Computerized navigation for immediate loading of dental implants with a prefabricated metal frame: a feasibility study

Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis

OBJECTIVES

To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement.

MATERIALS AND METHODS

An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I² = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I² = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I² = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I² = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): -0.86°; 95% CI: -1.35 to -0.36) and freehand implant placement (MD: -4.33°; 95% CI: -5.40 to -3.25).

CONCLUSION

dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems.

CLINICAL RELEVANCE

The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.

Impact of Platelet-Rich Plasma on Bone Height Changes around Platform Switched Implants Supporting Mandibular Overdentures in Controlled Diabetic Patients

BACKGROUND:

The platform switching concept was recently introduced to implant dentistry involving the reduction of restoration abutment diameter with respect to the diameter of dental implant. Long-term follow-up around these implants showed higher levels of bone preservation and proper stress distribution and improved esthetics.

AIM:

The aim of the present study was to evaluate the changes in bone height by means of radiographic examination around platform switched implant supporting mandibular overdentures in controlled diabetic patients.

SUBJECTS AND METHODS:

Fourteen male complete edentulous patients were selected and enrolled in a follow-up study plan. Split mouth technique was applied; one side implant chosen randomly with Platelet-rich-plasma (PRP) and the other without PRP, bone height changes was assessed by Cone Beam Computed Tomography (CBCT) radiographic examination after 3 months, 6 months, 9 months and 1 year later.

RESULTS:

There was increase in bone height loss in both sides but with no statistical significance difference between the two sides after 3 months, 6 months, 9 months and 1 year respectively.

CONCLUSION:

The result of this article satisfied the patients both esthetically and functionally with recorded increase in bone height loss.

Static or Dynamic Navigation for Implant Placement-Choosing the Method of Guidance

The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.

Electrical nerve stimulation method for intraoperative localization of the inferior alveolar nerve within the mandible: a pilot study in rabbits

The efficacy of the electrical nerve stimulation method for localizing the inferior alveolar nerve (IAN) within the mandibular bone was evaluated. Six New Zealand rabbits were used (both sides of the mandible). The IAN was stimulated through the mandibular bone and compound action potentials (CAPs) were recorded proximally from the main trunk of the nerve. Stimulation current pulse widths were set at 0.05, 0.1, 0.3, 0.5, and 1ms. The minimum current magnitude that generated a CAP with a criterion level (300mV peak-to-peak amplitude) was measured in the range of 0.05-5mA. Correlations between the distance of the IAN from the active electrode site and the minimum current magnitudes were studied for each pulse width. The correlation coefficients were 0.678, 0.807, 0.893, 0.851, and 0.890 for the pulse widths of 0.05, 0.1, 0.3, 0.5, and 1ms, respectively. The minimum current producing the criterion CAP response in the IAN was significantly (P<0.0001 for all pulse widths) and highly correlated with the distance between the stimulation site and the nerve. The results suggest that electrical nerve stimulation is a promising method that can be used for the localization of the IAN, especially during mandibular implant surgery.

Evaluation of immediately loaded dental implants bioactivated with platelet-rich plasma placed in the mandibular posterior region: A clinico-radiographic study

BACKGROUND AND OBJECTIVES

The purpose of the present study was to clinically and radiographically assess the soft and hard tissue changes around the immediately loaded single tooth implants bioactivated with platelet-rich plasma (PRP), placed in the mandibular posterior region.

MATERIALS AND METHODS

A total of 11 patients having single tooth edentulous space in the mandibular posterior region were selected. An endosseous implant was placed after clinical and radiographic examination in each selected site using single stage surgical approach. The patients were followed up at 3, 6, 9, and at 12 months of post implant insertion. The patients were subjected to recording of clinical parameters like modified plaque index, modified gingival index, probing depth, and clinical implant mobility scale. Radiographs made at different intervals were subjected to assessment of bone level mesial and distal to each implant using computer assisted image analysis.

RESULTS

Scores for clinical parameters were minimal and comparable. The probing depth around the implant was measured during the follow-up period and the changes observed were statistically non-significant. None of the implants were clinically mobile during the follow-up period. Radiographically, the peri-implant bone resorption both on mesial and distal sides was within normal limit after one year of immediate loading. Finally, the overall success rate for the immediately loaded bioactivated implant placed in the mandibular posterior region was recorded as 100%.

INTERPRETATION AND CONCLUSION

The use of platelet-rich plasma may lead to improved early bone apposition around the implant; and thus, results in increased rate of osseointegration. Single stage implant procedure with the adjunctive use of PRP enhances the ability of peri-implant healing tissue to create favorable soft and hard tissue relationships. It also gives the added advantage of psychological boost for the patient by getting fixed replacement of tooth within a short time period.

Planning for immediate loading of implant-supported prostheses: literature review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.