases were produced and the implants placed using FG and FH methods on the respective models. The outcome variables of the study, angular deviations were calculated and the distance to the IAN was measured. The mean deviations for the planned position observed were 1.10 mm coronally, 1.88 mm apically with up to 6.3 degrees’ angular deviation for FH surgery. For FG surgical technique the mean deviation was found to be at 0.35 mm coronally, 0.43 mm apically with 0.78 degrees angularly respectively. The maximum deviation from the planned position for the apex of the implant to the IAN was 2.55 mm using FH and 0.63 mm FG. This bench study, within its limitations, demonstrated surgically acceptable accuracy for both FH and FG techniques that would allow safe placement of implants to vital structures such as the IAN when a safety zone of 3 mm is allowed. Nevertheless, a better margin of error was observed for FG surgery with respect to the angular deviation and controlling the distance of the implant to the IAN using R2 Gate® system.
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Affiliation(s)
- Amit Mistry
- Amit Mistry Implants, The Whitehouse, Greenalls Avenue, Warrington WA4 6HL, UK;
| | - Cemal Ucer
- ICE Postgraduate Dental Institute and Hospital, Salford M50 3XZ, UK;
| | - John D. Thompson
- School of Health and Society, University of Salford, Salford M5 4WT, UK;
| | - Rabia Sannam Khan
- Education and Research Director, ICE Postgraduate Dental Institute and Hospital, 24 Furness Quay, Salford M50 3XZ, UK;
| | - Emina Karahmet
- Department of Medical Chemistry, Faculty of Pharmacy, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina;
| | - Farooq Sher
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
- Correspondence: ; Tel.: +44-(0)-115-84-86679
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Parra-Tresserra A, Marquès-Guasch J, Ortega-Martínez J, Basilio-Monné J, Hernández-Alfaro F. Current state of dynamic surgery. A literature review. Med Oral Patol Oral Cir Bucal 2021; 26:e576-e581. [PMID: 34023841 PMCID: PMC8412455 DOI: 10.4317/medoral.24566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Recently, dental implant technology has been widely used for oral reconstruction. Dental implants are the treatment of choice for those patients with dental absences. An optimal implant placement is based on the prosthetic driven concept in order to achieve an aesthetic and functional restoration with a long-term prognosis. There are two types of guided implant surgery that are described in the literature: Static Guided Surgery (SGS) and Dynamic Guided Surgery (DGS). The aim of this study is to be aware of the current state of dynamic surgery and compare in the literature the discrepancies between planning and placement of dental implants. Material and Methods The study consists of a bibliographic review on the topic. The research has been performed in the Medline/Pubmed of articles published by different professional associations and societies in the international context. Results Twenty two studies out of 100 articles from the initial search were finally included. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Conclusions Dynamic navigation shows a better accuracy and precision of implant placement. To corroborate the results of this review as well as to evaluate the different variables that could influence the accuracy of this technique, future randomized control trials will be needed. Key words:Guided surgery, dynamic navigation, dynamic guided surgery, computer assisted surgery.
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Affiliation(s)
- A Parra-Tresserra
- Faculty of Dentistry Universitat Internacional de Catalunya Josep Trueta s/n 08195 Sant Cugat del Vallès, Barcelona, Spain
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A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116142. [PMID: 34200143 PMCID: PMC8201303 DOI: 10.3390/ijerph18116142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.
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Postl L, Mücke T, Hunger S, Bissinger O, Malek M, Holberg S, Burgkart R, Krennmair S. In-house 3D-printed surgical guides for osseous lesions of the lower jaw: an experimental study. Eur J Med Res 2021; 26:25. [PMID: 33722284 PMCID: PMC7958719 DOI: 10.1186/s40001-021-00495-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background The accuracy of computer-assisted biopsies at the lower jaw was compared to the accuracy of freehand biopsies. Methods Patients with a bony lesion of the lower jaw with an indication for biopsy were prospectively enrolled. Two customized bone models per patient were produced using a 3D printer. The models of the lower jaw were fitted into a phantom head model to simulate operation room conditions. Biopsies for the study group were taken by means of surgical guides and freehand biopsies were performed for the control group. Results The deviation of the biopsy axes from the planning was significantly less when using templates. It turned out to be 1.3 ± 0.6 mm for the biopsies with a surgical guide and 3.9 ± 1.1 mm for the freehand biopsies. Conclusions Surgical guides allow significantly higher accuracy of biopsies. The preliminary results are promising, but clinical evaluation is necessary.
