Accuracy of dental implant placement using static versus dynamic computer-assisted implant surgery: An in vitro study: Accuracy of static vs. dynamic CAIS

The effect on the performance of a dynamic navigation system of superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a cone beam computer tomograph (CBCT). An experimental in vitro study

OBJECTIVES

To compare the accuracy and operative time of implant placement using a dynamic computer assisted implant surgery (dCAIS) system based on a cone beam computer tomography (CBCT) image, with and without superimposing a standard tessellation language (STL) file of an intraoral scan of the patient.

METHODS

Ten identical resin models simulating an upper maxilla with posterior edentulism were assigned to two groups. In the CBCT+STL group, a CBCT file and an intraoral STL file were superimposed and used for registration; in the CBCT group, registration was performed using CBCT images. Six implants were placed in each model using the Navident® dynamic navigation system. Anatomy registration was performed by tracing fiducial points on the CBCT or STL image, depending on the group. Preoperative and postoperative CBCT images were overlaid to assess implant placement accuracy.

RESULTS

Sixty implants were analyzed (30 implants in each group). 3D platform deviation was significantly lower (mean difference (MD): 0.17 mm; 95 % confidence interval (CI): 0.01 to 0.23; P = 0.039) in the CBCT+STL group (mean: 0.71 mm; standard deviation (SD): 0.29) than in the CBCT group (mean: 0.88 mm; SD: 0.39). The remaining accuracy outcome variables (angular deviation MD: -0.01; platform lateral deviation MD: 0.08 mm; apex global MD: 0.01 mm; apex depth MD: 0.33 mm) and surgery time (MD: 3.383 min.) were similar in both groups (p > 0.05).

CONCLUSIONS

The introduction of an intraoral scan (STL) seems to reduce deviations slightly in dental implant placement with dCAIS systems. However, the clinical repercussion of this improvement is questionable.

CLINICAL SIGNIFICANCE

Superimposing an intraoral scan on the CBCT image does not seem to increase the accuracy of dCAIS systems but can be useful when radiographic artifacts are present.

Accuracy of different registration areas using active and passive dynamic navigation systems in dental implant surgery: An in vitro study

OBJECTIVES

To gauge the relative accuracy of the use of passive and active dynamic navigation systems when placing dental implants, and to determine how registration areas affect the performance of these systems.

MATERIALS AND METHODS

Eighty implants were assigned to be placed into 40 total resin mandible models missing either the left or right first molars using either passive or active dynamic navigation system approaches. U-shaped tube registration devices were fixed in the edentulous site for 20 models each on the left or right side. Planned and actual implant positions were superimposed to assess procedural accuracy, and parameters including 3D entry deviation, angular deviation, and 3D apex deviation were evaluated with Mann-Whitney U tests and Wilcoxon signed-rank tests.

RESULTS

Respective angular, entry, and apex deviation values of 1.563 ± 0.977°, 0.725 ± 0.268 mm, and 0.808 ± 0.284 mm were calculated for all included implants, with corresponding values of 1.388 ± 1.090°, 0.789 ± 0.285 mm, and 0.846 ± 0.301 mm in the active group and 1.739 ± 0.826°, 0.661 ± 0.236 mm, and 0.769 ± 0.264 mm in the passive group. Only angular deviation differed significantly among groups, and the registration area was not associated with any significant differences among groups.

CONCLUSIONS

Passive and active dynamic navigation approaches can achieve comparable in vitro accuracy. Registration on one side of the missing single posterior tooth area in the mandible can complete single-tooth implantation on both sides of the posterior teeth, highlighting the promise of further clinical research focused on this topic.

Clinical study of immediate implant placement in posterior maxillary region assisted by dynamic real-time navigation: A randomized controlled trial

OBJECTIVE

To evaluate the accuracy of the implant accuracy and clinical effect of navigation-assisted immediate implant placement (IIP) in the posterior maxillary tooth region.

METHODS

This study included 60 patients with 96 implants undergoing IIP in the posterior maxillary region from January 2021 to December 2022, stratified into dynamic navigation and freehand implant groups. All clinical indicators, including initial stability, implant deviation (entry point deviation, end point deviation, depth deviation and angle deviation), marginal bone resorption and implant success rate, were systematically recorded.

