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Tang G, Liu S, Sun M, Wang Y, Zhu W, Wang D, Li X, Wu H, Men S, Zhang L, Feng C, Wang Y, Ding Y. High-precision all-in-one dual robotic arm strategy in oral implant surgery. BDJ Open 2024; 10:43. [PMID: 38830840 PMCID: PMC11148145 DOI: 10.1038/s41405-024-00231-6] [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: 03/21/2024] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Dental implantation has emerged as an efficient substitute for missing teeth, which is essential for restoring oral function and aesthetics. Compared to traditional denture repair approaches, dental implants offer better stability and sustainability. The position, angle, and depth of dental implants are crucial factors for their long-term success and necessitate high-precision operation and technical support. METHOD We propose an integrated dual-arm high-precision oral implant surgery navigation positioning system and a corresponding control strategy. Compared with traditional implant robots, the integrated dual-arm design greatly shortens the preparation time before surgery and simplifies the operation process. We propose a novel control flow and module for the proposed structure, including an Occluded Target Tracking Module (OTTM) for occlusion tracking, a Planting Plan Development Module (PPDM) for generating implant plans, and a Path Formulation Module (PFM) for controlling the movement path of the two robot arms. RESULT Under the coordinated control of the aforementioned modules, the robot achieved excellent accuracy in clinical trials. The average angular error and entry point error for five patients who underwent implant surgery using the proposed robot were 2.1° and 0.39 mm, respectively. CONCLUSION In essence, our study introduces an integrated dual-arm high-precision navigation system for oral implant surgery, resolving issues like lengthy preoperative preparation and static surgical planning. Clinical results confirm its efficacy, emphasizing its accuracy and precision in guiding oral implant procedures.
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Affiliation(s)
- Gang Tang
- Logistics Engineering College, Shanghai Maritime University, St. Haigang, Shanghai, 201306, Shanghai, China
| | - Shibo Liu
- Logistics Engineering College, Shanghai Maritime University, St. Haigang, Shanghai, 201306, Shanghai, China
| | - Meng Sun
- Electronic Information Engineering College, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, Jiangsu, China.
- Nanjing Panda Electronics Company Limited, Nanjing, 210000, China.
| | - Yide Wang
- Institut d'Electronique et des Technologies du numerique, Polytech Nantes-Site de la Chantrerie, 44306, Nantes, France
| | - Weidong Zhu
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD, 21250, USA
| | - Dongmei Wang
- School of Mechanical Engineering, Shanghai Jiao Tong Univ, Shanghai, 200240, Shanghai, China
| | - Xiang Li
- School of Mechanical Engineering, Shanghai Jiao Tong Univ, Shanghai, 200240, Shanghai, China
| | - Hao Wu
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Shaoyang Men
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, postcode 510006, Guangzhou, China
| | | | - Changfen Feng
- Emergency Department of Stomatology, Suzhou Stomatology Hospital, Suzhou, Jiangsu, 215031, China
| | - Yingfu Wang
- Logistics Engineering College, Shanghai Maritime University, St. Haigang, Shanghai, 201306, Shanghai, China
| | - Yuehua Ding
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, 510640, China
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Khaohoen A, Powcharoen W, Sornsuwan T, Chaijareenont P, Rungsiyakull C, Rungsiyakull P. Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials. BMC Oral Health 2024; 24:359. [PMID: 38509530 PMCID: PMC10956322 DOI: 10.1186/s12903-024-04033-y] [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: 10/09/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.
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Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Warit Powcharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Zevallos EAA, Lima LHF, Mendes KLC, Sverzut AT. Accuracy of dental implants positioning in computer-assisted surgeries: In vitro study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101828. [PMID: 38508394 DOI: 10.1016/j.jormas.2024.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The aim of this study is to presents an experimental method for surgical guide confection using an intraoral scanner to obtain a 3D model of the patient's complete denture and compare its accuracy with the conventional methodology using computed tomography. STUDY DESIGN This prospective in-vitro study used 30 polyurethane pre-manufactured mandibles which were divided into two groups, conventional technique (group I) and a new method using intraoral scanner (group II), establishing the virtually planned position of the dental implants as a control group, considered as the gold standard for postoperative comparison. RESULTS The difference between these methods is close to zero and not statistically significant (p > 0.05), being heigh deviation (Xh) with p:0.130 and angulation difference of dental implants between the groups (Ang) with p:0.396. CONCLUSION The acquisition of stereolithography image of the prosthesis using an intraoral scanner has a clinically acceptable accuracy, being in agreement with the conventional method.
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Affiliation(s)
| | | | - Karine Laura Cortellazzi Mendes
- Department of Health Sciences and Children's Dentistry, Piracicaba Dental School, University of Campinas, UNICAMP, Piracicaba, SP, Brazil
| | - Alexander Tadeu Sverzut
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, UNICAMP, Piracicaba, SP, Brazil.
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Knipper A, Kuhn K, Luthardt RG, Schnutenhaus S. Accuracy of Dental Implant Placement with Dynamic Navigation-Investigation of the Influence of Two Different Optical Reference Systems: A Randomized Clinical Trial. Bioengineering (Basel) 2024; 11:155. [PMID: 38391641 PMCID: PMC10886004 DOI: 10.3390/bioengineering11020155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6-3.9°) than group A, with a value of 6.3° (95% CI 4.0-8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92-2.78 mm) and 1.62 mm for workflow B (95% CI 1.2-2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.