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Affiliation(s)
- Lukas Postl
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria. .,NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany. .,Department of Oral and Maxillo-Facial Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Thomas Mücke
- Department of Oral and Maxillo-Facial Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Stefan Hunger
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Oliver Bissinger
- Department of Oral and Maxillofacial Surgery, Medizinische Universitaet Innsbruck, Innsbruck, Austria
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Svenia Holberg
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Stefan Krennmair
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria.,NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
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12
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Ketabi AR, Kastner E, Brenner M, Lauer HC, Schulz MC. Implant insertion using an orientation template and a full-guiding template - A prospective model analysis in a cohort of dentists participating in an implantology curriculum. Ann Anat 2021; 236:151716. [PMID: 33675946 DOI: 10.1016/j.aanat.2021.151716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dental implantology has become an established option for treating tooth loss over the recent decades. Before inserting an implant in a clinical situation, theoretical and practical training is recommended. Different methods are available to give assistance in determining the correctly planned implant position. In this study, two different guiding methods were assessed considering their accuracy for implant insertion in a group of dentists. METHODS After three-dimensional planning of the implant positions, two surgical templates were manufactured as follows: in region 34 a stereolithographic template was used to perform a full-guided implant insertion, in region 44 a CAD/CAM milled template was used to determine the implant position and subsequently, perform a free-hand insertion. In total, 86 implants were placed in mandibular models by 43 dentists participating in a postgraduate curriculum. The differences between planned and achieved implant positions were measured and statistically analyzed. RESULTS The implants inserted fully-guided showed a lower deviation of the three-dimensional angulation (2.266 ± 1.443 degrees vs. 7.954 ± 4.372 degrees) and the cumulated mismatch of the implant position (0.547 ± 0.237 mm vs. 1.160 ± 0.427 mm) compared to the free-handed mode. For the angulation and the mismatch at the implant base the differences were statistically significant (p < 0.001). CONCLUSIONS Within the limits of the study it can be summarized that the full-guided implant insertion leads to a higher transfer accuracy compared to the free-hand method in a cohort of dentist inexperienced in dental implantology. However, the clinical effect has to be discussed as the study was performed using artificial mandibles and ideal conditions.
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Affiliation(s)
- Ali-Reza Ketabi
- Private Dental Office, Epplestraße 29 a, 70597 Stuttgart, Germany.
| | - Enuar Kastner
- Private Dental Office, Buddestraße 14 A, 13507 Berlin-Reinickendorf, Germany.
| | - Martin Brenner
- Zahnärzte am Schloss, Bismarckstraße 15, 72574 Bad Urach, Germany.
| | - Hans-Christoph Lauer
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
| | - Matthias C Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstraße 2-8, 72076 Tübingen, Germany.
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Hartman M. Design and fabrication of a fixed implant-supported interim restoration from a dynamic navigation virtual plan. J Prosthet Dent 2020; 124:632-636. [DOI: 10.1016/j.prosdent.2019.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
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Abstract
Guides used in dental implant surgery add accuracy and an overall predictability. Successful guided implant workflow depends on 3-dimensional image acquisition and precise medical model fabrication. The contemporary process blends acquired images to existing dentition to create implant-specific precise guides. We discuss the overall process, types of guides, and complications to expect during surgery.