RESULTS

All implants were successfully placed with an average torque of (24.38 ± 1.84)N.cm. The mean entry point deviation, apex point deviation and angular deviation in the navigation group were significantly smaller than that of the freehand group (P < 0.05). Marginal bone resorption was significantly less in the navigated group than in the freehand group (P < 0.05). All dental implants were considered an operational success and the mean follow-up time was (27.8 ± 8.4) months.

CONCLUSION

The application of dynamic navigation-assisted immediate implant placement in the maxillary posterior region can achieve good implant accuracy and satisfactory clinical results.

Artificial intelligence and mixed reality for dental implant planning: A technical note

AIM

The aim of this work is to present a new protocol for implant surgical planning which involves the combined use of artificial intelligence (AI) and mixed reality (MR).

METHODS

This protocol involves the acquisition of three-dimensional (3D) patient data through intraoral scanning (IOS) and cone beam computed tomography (CBCT). These data are loaded into AI software which automatically segments and aligns the patient's 3D models. These 3D models are loaded into MR software and used for planning implant surgery through holography. The files are then exported and used to design surgical guides via open-source software, which are 3D printed and used to prepare the implant sites through static computer-assisted implant surgery (s-CAIS). The case is finalized prosthetically through a fully digital protocol. The accuracy of implant positioning is verified by comparing the planned position with the actual position of the implants after surgery.

RESULTS

As a proof of principle, the present protocol seems to be to be reliable and efficient when used for planning simple cases of s-CAIS in partially edentulous patients. The clinician can plan the implants in an authentic 3D environment without using any radiology-guided surgery software. The precision of implant placement seems clinically acceptable, with minor deviations.

CONCLUSIONS

The present study suggests that AI and MR technologies can be successfully used in s-CAIS for an authentic 3D planning. Further clinical studies are needed to validate this protocol.

Robotic dental implant placement workflow for edentulous jaws

Yakebot, the first autonomous robotic dental implant system, provides a 1-stop solution for implant design, robot operation, real-time navigation, and precision analysis. This report describes the composition, principles, and implant operation procedures of the Yakebot dental implant robotic system in a patient for whom the robotic workflow procedure was used to place implants in the edentulous maxilla. The results showed that this workflow was more precise and predictable than traditional methods.

Axial and tilted implant surgical technique assisted by an autonomous dental implant robot: A clinical report

Optimal implant placement is essential for long-term implant survival and satisfactory prosthodontic outcomes. Autonomous dental implant robots have been reported to achieve accurate implant placement with satisfactory outcomes. This clinical report describes the use of an autonomous dental implant robot for axial and tilted implant placement in an edentulous mandible.

Accuracy in static guided implant surgery: Results from a multicenter retrospective clinical study on 21 patients treated in three private practices

PURPOSE

To evaluate the accuracy of a static computer-assisted implant surgery (s-CAIS) system across different private practices.

METHODS

This retrospective clinical study was based on data retrieved from 21 patients who received 61 implants between 2018 and 2020 in 3 private practices run by surgeons with extensive experience with s-CAIS. All patients were treated using the same s-CAIS system, planning software, template manufacturing process, and surgical guides. The standard tessellation language (STL) file of the intraoral scan of the fixture taken immediately after implant placement was matched with that of the preoperative plan for comparisons of preoperative and planned implant positions with postoperative and actual implant positions. The study outcomes were linear and angular deviations between the planned and actual implant positions.

RESULTS

No surgical or postsurgical complications occurred. The overlap of the two STL files resulted in a mean angular deviation of 2.94° The mean linear deviation at the implant shoulder was 0.73 mm, and that at the apex was 1.06 mm. The mean vertical deviations at the implant shoulder and the apex were 0.29 mm and 0.01 mm, respectively.

CONCLUSION

All cases showed satisfactory accuracy within the limits of this study (small number of patients and retrospective design). These results might be related to the use of a standardized digital workflow by experienced operators.

STATEMENT OF CLINICAL RELEVANCE

The study shows that careful control of each step, from data acquisition to final execution, is key for the accuracy of stent-guided systems.