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Affiliation(s)
- Anne Knipper
- Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH, Breiter Wasmen 10, 78247 Hilzingen, Germany
| | - Katharina Kuhn
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Ralph G Luthardt
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Sigmar Schnutenhaus
- Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH, Breiter Wasmen 10, 78247 Hilzingen, Germany
- Department for Dentistry, Clinic for Prosthodontics, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
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Schnutenhaus S, Edelmann C, Wetzel M, Luthardt RG. Influence of the macrodesign of an implant and the sleeve system on the accuracy of template-guided implant placement: A prospective clinical study. J Prosthet Dent 2024; 131:212-219. [PMID: 35940950 DOI: 10.1016/j.prosdent.2021.09.016] [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: 02/11/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
STATEMENT OF PROBLEM Three-dimensional (3D) implant planning facilitates determining the optimal position and number of implants, in terms of function and esthetics, by taking into account adjacent structures. Template-guided implant placement is an established procedure for implementing this planning, although the accuracy between the planned and the actual implant position is subject to many influences. The influences of the macrodesign of the implants and the sleeve materials used have rarely been investigated clinically. PURPOSE The purpose of this prospective clinical study was to investigate the accuracy of template-guided implant placement according to the macrodesign of different implants and the design of the drill sleeve. MATERIAL AND METHODS Implants were placed in 60 participants within 3 groups (n=20): tapered implant with a metal sleeve (T-MS), tapered implant with a polymeric sleeve (T-PS), and progressive tapered implant with a polymeric sleeve (XT-PS). After overlaying the 3D implant planning image with the postoperative intraoral scan, deviations were 2-dimensionally related to the implant shoulder (S) and the apex (A) in terms of height (2DHS/2DHA), mesiodistal (2DSmd/2DAmd) and buccolingual (2DSbo/2DAbo), as well as 3-dimensionally on the implant shoulder (3DS), on the apex (3DA), and on the axis deviation (Axis). The groups were compared by using the analysis of variance. The Tukey post hoc test was performed for normally distributed data to identify significant differences among groups (α=.05). RESULTS The errors for 2DSmd and 2DSbo were 0.26 to 0.40 mm across all groups. The 3DS group varied between 0.67 and 0.87 mm. No significant differences were found in terms of the material of the sleeves or the macrodesign of the implants (P>.05). Significant differences were found for 2DHS (P=.029) and 2DHA (P=.016) between the groups with the different sleeves. Group T-PS showed the least height deviation. CONCLUSIONS In terms of height deviation, significant differences were found among the groups, with deviations depending on the implant type and the sleeve type. Overall, the method showed a high level of accuracy, providing good predictability of the prosthetic rehabilitation.
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Affiliation(s)
- Sigmar Schnutenhaus
- Private practice, Hilzingen Dental Care Center, Hilzingen, Germany; Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial Medicine, Ulm University, Ulm, Germany.
| | | | - Martin Wetzel
- Private practice, Hilzingen Dental Care Center, Hilzingen, Germany
| | - Ralph G Luthardt
- Professor and Head, Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial Medicine, Ulm University, Ulm, Germany
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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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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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Bergamaschi IP, Cortellazzi KL, Sverzut AT. Is Intraoral Scanning Accurate to Evaluate Dental Implant Position? An In-Vitro Study. J Oral Maxillofac Surg 2022; 81:441-455. [PMID: 36584976 DOI: 10.1016/j.joms.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The position of dental implants is generally verified through imaging exams, even though its use exposes patients to radiation. Intraoral scanning (IOS) may be a suitable alternative to using radiographic imaging to verify implant position. Using polyurethane jaw models, the purpose of this in-vitro study was to measure and compare implant positions determined by IOS and cone-bean computed tomography (CBCT). METHODS One hundred twenty implants were installed in 30 edentulous polyurethane jaws, 4 dental implants in each prototype. Four scanbodies were attached to the implants, and a scanning of each mandible was acquired using an intraoral scanner (CS 3600). All prototypes were also submitted to CBCT. Then, the 3D scan files in STL (Standard Tessellation Language) format were superimposed on the DICOM (Digital Imaging and Communications in Medicine) images of the tomographic mandibles. The accuracy of IOS was evaluated by the metric analyses of deviations between the position of the implants projected by the IOS versus the detected tomographically, in which CBCT served as the gold standard, using a free software for digital planning (Bluesky 4 - Grayslake, IL, USA). The following measures were analyzed: radial deviations at the shoulder (Xc) and at the apex of the implants (Xa), height deviation (Xh) and axial deviation. Bland-Altman and a paired t-test were applied to verify the reproducibility between measurements and a t-test for a mean was applied to compare the measurements with zero value. RESULTS The results showed Xc and Xa deviation means of 0.14 ± 0.09 mm and 0.12 ± 0.12 mm, respectively. The Xh mean was 0.2 ± 0.12 mm and the axial deviation mean was 0.71° ± 0.66°. T-test showed a statistically significant difference when the 4 means were compared to zero value, represented by the CBCT (P < .0001). CONCLUSIONS There was a statistically significant difference IN the scanned measures compared to CBCT as the standard, but the differences may not be clinically significant. The IOS utilization to evaluate the position of dental implants is a radiation-free and reproducible method, with the advantage of not generating metal artifacts. Further clinical studies are needed to validate this new method of postoperative evaluation.
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Affiliation(s)
- Isabela Polesi Bergamaschi
- PhD Student of the Oral and Maxillofacial Surgery Area, Department of Oral Diagnosis, School of Dentistry of the Universidade Estadual de Campinas, Piracicaba, SP, Brazil.
| | - Karine Laura Cortellazzi
- Professor of Biostatics in the Area, Department of Health Sciences and Children's Dentistry, School of Dentistry of Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Alexander Tadeu Sverzut
- Professor of Oral and Maxillofacial Surgery Area, Department of Oral Diagnosis, School of Dentistry of Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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9
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Guentsch A, An H, Dentino AR. Precision and trueness of computer-assisted implant placement using static surgical guides with open and closed sleeves: An in-vitro analysis. Clin Oral Implants Res 2022; 33:441-450. [PMID: 35148444 PMCID: PMC9302989 DOI: 10.1111/clr.13904] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/28/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022]
Abstract
Objectives The aim of this in vitro study was to determine accuracy defined by trueness and precision of computer‐assisted implant surgery comparing two guided surgery kits designed for either closed sleeves or open sleeves with a lateral window. Material and methods Each n=20 implants were placed fully guided (sleeve‐bone distance of 2 or 4 mm) in identical replicas using a surgical guide with both closed sleeve or an open sleeve, partially guided, or free hand. The achieved implant position was digitized and compared with the planned position. Trueness and precision were determined. The angular deviation was defined as the primary outcome parameter. The means, standard deviation, and 95%‐confidence intervals were analyzed statistically with 1‐way ANOVA and the Scheffé procedure. Results The accuracy of guided implant placement using closed and open sleeves was comparable when the sleeve‐bone distance was 2 mm. Accuracy decreased when the sleeve‐bone distance increased in both fully guided groups, more so in the open than in the closed sleeve group. The least accurate method was the free‐hand group. Partially guided implant surgery was more accurate than free‐hand placement, but less accurate than the fully guided groups with 2‐mm sleeve‐bone distance. Conclusions The closer the sleeve to the bone, the more accurate and precise is computer‐assisted implant surgery using a closed system and a system using open sleeves. Partially guided implant surgery using only the static guide for the pilot drill is less accurate than both fully guided approaches, but more accurate than free‐hand surgery.