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Affiliation(s)
- Peter Chen
- Department of Oral and Maxillofacial Surgery, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA; Department of Dentistry, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA.
| | - Levon Nikoyan
- Department of Oral and Maxillofacial Surgery, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA; Department of Dentistry, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA; Private Practice, Forward Oral Surgery, 248-62 Jericho Tpke, Floral Park, NY 11001, USA
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Pellegrino G, Bellini P, Cavallini PF, Ferri A, Zacchino A, Taraschi V, Marchetti C, Consolo U. Dynamic Navigation in Dental Implantology: The Influence of Surgical Experience on Implant Placement Accuracy and Operating Time. An in Vitro Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062153. [PMID: 32213873 PMCID: PMC7142455 DOI: 10.3390/ijerph17062153] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/16/2022]
Abstract
AIM the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator's experience. MATERIALS AND METHODS sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated. RESULTS considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial components of the deviation at the apical point and the angular errors of some operators differed from each other. CONCLUSIONS within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians.
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Affiliation(s)
- Gerardo Pellegrino
- Oral and Maxillofacial Surgery Division, DIBINEM, University of Bologna, 40125 Bologna, Italy; (G.P.); (A.F.); (A.Z.); (V.T.); (C.M.)
| | - Pierantonio Bellini
- Division of Oral and Maxillofacial Surgery, Dental Clinic, University of Modena and Reggio Emilia, 41125 Modena, Italy; (P.B.); (P.F.C.)
| | - Pier Francesco Cavallini
- Division of Oral and Maxillofacial Surgery, Dental Clinic, University of Modena and Reggio Emilia, 41125 Modena, Italy; (P.B.); (P.F.C.)
| | - Agnese Ferri
- Oral and Maxillofacial Surgery Division, DIBINEM, University of Bologna, 40125 Bologna, Italy; (G.P.); (A.F.); (A.Z.); (V.T.); (C.M.)
| | - Andrea Zacchino
- Oral and Maxillofacial Surgery Division, DIBINEM, University of Bologna, 40125 Bologna, Italy; (G.P.); (A.F.); (A.Z.); (V.T.); (C.M.)
| | - Valerio Taraschi
- Oral and Maxillofacial Surgery Division, DIBINEM, University of Bologna, 40125 Bologna, Italy; (G.P.); (A.F.); (A.Z.); (V.T.); (C.M.)
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Division, DIBINEM, University of Bologna, 40125 Bologna, Italy; (G.P.); (A.F.); (A.Z.); (V.T.); (C.M.)
| | - Ugo Consolo
- Division of Oral and Maxillofacial Surgery, Dental Clinic, University of Modena and Reggio Emilia, 41125 Modena, Italy; (P.B.); (P.F.C.)
- Correspondence: ; Tel.: +39-059-422-49-12
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Wang XH, Liu AP, Deng WZ. [Research advances in the use of digital surgical guides in implantology]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:95-100. [PMID: 32037774 DOI: 10.7518/hxkq.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dental implants have become the main choice for patients to fill in their missing teeth. A precise placement is the basis for a functional and aesthetic restoration. A digital surgical guide is a carrier that transfers the preoperative plan of dental implants to the actual surgery. This paper provides some references that can help clinicians improve the accuracy of implant surgery by stating the development, classification, advantages and disadvantages, and factors that affect the accuracy of digital guides.