Accuracy and Self-Confidence Level of Freehand Drilling and Dynamic Navigation System of Dental Implants: An In Vitro Study

BACKGROUND AND OBJECTIVE

The impact of the experience of the clinician on learning a new skill or equipment was still an intriguing subject. The goal of this research is to determine the accuracy level of a dynamic navigation system to that of freehand drilling by expert and novice practitioners with varied levels of experience. Additionally, the duration of the surgical procedure and the self-confidence level of the surgeons were also evaluated.

MATERIALS AND METHODS

An analog impression of the patient was used to make 20 polyurethane simulation models of the maxilla. Five expert and five inexperienced surgeons prepared the site and placed the implants at random on ten models each. Two different techniques were used to insert dental implants: freehand and dynamic navigation systems. Dental implants were placed in Group 1 utilizing a computer-assisted dynamic navigation device. The implants in Group 2 were secured using free-hand drilling. The dental implants were inserted first in the maxillary right first molar, then in the maxillary right lateral incisor, and the maxillary left second premolar. Preoperative and postoperative CBCT scans were superimposed by employing the Evalunav software and contrasted. The coronal 3-D, apex 3-D, apex vertical depth, and angular deviations for both procedures were evaluated. A pre-tested self-confidence questionnaire was also administered to assess the self-confidence of the practitioners. The duration of the surgical time was also documented for each strategy. The t-test was used to measure the difference in accuracy and confidence levels between freehand and dynamic navigation systems among expert and novice surgeons using SPSS software (IBM Corp., Armonk, NY, USA).

RESULTS

A total of 60 implants were used (three insertion sites, two methods, and 10 practitioners). Each of the five expert and novice clinicians implanted 15 implants (five models each). Except for entry 3-D, there was a statistically significant difference between the two approaches in all of the primary outcome variables. The apex 3-D (5.89±1.08 mm) and apex vertical (2.08±1.27 mm) dimensions of the dynamic navigation system were significantly smaller than those of the freehand drilling approach (p<005). Dynamic navigation and freehand drilling had angular deviations of 7.16±1.76ᵒ and 9.06±2.18ᵒ, respectively (p=0.0004). The apex vertical deviation was reduced in the navigation technique (2.07±1.5 mm) than in the freehand drilling (2.86±1.4 mm) by experienced practitioners (p=0.04). The difference in time between the two procedures was determined to be statistically highly significant (p<0.001) by both expert and novice surgeons. Furthermore, when contrasting with experienced practitioners, novice practitioners had an overall increase in surgery time (p<0.001) for both approaches.

CONCLUSION

The current in vitro study found that the dynamic navigation system enables more accurate implant placement than the freehand drilling technique, irrespective of the experience of the surgeons. However, this technique appears to benefit novice practitioners more, as they can profoundly minimize their deviations while accomplishing results comparable to those of expert surgeons.

Is dynamic computer-assisted surgery more accurate than the static method for dental implant placement? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Dynamic computer-assisted surgery for dental implant placement has become popular, but systematic comparisons of the accuracy of computer-assisted surgery with static surgery are lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to determine evidence on the difference in the accuracy of dynamic computer-assisted surgery compared with the static method for dental implant placement.

MATERIAL AND METHODS

A systematic search was conducted in 3 electronic databases: PubMed, Ovid, and Cochrane. Studies conducted on dental implants that compared the accuracy of positioning implants with a dynamic system with that of a static system were included. Randomized clinical trials, prospective and retrospective cohort studies, and in vitro studies were included in the review. Review articles, case reports, letters, opinion articles, commentaries, and nonpeer-reviewed literature were excluded.

RESULTS

Of the 26 full-text articles, 14 fulfilled the inclusion criteria. Of these, 2 were randomized clinical trials, 2 were prospective studies, and 1 was a retrospective cohort study. The remaining 9 were in vitro studies. A total of 1633 implants were placed with the static and 902 with the dynamic method. A significant mean difference (-0.51 degrees [95% CI: -0.90, -0.13]) between dynamic and static systems was only observed in the angular deviation of in vitro studies (P=.009). Meta-analysis was performed using Review Manager statistical software and forest plots were generated.

CONCLUSIONS

A difference was found in the angular deviation of implants placed with the dynamic approach compared with the static system. The dynamic system was better, but this difference was not demonstrable in clinical studies. No significant difference was found in the apical and coronal deviations of the dynamic and static systems.