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Affiliation(s)
- Arndt Guentsch
- Professor of Periodontics and Department Chair, Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA
| | - Hongseok An
- Assistant Professor of Restorative Dentistry, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Andrew R Dentino
- Professor of Periodontics and Associate Dean for Research and Graduate Studies, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA
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Dge T, L S, J G, B AN, M G, Pw K. Marker-free registration for intraoperative navigation using the transverse palatal rugae. Int J Med Robot 2021; 18:e2362. [PMID: 34972255 DOI: 10.1002/rcs.2362] [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: 12/05/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Registration is most important in navigation-assisted-surgery including the matching between the coordinates of the actual patient space and the medical image. Marker-based techniques mostly include marker application with subsequent radiography. In the edentulous patient, maker-free methods are generally less accurate and reproducible. This new method of a marker-free registration uses the transverse palatal rugae as registration structures. METHODS (1)Segmentation of bone and hard palatal mucosa from initial 3D imaging (DICOM), (2)Maxillary intraoral-scan (IOS) with transfer to the 3D imaging using an Iterative-Closest-Point-Algorithm (ICP), (3)Marking digital registration points with holes within IOS-stl, (4)Transformation of the spatially aligned IOS-stl to LabelMap and storage in DICOM (IOS-DICOM), (5)Alignment of DICOM and IOS-DICOM, (6)Controlled positioning of digital reg.points and clinical correlation. RESULTS Fiducial localization error (0.48mm) and target registration error (0.65mm) is comparable to those of tooth-supported registration methods. CONCLUSION This methodology is a promising approach to marker-free navigation-assisted-surgery in the edentulous patient. This approach of marker-free registration for navigation-assisted-surgery could improve the treatment in edentulous patients avoiding additional imaging and invasive marker insertion. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thiem Dge
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Seifert L
- Department of Oral and Maxillofacial surgery, Facial Plastic Surgery, Goethe University Medical Centre Frankfurt, 60590, Frankfurt, Germany
| | - Graef J
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Al-Nawas B
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Gielisch M
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Kämmerer Pw
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Geometric Reproducibility of Three-Dimensional Oral Implant Planning Based on Magnetic Resonance Imaging and Cone-Beam Computed Tomography. J Clin Med 2021; 10:jcm10235546. [PMID: 34884244 PMCID: PMC8658654 DOI: 10.3390/jcm10235546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to investigate the geometric reproducibility of three-dimensional (3D) implant planning based on magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT). Four raters used a backward-planning approach based on CBCT imaging and standard software to position 41 implants in 27 patients. Implant planning was repeated, and the first and second plans were analyzed for geometric differences regarding implant tip, entry-level, and axis. The procedure was then repeated for MRI data of the same patients. Thus, 656 implant plans were available for analysis of intra-rater reproducibility. For both imaging modalities, the second-round 3D implant plans were re-evaluated regarding inter-rater reproducibility. Differences between the modalities were analyzed using paired t-tests. Intra- and inter-rater reproducibility were higher for CBCT than for MRI. Regarding intra-rater deviations, mean values for MRI were 1.7 ± 1.1 mm/1.5 ± 1.1 mm/5.5 ± 4.2° at implant tip/entry-level/axis. For CBCT, corresponding values were 1.3 ± 0.8 mm/1 ± 0.6 mm/4.5 ± 3.1°. Inter-rater comparisons revealed mean values of 2.2 ± 1.3 mm/1.7 ± 1 mm/7.5 ± 4.9° for MRI, and 1.7 ± 1 mm/1.2 ± 0.7 mm/6 ± 3.7° for CBCT. CBCT-based implant planning was more reproducible than MRI. Nevertheless, more research is needed to increase planning reproducibility—for both modalities—thereby standardizing 3D implant planning.
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12
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Guentsch A, Sukhtankar L, An H, Luepke PG. Precision and trueness of implant placement with and without static surgical guides: An in vitro study. J Prosthet Dent 2021; 126:398-404. [DOI: 10.1016/j.prosdent.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
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13
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Huang L, Zhang X, Mo A. A Retrospective Study on the Transferring Accuracy of a Fully Guided Digital Template in the Anterior Zone. MATERIALS 2021; 14:ma14164631. [PMID: 34443154 PMCID: PMC8399113 DOI: 10.3390/ma14164631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 02/05/2023]
Abstract
The accuracy of implant placement with a fully guided digital template can be influenced by many factors, such as arch difference, alveolar bone density, timing of implant placement and open flap. The purpose of this article was to evaluate the factors presumptively affecting the accuracy of implant placement assisted by the fully guided template in the anterior zone. In 40 patients with missing anterior teeth, a total of 52 implants were placed with tooth-borne, fully guided templates after CBCT evaluation, in West China Hospital of Stomatology, Sichuan University. After overlapping the pre-and post-operative DICOM data, measurements were taken in the dental implant planning software (Nobel Clinician®) to calculate linear and angular deviations between virtual placement plan and actual implant placement. Grouping was categorized according to three factors that possibly have an influence on accuracy: arch type (maxilla/mandible), timing of implant placement (immediate/delayed), surgical technique (open flap/flapless). The data was analyzed with independent sample t-test (p < 0.05). The results showed that the apical, coronal, depth and angular mean deviations of implant positions in anterior zone were 1.13 ± 0.39 mm, 0.86 ± 0.33 mm, 0.41 ± 0.66 mm, 3.32 ± 1.65° with the fully guided templates. The accuracy at apex level, coronal level and the angulation were similar between the maxilla and mandible, and the magnitude of all four deviations between immediate and delayed implantation, open flap and flapless technique were small. No statistically significant difference was observed (p > 0.05). Whereas there was significant difference in depth deviation between maxilla and mandible (p < 0.05). Conclusively, the implant site, alveolar bone density, timing of implant placement and surgical techniques merely compromise the implant placement accuracy under the assistance of a fully guided template.