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Affiliation(s)
- Xiao-Hua Wang
- Dept. of Stomatology, Wuzhou Red Cross Hospital, Wuzhou 543000, China;School of Stomatology, Youjiang Medical University for Nationalities, Baise 533000, China
| | - Ai-Peng Liu
- Dept. of Stomatology, Wuzhou Red Cross Hospital, Wuzhou 543000, China
| | - Wen-Zheng Deng
- Dept. of Stomatology, Wuzhou Red Cross Hospital, Wuzhou 543000, China
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Golob Deeb J, Bencharit S, Carrico CK, Lukic M, Hawkins D, Rener-Sitar K, Deeb GR. Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:415-423. [PMID: 31141291 DOI: 10.1111/eje.12447] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model. MATERIALS AND METHODS Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). RESULTS Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001). DISCUSSION Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation. CONCLUSION Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caroline K Carrico
- Oral Health Promotion and Community Outreach, Oral Health Research Core, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marija Lukic
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Hawkins
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ksenija Rener-Sitar
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Prosthodontics, University Dental Clinics, University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - George R Deeb
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Schulz MC, Hofmann F, Range U, Lauer G, Haim D. Pilot-drill guided vs. full-guided implant insertion in artificial mandibles-a prospective laboratory study in fifth-year dental students. Int J Implant Dent 2019; 5:23. [PMID: 31240421 PMCID: PMC6593025 DOI: 10.1186/s40729-019-0176-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/06/2019] [Indexed: 01/27/2023] Open
Abstract
Background As a growing field in dentistry, the practical education during the undergraduate curriculum in implant dentistry should be extended. Not only the theoretical background but also practical skills are crucial to place implants in patients. In order to determine the exact implant position, several positioning aids are available. In the present laboratory study, the accuracy of implant insertion using two different guiding modes in a group of inexperienced participants was assessed. Methods After three-dimensional planning using the data of a cone beam computed tomography of artificial mandibles, surgical templates were manufactured by thermoforming. In region 35, a sleeve for the pilot drill was used, whereas in region 45, a sleeve allowing a full-guided implant insertion was inserted. Subsequently, a total of 104 implants were placed by 52 undergraduates. Radiographical assessment of the three-dimensional accuracy was performed. Furthermore, the time required to insert the implants was recorded. Statistical analysis followed. Discussion When comparing the three-dimensional accuracy of the virtually planned to the actual inserted implant, a statistically significantly higher accuracy in three-dimensional angulation was achieved for the full-guided (3.388 ± 1.647°) compared to the pilot-drill guided mode (5.792 ± 3.290°). Furthermore, the time required to insert the implant was shorter for the full-guided template (6.23 ± 1.78 min) vs. for the pilot-drill guided (8.84 ± 2.39 min). Both differences reached a statistical significance (p < 0.001). Conclusion Within the limit of this laboratory study, the results suggest that inexperienced surgeons benefit from a full-guided implant insertion. However, the clinical effects have to be discussed as the mismatch was varying in the decimillimeter range.
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Affiliation(s)
- Matthias C Schulz
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Francisca Hofmann
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Blasewitzer Str. 86, 01309, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Dominik Haim
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Möhlhenrich SC, Brandt M, Kniha K, Prescher A, Hölzle F, Modabber A, Wolf M, Peters F. Accuracy of orthodontic mini-implants placed at the anterior palate by tooth-borne or gingiva-borne guide support: a cadaveric study. Clin Oral Investig 2019; 23:4425-4431. [PMID: 30982181 DOI: 10.1007/s00784-019-02885-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this cadaveric study was to measure the transfer accuracy of orthodontic mini-implant placement at the anterior palate depending on tooth-borne or gingiva-borne guide support. MATERIALS AND METHODS Forty orthodontic mini-implants were placed paramedian in the anterior palate of 20 cadaver heads using tooth-borne (TBG) or gingiva-borne guides (GBG). Placement was planned after superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, digital impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using automatic surface registration based on an iterative closest point algorithm. RESULTS Statistical differences between TBG and GBG were detected for lateral deviations 0.88 mm (SD 0.46) versus 1.65 mm (SD 1.03) (p = .004) and sagittal angular deviations 3.67° (SD 2.25) versus 6.46° (SD 5.5) (p = .043). No differences were found for vertical deviations 2.34 mm (SD 0.74) versus 2.14 mm (SD 0.73) (p = .40) and transverse angular deviations 3.60° (SD 2.89) versus 4.06° (SD 3.04) (p = .62). CONCLUSIONS The use of surgical guides based on silicone provides sufficient control of orthodontic mini-implant placement and is comparable to CAD/CAM templates. However, when compared with guided dental implantology, the planned mini-implant position is more inaccurate. However, accuracy can be significantly increased by guide extension involving the teeth. Clinical investigations have to prove if the accuracy is sufficient for receiving an orthodontic appliance. CLINICAL RELEVANCE The use of lateral cephalograms and plaster models for silicone guide construction leads to lower radiation exposure and provides sufficient accuracy for palatal orthodontic mini-implant placement.