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Kim YY, Song YW, Kim MJ, Cha JK, Park JM, Kim JH, Jung UW. Immediate loading of fixed partial prostheses reconstructed using either tapered or straight implants in the posterior area: A randomized clinical trial. Clin Implant Dent Relat Res 2021; 23:703-715. [PMID: 34378853 DOI: 10.1111/cid.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND In immediately loaded implants within 72 h after the implant placement in the unilaterally and partially edentulous ridge, primary stability is considered critical, which can be influenced by the design of the implant fixture. PURPOSE To determine the outcomes at 1 year after the immediate loading of multiunit fixed partial prostheses over either tapered implants (TIs) or straight implants (SIs) in the posterior region. MATERIALS AND METHODS Forty-eight patients (24 patients, 52 implants in TI group; 24 patients, 50 implants in SI group) were included for the study. Except for the one SI group patient whose two implants showed the insertion torque less than 30 Ncm, provisional prostheses designed and fabricated from intraoral scan data obtained immediately after implant surgery were delivered to rest of the 47 subjects at 3-7 days. After a year, the survival rate was estimated by intention-to-treat (ITT) and per-protocol (PP) analyses, and marginal bone loss (MBL) and implant stability were also analyzed statistically (p < 0.05). RESULTS Survival rate at implant level in TI group was 96.2%, and that of SI group in the ITT analysis was 86.0%. Intergroup difference, however, was not statistically significant (p > 0.05). Insertion torque was significantly higher in TI group than SI group (47.12 ± 6.37 Ncm vs. 41.60 ± 9.77 Ncm; p < 0.05). MBLs of both groups were less than 0.1 mm at 1-year follow-up and was similar between two groups (p > 0.05). CONCLUSIONS Immediate loading of fixed partial prostheses after TI and SI placement showed reliable outcomes in the partially edentulous posterior ridge. In terms of the initial mechanical stability, the performance was superior for TIs than for SIs.
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Affiliation(s)
- Yoo-Yeon Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Young Woo Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Myong Ji Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Man Park
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jee-Hwan Kim
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
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15
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Schwindling FS, Juerchott A, Boehm S, Rues S, Kronsteiner D, Heiland S, Bendszus M, Rammelsberg P, Hilgenfeld T. Three-dimensional accuracy of partially guided implant surgery based on dental magnetic resonance imaging. Clin Oral Implants Res 2021; 32:1218-1227. [PMID: 34352147 DOI: 10.1111/clr.13819] [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: 07/15/2020] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To measure in vivo 3D accuracy of backward-planned partially guided implant surgery (PGIS) based on dental magnetic resonance imaging (dMRI). MATERIAL AND METHODS Thirty-four patients underwent dMRI examinations. Tooth-supported templates were backward planned using standard dental software, 3D-printed, and placed intraorally during a cone beam computed tomography (CBCT) scan. Treatment plans were verified for surgical viability in CBCT, and implants were placed with guiding of the pilot drill. High-precision impressions were taken after healing. The 3D accuracy of 41 implants was evaluated by comparing the virtually planned and definitive implant positions with respect to implant entry point, apex, and axis. Deviations from the dMRI-based implant plans were compared with the maximum deviations calculated for a typical single implant. RESULTS Twenty-eight implants were placed as planned in dMRI. Evaluation of 3D accuracy revealed mean deviations (99% confidence intervals) of 1.7 ± 0.9mm (1.2-2.1mm) / 2.3 ± 1.1mm (1.8-2.9 mm) / 7.1 ± 4.8° (4.6-9.6°) for entry point / apex / axis. The maximum deviations calculated for the typical single implant surpassed the upper bounds of the 99% CIs for the apex and axis, but not for the entry point. In the 13 other implants, dMRI-based implant plans were optimized after CBCT. Here, deviations between the initial dMRI plan and definitive implant position were only in part higher than in the unaltered group (1.9 ± 1.7 mm [0.5-3.4 mm] / 2.5 ± 1.5 mm [1.2-3.8 mm] / 6.8 ± 3.8° [3.6-10.1°] for entry point / apex / axis). CONCLUSIONS The 3D accuracy of dMRI-based PGIS was lower than that previously reported for CBCT-based PGIS. Nonetheless, the values seem promising to facilitate backward planning without ionizing radiation.
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Affiliation(s)
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophia Boehm
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rues
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Accuracy of Dental Implant Placement by a Novel In-House Model-Free and Zero-Setup Fully Guided Surgical Template Made of a Light-Cured Composite Resin (VARO Guide ®): A Comparative In Vitro Study. MATERIALS 2021; 14:ma14144023. [PMID: 34300944 PMCID: PMC8304558 DOI: 10.3390/ma14144023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This in vitro study mainly aimed to compare VARO Guide® to the surgical guide fabricated by CAD/CAM (NAVI Guide®) in terms of accuracy and efficacy of the implant surgery held in the dentiform model. METHODS Twenty surgeons, 10 dentists in the beginner group and 10 dentists in the expert group, participated in the study. Each surgeon conducted fully guided surgery in dentiform models twice, once with VARO Guide® (VG surgery) and the other time with a conventional type of templates, NAVI Guide® (NG surgery). Based on the superimposition of presurgical and postsurgical STL files, the positional deviations between the virtually planned and actually placed implants and the time spent on presurgical preparation and surgical procedures were estimated and compared. RESULTS All dimensional deviations were similar between the two groups (p > 0.05), and there was no significant difference between the expert and beginner groups regardless of the guide system. The total procedure time (mean (median)) of the VG surgery (26.33 (28.58) min) was significantly shorter than that of the NG surgery (378.83 (379.35) min; p < 0.05). While the time spent only for the fully guided implant surgery (from the start of the surgical guide sitting onto the dentiform model to the final installation of the implant fixture) was comparable (p > 0.05), the presurgical preparation time spent on virtual implant planning and surgical guide fabrication in the VG surgery (19.63 (20.93) min) was significantly shorter compared to the NG surgery (372.93 (372.95) min; p < 0.05). CONCLUSIONS Regardless of experience, both VG and NG surgery showed reliable positional accuracy; however, the total procedure time and the preparation time were much shorter in the VG surgery compared to the NG surgery.
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Horsch L, Labis C, Trebing CT, Kronsteiner D, Hilgenfeld T, Rammelsberg P, Schwindling FS. Predictability and image quality of low-dose cone-beam computed tomography in computer-guided implantology: An experimental study. J Dent 2021; 112:103744. [PMID: 34252488 DOI: 10.1016/j.jdent.2021.103744] [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: 03/11/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the predictability and image quality of low-dose cone-beam computed tomography (LD-CBCT) in computer-guided implantology. METHODS Pig cadaver mandibles were imaged using high-definition CBCT (HD-CBCT) and LD-CBCT (HD-CBCT: 85 kV, 6 mA, 14.2 s, 767 frames, 1184 mGycm2, voxel size 80 µm, effective dose 231 µSv; LD-CBCT: 85 kV, 10 mA, 2.1 s, 384 frames, 84 mGycm2, voxel size 160 µm, effective dose 16 µSv; Orthophos SL, Dentsply Sirona, Bensheim, Germany). Digital impressions were taken using intraoral scanning (IOS; Omnicam, Dentsply Sirona). Data of CBCT modalities and IOS were aligned. Forty-eight implants were planned virtually (24 implants per modality; Bone Level 4.1 × 10 mm; Straumann AG, Basel, Switzerland). Implants were inserted using templates by initial pilot drilling ("partially-guided implantation"). Implant positions were recorded using IOS. Geometric deviations between planned and definitive positions were assessed regarding implant apex, entry-point and angle. CBCT image quality was evaluated by raters twice on a four point scale. The results were exploratively compared (linear models, Mann-Whitney-U tests). RESULTS Regarding implant apex, deviations were greater for LD-CBCT (mean 3.0±1.2 mm), as compared to HD-CBCT (mean 2.3±1.1 mm). For entry-point, no distinct difference was detected with a mean deviation of 1.4±0.9 mm in LD-CBCT, and 1.7±0.6 mm in HD-CBCT. Regarding angle, deviations were greater for LD-CBCT (mean 13.2±6.3°), as compared to HD-CBCT (mean 9.2±5.3°). The image quality of HD-CBCT provided to be better (mean 2.7±0.6) than that of LD-CBCT (mean 2.5±0.6). CONCLUSIONS Within the partially-guided approach, the results underline the potential of LD-CBCT alternatively to HD-CBCT for computer-guided implantology. Advantages of HD-CBCT need to be balanced against the higher radiation dose.
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Affiliation(s)
- Laura Horsch
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Christos Labis
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Charlotte Theresa Trebing
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Franz Sebastian Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Factors Influencing the Accuracy of Freehand Implant Placement: A Prospective Clinical Study. Dent J (Basel) 2021; 9:dj9050054. [PMID: 34068734 PMCID: PMC8151810 DOI: 10.3390/dj9050054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
(1) Background: The objective of implant prosthetic restoration is to ensure the best possible rehabilitation of function and esthetics. Optimal positioning of the implant with regard to the bone availability, surrounding soft tissue, and prosthetic sustainability should be strived for during implant placement. The factors influencing freehand implant placement and the accuracy achieved with this procedure are investigated in this prospective clinical study. (2) Methods: Implants were placed in the single-tooth edentulous sites of the premolar and molar areas in 52 patients. Three-dimensional (3D)-planning was performed virtually prior to the freehand implant operation, and the desired position of the implant was provided to the surgeon. (3) Results: The deviations between the planned and the actually achieved position with freehand implant placement showed the following mean values and standard deviations: angle 8.7 ± 4.8°, 3D deviation at the implant shoulder 1.62 ± 0.87 mm, mesiodistal deviation 0.87 ± 0.75 mm, buccolingual deviation 0.70 ± 0.66 mm, and apiocoronal deviation 0.95 ± 0.61 mm. The type of jaw had a significant influence on accuracy. Major deviations were observed in the lower jaw. Furthermore, the timing of implant placement influenced the mesiodistal deviation and angular deviation; (4) Conclusions: Freehand implant placement demonstrated a higher level of deviation between the planned and actually achieved implant positions. In particular, the ranges showed a large spread. From a prosthetic point of view, there may be complications during the restoration of the prosthetic crown if the implant exit point is not optimally located or if the implants show a high angular deviation.
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Schnutenhaus S, Edelmann C, Rudolph H. Does the macro design of an implant affect the accuracy of template-guided implantation? A prospective clinical study. Int J Implant Dent 2021; 7:42. [PMID: 33899126 PMCID: PMC8071785 DOI: 10.1186/s40729-021-00320-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background An implant prosthesis aims to ensure the best possible rehabilitation of function and esthetics following tooth loss. Template-guided insertion is used to achieve an optimal position of the implant with regard to prosthetic restorability, bone availability, and condition of the surrounding soft tissues. The accuracy of template-guided implant placement is subject to various influencing factors. The clinically achievable accuracy depending on the macro design of the implant body was investigated in this prospective clinical study. Material and methods In this prospective clinical study, 20 implants were placed in 20 patients. The implant had a pronounced conical outer geometry (Conelog ProgressiveLine, Camlog Wimsheim, Germany). Data from a study using an implant with a distinct cylindrical outer geometry were used as a comparison group (Conelog ScrewLine, Camlog, Wimsheim, Germany). The clinically achieved implant position was compared with the planned position. Results The evaluation of the two-dimensional deviations in direction resulted in the following mean values (standard deviation) at the shoulder: 0.42 mm (0.33) in the buccolingual direction, 0.27 mm (0.25) in the mesiodistal direction, and 0.68 mm (0.55) in the apicocoronal direction. The mean angular deviation was 4.1° (2.3). The three-dimensional (3D) deviation was 0.94 mm (0.53) at the shoulder and 1.36 mm (0.62) at the apex of the implant. Significant differences between implants with different macro designs were found in the apicocoronal direction. In connection to this, a significant 3D deviation was found at the implant shoulder. Conclusions Significant differences in height were found between the groups. The study had shown that the macro design of an implant has no influence on accuracy in all other directions. Overall, the implants showed a high level of accuracy and a low variation in values. The values were in the range determined by the template-guided insertion system in numerous other investigations. This provides good predictability of prosthetic rehabilitation. Trial registration German Register for Clinical Studies (DRKS-ID: DRKS000018939). Date of registration: November 11, 2019.