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Affiliation(s)
| | - Maximilian Brandt
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Prescher
- Medical Faculty of RWTH Aachen, Institute of Molecular and Cellular Anatomy, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Michael Wolf
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Deeb JG, Bencharit S, Loschiavo CA, Yeung M, Laskin D, Deeb GR. Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery? J Oral Maxillofac Surg 2018; 76:2540-2550. [DOI: 10.1016/j.joms.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 11/25/2022]
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Schulz MC, Rittmann L, Range U, Lauer G, Haim D. The Use of Orientation Templates and Free-Hand Implant Insertion in Artificial Mandibles-An Experimental Laboratory Examination in Fifth-Year Dental Students. Dent J (Basel) 2018; 6:dj6030043. [PMID: 30200450 PMCID: PMC6162789 DOI: 10.3390/dj6030043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/15/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
Abstract
Implant dentistry is a growing field in the education of undergraduate dental students. The present laboratory study evaluates factors which may potentially influence the accuracy of free-hand implant insertion and the use of an orientation template. After three-dimensional planning using coDiagnostiXTM, orientation templates, including sleeves for the pilot-drill in regions 41 and 45, were manufactured by thermoforming. Sixty-one fifth year dental students inserted one implant using the orientation template and another implant free-hand in an artificial mandible. Information regarding age, sex, handedness, education, and the time required for implant insertion were recorded. Subsequently, the mandibles were scanned using cone-beam-computed tomography and the accuracy of the implant position was assessed, while statistical analysis followed. The free-hand implant insertion resulted in a distal deviation of −1.34 ± 5.15° and a mesial mismatch of 0.06 ± 0.79 mm at the artificial bone level compared to the sleeves. When using the orientation templates, the deviation decreased to −0.67 ± 3.48° and a distal mismatch of −0.22 ± 0.62 mm was achieved. The difference was statistically significant for the mismatch (p < 0.049). Regarding the limitations of our study, it could be said that the accuracy level achieved by dental undergraduates using implant placement with orientation templates is comparable to that in other studies.
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Affiliation(s)
- Matthias C Schulz
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
| | - Lena Rittmann
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Blasewitzer Str. 86, D-01307 Dresden, Germany.
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
| | - Dominik Haim
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
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Schnutenhaus S, Gröller S, Luthardt RG, Rudolph H. Accuracy of the match between cone beam computed tomography and model scan data in template-guided implant planning: A prospective controlled clinical study. Clin Implant Dent Relat Res 2018; 20:541-549. [PMID: 29691987 DOI: 10.1111/cid.12614] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/27/2018] [Accepted: 03/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Template-guided implant placement is a method for optimal implant positioning from a prosthetic and surgical viewpoint. The treatment planning is based on three-dimensional X-ray data and model scan data, as well as on prosthetic planning (set-up). These data are matched (superimposed) with the aid of an X-ray template or by manual matching without special referencing. PURPOSE The objective of this prospective controlled clinical study was to determine and compare the accuracy of the match with and without an additional X-ray template. MATERIALS AND METHODS The DICOM data of the cone beam computed tomography (CBCT) were converted into surface data sets and then superimposed on model scan data using three different methods (manually, based on an X-ray template, or semi-automatically with computer assistance). The mean deviations between these results of these matching methods were investigated. RESULTS The procedures achieved a matching accuracy of 0.2 mm on average. This corresponds to the resolution of the CBCT (0.2 voxels). Further studies are necessary to verify the procedure even for patients with few (0-4) residual teeth. CONCLUSION In the presence of a sufficient number of residual teeth, the manual matching of model scan data with CBCT data is sufficiently accurate for implant planning and template-guided implementation. The results of the present study suggest that X-ray templates can be dispensed with saving the patient a substantial amount of time and money.