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Affiliation(s)
- Sigmar Schnutenhaus
- Zentrum für Zahnmedizin Dr. Schnutenhaus MVZ GmbH [Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH], Breiter Wasmen 10, 78247, Hilzingen, Germany. .,Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - Cornelia Edelmann
- Zentrum für Zahnmedizin Dr. Schnutenhaus MVZ GmbH [Center for Dentistry, Dr. Schnutenhaus Community Health Center (CHC) GmbH], Breiter Wasmen 10, 78247, Hilzingen, Germany
| | - Heike Rudolph
- Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
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20
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Lotz M, Schumacher C, Stadlinger B, Ikenberg K, Rücker M, Valdec S. Accuracy of guided biopsy of the jawbone in a clinical setting: A retrospective analysis. J Craniomaxillofac Surg 2021; 49:556-561. [PMID: 33726950 DOI: 10.1016/j.jcms.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/18/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to investigate the accuracy of a previously described technique for guided biopsy of osseous pathologies of the jawbone in a clinical setting. The data sets of patients who had undergone guided biopsy procedures were retrospectively examined for accuracy. Digital planning of the biopsies and manufacturing of the tooth-supported drilling template were performed with superimposed cone beam computed tomography and intraoral scans using implant planning software. After a trephine biopsy was taken using the template, the postoperative low-dose cone beam computed tomography was analyzed for accuracy using the planning software with the corresponding (digitally-planned) biopsy cylinder. The mean angular deviation was 4.35 ± 2.5°. The mean depth deviation was -1.40 ± 1.41 mm. Guided biopsy seems to be an alternative to a conventional approach for minimally invasive and highly accurate jawbone biopsy.
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Affiliation(s)
- Martin Lotz
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Caterina Schumacher
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Kristian Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
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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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22
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Putra RH, Yoda N, Astuti ER, Sasaki K. The accuracy of implant placement with computer-guided surgery in partially edentulous patients and possible influencing factors: A systematic review and meta-analysis. J Prosthodont Res 2021; 66:29-39. [PMID: 33504723 DOI: 10.2186/jpr.jpr_d_20_00184] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To review the current clinical studies regarding the accuracy of implant computer-guided surgery in partially edentulous patients and investigate potential influencing factors. STUDY SELECTION Electronic searches on the PubMed and Cochrane Central Register of Controlled Trials databases, and subsequent manual searches were performed. Two reviewers selected the studies following our inclusion and exclusion criteria. Qualitative review and meta-analysis of the implant placement accuracy were performed to analyze potential influencing factors. Angular deviation, coronal deviation, apical deviation, and depth deviation were evaluated as the accuracy outcomes. RESULTS Eighteen studies were included in this systematic review, including six randomized controlled trials, nine prospective studies, and three retrospective clinical studies. A total of 1317 implants placed in 642 partially edentulous patients were reviewed. Eight studies were evaluated using meta-analysis. Fully guided surgery showed statistically higher accuracy in angular (P <0.001), coronal (P <0.001), and apical deviation (P <0.05) compared with pilot-drill guided surgery. A statistically significant difference (P <0.001) was also observed in coronal deviation between the bounded edentulous (BES) and distal extension spaces (DES). A significantly lower angular deviation (P <0.001) was found in implants placed using computer-aided design/computer-aided manufacturing (CAD/CAM) compared to the conventional surgical guides. CONCLUSIONS The edentulous space type, surgical guide manufacturing procedure, and guided surgery protocol can influence the accuracy of computer-guided surgery in partially edentulous patients. Higher accuracy was found when the implants were placed in BES, with CAD/CAM manufactured surgical guides, using a fully guided surgery protocol.
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Affiliation(s)
- Ramadhan Hardani Putra
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry.,Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga
| | - Nobuhiro Yoda
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry
| | - Eha Renwi Astuti
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry
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23
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Baruffaldi A, Baruffaldi A, Baruffaldi M, Maiorana C, Poli PP. A suggested protocol to increase the accuracy of prosthetic phases in case of full-arch model-free fully guided computer-aided implant placement and immediate loading. Oral Maxillofac Surg 2020; 24:343-351. [PMID: 32385530 DOI: 10.1007/s10006-020-00849-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The accuracy of fully digital model-free surgical and prosthetic procedures depends on the cumulative effect and interaction of all errors gathered along the entire workflow process. In the present case series, a technique is described that increases the accuracy in the transition from the surgical to the prosthetic phase to reduce the risk of developing prosthetic complications in the case of immediate loading protocols. METHODS Overall, 86 dental implants were placed and immediately loaded with definitive prostheses in 11 edentulous patients following computer-guided implant surgery according to a fully digital model-free workflow. The same reference template used to anchor the surgical stent during computer-aided implant placement was used to guide the insertion of the definitive abutments and to seat in the correct position the final screw-retained implant-supported fixed restoration. The template used during all surgical and prosthetic procedures, which served as a stable and reproducible connection between the digital and surgical environments, was finally removed. RESULTS Healing proceeded uneventfully in all subjects. The implant survival and success rates were 100% over a minimum follow-up period of 1 year from the prosthetic loading. No biological or prosthetic complications were clinically and radiographically observed up to the last follow-up recall. CONCLUSION The use of a reference template used to transfer the digital project to the surgical field increased the accuracy and the integration of the surgical and prosthetic phases during the entire workflow.
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Affiliation(s)
| | | | | | - C Maiorana
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, School of Dentistry, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - P P Poli
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy.
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24
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Emara A, Sharma N, Halbeisen FS, Msallem B, Thieringer FM. Comparative Evaluation of Digitization of Diagnostic Dental Cast (Plaster) Models Using Different Scanning Technologies. Dent J (Basel) 2020; 8:dj8030079. [PMID: 32748890 PMCID: PMC7558308 DOI: 10.3390/dj8030079] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
Rapidly developing digital dental technologies have substantially simplified the documentation of plaster dental models. The large variety of available scanners with varying degrees of accuracy and cost, however, makes the purchase decision difficult. This study assessed the digitization accuracy of a cone-beam computed tomography (CBCT) and an intraoral scanner (IOS), as compared to a desktop optical scanner (OS). Ten plaster dental models were digitized three times (n = 30) with each scanner. The generated STL files were cross-compared, and the RMS values were calculated. Conclusions were drawn about the accuracy with respect to precision and trueness levels. The precision of the CBCT scanner was similar to the desktop OS reference, which both had a median deviation of 0.04 mm. The IOS had statistically significantly higher deviation compared to the reference OS, with a median deviation of 0.18 mm. The trueness values of the CBCT was also better than that of IOS—median differences of 0.14 and 0.17 mm, respectively. We conclude that the tested CBCT scanner is a highly accurate and user-friendly scanner for model digitization, and therefore a valuable alternative to the OS. The tested IOS was generally of lower accuracy, but it can still be used for plaster dental model digitization.
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Affiliation(s)
- Aalaa Emara
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo 12613, Egypt;
| | - Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland; (N.S.); (F.M.T.)
- Medical Additive Manufacturing Research Group (MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Florian S. Halbeisen
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Bilal Msallem
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland; (N.S.); (F.M.T.)
- Medical Additive Manufacturing Research Group (MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Correspondence:
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland; (N.S.); (F.M.T.)
- Medical Additive Manufacturing Research Group (MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
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25
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Pieralli S, Spies BC, Hromadnik V, Nicic R, Beuer F, Wesemann C. How Accurate Is Oral Implant Installation Using Surgical Guides Printed from a Degradable and Steam-Sterilized Biopolymer? J Clin Med 2020; 9:jcm9082322. [PMID: 32707759 PMCID: PMC7463912 DOI: 10.3390/jcm9082322] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/25/2023] Open
Abstract
3D printed surgical guides are used for prosthetically-driven oral implant placement. When manufacturing these guides, information regarding suitable printing techniques and materials as well as the necessity for additional, non-printed stock parts such as metal sleeves is scarce. The aim of the investigation was to determine the accuracy of a surgical workflow for oral implant placement using guides manufactured by means of fused deposition modeling (FDM) from a biodegradable and sterilizable biopolymer filament. Furthermore, the potential benefit of metal sleeve inserts should be assessed. A surgical guide was designed for the installation of two implants in the region of the second premolar (SP) and second molar (SM) in a mandibular typodont model. For two additive manufacturing techniques (stereolithography [SLA]: reference group, FDM: observational group) n = 10 surgical guides, with (S) and without (NS) metal sleeves, were used. This resulted in 4 groups of 10 samples each (SLA-S/NS, FDM-S/NS). Target and real implant positions were superimposed and compared using a dedicated software. Sagittal, transversal, and vertical discrepancies at the level of the implant shoulder, apex and regarding the main axis were determined. MANOVA with posthoc Tukey tests were performed for statistical analyses. Placed implants showed sagittal and transversal discrepancies of <1 mm, vertical discrepancies of <0.6 mm, and axial deviations of ≤3°. In the vertical dimension, no differences between the four groups were measured (p ≤ 0.054). In the sagittal dimension, SLA groups showed decreased deviations in the implant shoulder region compared to FDM (p ≤ 0.033), whereas no differences in the transversal dimension between the groups were measured (p ≤ 0.054). The use of metal sleeves did not affect axial, vertical, and sagittal accuracy, but resulted in increased transversal deviations (p = 0.001). Regarding accuracy, biopolymer-based surgical guides manufactured by means of FDM present similar accuracy than SLA. Cytotoxicity tests are necessary to confirm their biocompatibility in the oral environment.
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Affiliation(s)
- Stefano Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
- Correspondence: ; Tel.: +49-761-270-49060
| | - Valentin Hromadnik
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Robert Nicic
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Florian Beuer
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Christian Wesemann
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
- Department of Orthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Dentofacial Orthopedics and Pedodontics, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
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26
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Schnutenhaus S, Brunken L, Edelmann C, Dreyhaupt J, Rudolph H, Luthardt RG. Alveolar ridge preservation and primary stability as influencing factors on the transfer accuracy of static guided implant placement: a prospective clinical trial. BMC Oral Health 2020; 20:178. [PMID: 32600405 PMCID: PMC7322921 DOI: 10.1186/s12903-020-01155-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this prospective clinical study was to investigate differences between virtually planned and clinically achieved implant positions in completely template-guided implant placements as a function of the tooth area, the use of alveolar ridge preservation, the implant length and diameter, and the primary implant stability. Methods The accuracy of 48 implants was analyzed. The implants were placed in a completely template-guided manner. The data of the planned implant positions were superimposed on the actual clinical implant positions, followed by measurements of the 3D deviations in terms of the coronal (dc) and apical distance (da), height (h), angulation (ang), and statistical analysis. Results The mean dc was 0.7 mm (SD: 0.3), the mean da was 1.4 mm (SD: 0.6), the mean h was 0.3 mm (SD: 0.3), and the mean ang was 4.1° (SD: 2.1). The tooth area and the use of alveolar ridge preservation had no significant effect on the results in terms of the implant positions. The implant length had a significant influence on da (p = 0.02). The implant diameter had a significant influence on ang (p = 0.04), and the primary stability had a significant influence on h (p = 0.02). Conclusion Template-guided implant placement offers a high degree of accuracy independent of the tooth area, the use of measures for alveolar ridge preservation or the implant configuration. A clinical benefit is therefore present, especially from a prosthetic point of view. Trial registration German Clinical Trial Register and the International Clinical Trials Registry Platform of the WHO: DRKS00005978; date of registration: 11/09/2015.