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Affiliation(s)
- Sigmar Schnutenhaus
- Department of Prosthetic Dentistry, Center of Dentistry, University of Ulm, Germany and Private practice, Hilzingen, Germany
| | - Sebastian Gröller
- Department of Prosthetic Dentistry, Center of Dentistry, University of Ulm, Germany and Private practice, Hilzingen, Germany
| | - Ralph G Luthardt
- Department of Prosthetic Dentistry, Center of Dentistry, University of Ulm, Germany and Private practice, Hilzingen, Germany
| | - Heike Rudolph
- Department of Prosthetic Dentistry, Center of Dentistry, University of Ulm, Germany and Private practice, Hilzingen, Germany
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Schnutenhaus S, Edelmann C, Rudolph H, Dreyhaupt J, Luthardt RG. 3D accuracy of implant positions in template-guided implant placement as a function of the remaining teeth and the surgical procedure: a retrospective study. Clin Oral Investig 2018; 22:2363-2372. [DOI: 10.1007/s00784-018-2339-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Marheineke N, Scherer U, Rücker M, von See C, Rahlf B, Gellrich NC, Stoetzer M. Evaluation of accuracy in implant site preparation performed in single- or multi-step drilling procedures. Clin Oral Investig 2017; 22:2057-2067. [DOI: 10.1007/s00784-017-2312-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/12/2017] [Indexed: 01/06/2023]
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How Accurate Are Implant Surgical Guides Produced With Desktop Stereolithographic 3-Dimentional Printers? J Oral Maxillofac Surg 2017; 75:2559.e1-2559.e8. [DOI: 10.1016/j.joms.2017.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/22/2022]
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Block MS, Emery RW, Cullum DR, Sheikh A. Implant Placement Is More Accurate Using Dynamic Navigation. J Oral Maxillofac Surg 2017; 75:1377-1386. [DOI: 10.1016/j.joms.2017.02.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 01/29/2023]
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Accuracy Evaluation of a Stereolithographic Surgical Template for Dental Implant Insertion Using 3D Superimposition Protocol. Int J Dent 2017; 2017:4292081. [PMID: 28555157 PMCID: PMC5438863 DOI: 10.1155/2017/4292081] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the accuracy of a stereolithographic template, with sleeve structure incorporated into the design, for computer-guided dental implant insertion in partially edentulous patients. Materials and Methods Sixty-five implants were placed in twenty-five consecutive patients with a stereolithographic surgical template. After surgery, digital impression was taken and 3D inaccuracy of implants position at entry point, apex, and angle deviation was measured using an inspection tool software. Mann–Whitney U test was used to compare accuracy between maxillary and mandibular surgical guides. A p value < .05 was considered significant. Results Mean (and standard deviation) of 3D error at the entry point was 0.798 mm (±0.52), at the implant apex it was 1.17 mm (±0.63), and mean angular deviation was 2.34 (±0.85). A statistically significant reduced 3D error was observed at entry point p = .037, at implant apex p = .008, and also in angular deviation p = .030 in mandible when comparing to maxilla. Conclusions The surgical template used has proved high accuracy for implant insertion. Within the limitations of the present study, the protocol for comparing a digital file (treatment plan) with postinsertion digital impression may be considered a useful procedure for assessing surgical template accuracy, avoiding radiation exposure, during postoperative CBCT scanning.
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Chen X, Xu L, Wang W, Li X, Sun Y, Politis C. Computer-aided design and manufacturing of surgical templates and their clinical applications: a review. Expert Rev Med Devices 2016; 13:853-64. [DOI: 10.1080/17434440.2016.1218758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Static or Dynamic Navigation for Implant Placement-Choosing the Method of Guidance. J Oral Maxillofac Surg 2015; 74:269-77. [PMID: 26452429 DOI: 10.1016/j.joms.2015.09.022] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 11/23/2022]
Abstract
The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.
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