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Affiliation(s)
- Sigmar Schnutenhaus
- Zentrum für Zahnmedizin Dr. Schnutenhaus MVZ GmbH [Center for Dentistry Dr. Schnutenhaus Community Health Center (CHC) GmbH], Breiter Wasmen 10, 78247, Hilzingen, Germany. .,Department for Dentistry, Clinic for Prosthodontics, Universität Ulm, Department für Zahnheilkunde, Klinik für Zahnärztliche Prothetik [Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - Liesa Brunken
- Department for Dentistry, Clinic for Prosthodontics, Universität Ulm, Department für Zahnheilkunde, Klinik für Zahnärztliche Prothetik [Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Cornelia Edelmann
- Zentrum für Zahnmedizin Dr. Schnutenhaus MVZ GmbH [Center for Dentistry Dr. Schnutenhaus Community Health Center (CHC) GmbH], Breiter Wasmen 10, 78247, Hilzingen, Germany
| | - Jens Dreyhaupt
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie [Ulm University, Institute of Epidemiology and Medical Biometry], Schwabstr. 13, 89075, Ulm, Germany
| | - Heike Rudolph
- Department for Dentistry, Clinic for Prosthodontics, Universität Ulm, Department für Zahnheilkunde, Klinik für Zahnärztliche Prothetik [Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Ralph G Luthardt
- Department for Dentistry, Clinic for Prosthodontics, Universität Ulm, Department für Zahnheilkunde, Klinik für Zahnärztliche Prothetik [Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
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27
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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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28
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Wang Y, Yang X, Gan R, Liu H, Wu G, Yu Q, Wang Z, Lu X, Jing J, Ma W, Quan Y, Sun Z, Fan L, Wang Y. Digital planning workflow for partial maxillectomy using an osteotomy template and immediate rehabilitation of maxillary Brown II defects with prosthesis. J Oral Rehabil 2019; 46:1133-1141. [PMID: 31260120 DOI: 10.1111/joor.12850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing evidence of benefits for the rehabilitation of Brown II defects with prosthesis in surgery. However, the current literature is sparse for maxillary tumour resection using osteotomy templates. OBJECTIVES To assess the accuracy of maxillectomy using a custom fabricated osteotomy template and to evaluate the prosthesis for surgical accuracy, appearance and functioning (speech, swallowing and occlusal force). METHODS Ten patients with Brown II defects caused by tumour resection were treated with precise partial maxillectomy using an osteotomy template. The immediate rehabilitation of the Brown II defect was completed with a prefabricated prosthesis. The post-operative three-dimensional images and the pre-operative virtual images were superimposed, and average deviation and maximum deviation were calculated. Speech intelligibility, swallowing, appearance and University of Washington Quality of Life Questionnaire (UW-QoL) were examined at 1, 3 and 6 months after surgery. Occlusal force was examined post-operatively at 6 months. RESULTS The maximum deviation between the actual and virtual surgery was 5.12 ± 0.44 mm, with an average of 1.02 ± 0.17 mm. Speech intelligibility, swallowing and UW-QoL improved significantly (P < .05) after wearing the prosthesis. The recovery index of the occlusal force on the affected side was 20.19%-32.28%. The skewed degree of the mouth corner, the difference in the height of the left and right lips, the maximum deviation distance and the change area volume decreased significantly (P < .05). CONCLUSION The precise rehabilitation of maxillary Brown II defects can be achieved using a prosthesis fabricated with an osteotomy template. The prosthesis restored appearance and functional capabilities (such as speech and occlusal force).
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Affiliation(s)
- Yang Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xudong Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ronglin Gan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huifen Liu
- Department of Oral Implantology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guofeng Wu
- Department of Oral Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Yu
- Department of Oral Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhiyong Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaolin Lu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianlong Jing
- Department of Oral Prosthodontics Technician, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Ma
- Department of Oral Implantology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yi Quan
- Shanghai UEG Medical Device Co., Ltd, Shanghai, China
| | - Ziang Sun
- Shanghai UEG Medical Device Co., Ltd, Shanghai, China
| | - Lei Fan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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29
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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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30
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Marei MK, El Backly RM. Dental Mesenchymal Stem Cell-Based Translational Regenerative Dentistry: From Artificial to Biological Replacement. Front Bioeng Biotechnol 2018; 6:49. [PMID: 29770323 PMCID: PMC5941981 DOI: 10.3389/fbioe.2018.00049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
Dentistry is a continuously changing field that has witnessed much advancement in the past century. Prosthodontics is that branch of dentistry that deals with replacing missing teeth using either fixed or removable appliances in an attempt to simulate natural tooth function. Although such "replacement therapies" appear to be easy and economic they fall short of ever coming close to their natural counterparts. Complications that arise often lead to failures and frequent repairs of such devices which seldom allow true physiological function of dental and oral-maxillofacial tissues. Such factors can critically affect the quality of life of an individual. The market for dental implants is continuously growing with huge economic revenues. Unfortunately, such treatments are again associated with frequent problems such as peri-implantitis resulting in an eventual loss or replacement of implants. This is particularly influential for patients having co-morbid diseases such as diabetes or osteoporosis and in association with smoking and other conditions that undoubtedly affect the final treatment outcome. The advent of tissue engineering and regenerative medicine therapies along with the enormous strides taken in their associated interdisciplinary fields such as stem cell therapy, biomaterial development, and others may open arenas to enhancing tissue regeneration via designing and construction of patient-specific biological and/or biomimetic substitutes. This review will overview current strategies in regenerative dentistry while overviewing key roles of dental mesenchymal stem cells particularly those of the dental pulp, until paving the way to precision/translational regenerative medicine therapies for future clinical use.
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Affiliation(s)
- Mona K Marei
- Department of Removable Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania M El Backly
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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