A surgical guide for accurate mesiodistal paralleling of implants in the posterior edentulous mandible

Comparison of the accuracy of implant placement using a simple guide device and freehand surgery

Background/purpose

In clinical settings, there may be a need for a guide device that is simple and enhances the positioning accuracy of prosthetics. This study aimed to compare the accuracy of implant positioning using two methods: implant placement with a simple guide device (SGD) and freehand surgery.

Materials and methods

A total of 103 patients were randomly assigned to the control or study group. In the control group, implant placement was performed using the freehand technique. In the study group, implant placement was conducted with an SGD. Implant positioning accuracy was assessed by measuring how much the central position, fixture angulation, and fixture position differed from the ideal implant position based on periapical radiographs and cone-beam computed tomography images. In patients with double implants, parallelism between the two fixtures was also measured.

Results

There were 124 subjects, with 84 having single implants (42 in the control group and 42 in the study group) and 40 having double implants (20 in the control group and 20 in the study group). Utilization of the SGD for both single and double implant placement improved the accuracy of the central position, fixture angulation, and fixture position (P < 0.05). Additionally, in double implantation cases, it significantly enhanced parallelism between the two fixtures (P < 0.001).

Conclusion

These findings suggest that use of an SGD leads to more accurate implant placement compared with freehand surgery taking into account the final prosthetic restoration.

Comparative evaluation on wear resistance of metal sleeve, sleeve-free resin, and reinforced sleeve-free resin implant guide: An in vitro study

BACKGROUND

In-office three-dimensional (3D) printers and metal sleeveless surgical guides are becoming a major trend recently. However, metal sleeve-free designs are reported to be more prone to distortion which might lead to variation in the inner diameter of the drill hole and cause deviation and inaccuracy in the placement of the implant. Carbon fiber nanoparticles are reported to improve the properties of 3D printing resin material in industrial application.

AIM

The purpose of the study is to evaluate and compare the wear resistance of 3D-printed implant guides with metal sleeve, sleeve-free, and reinforced sleeve-free resin to the guide drill.

MATERIALS AND METHODS

A total of 66 samples with 22 samples in each group. Three groups including 3D-printed surgical guide with metal sleeve (Group A), without metal sleeve (Group B), an carbon fiber reinforced without metal sleeve (Group C) were included in the study. All samples were evaluated before sequential drilling and after sequential drilling using Vision Measuring Machine. The data were tabulated and statistically evaluated.

RESULTS

The data obtained were statistically analyzed with one-way analysis of variance and posthoc test. The data obtained for wear observed in the samples showed that the wear was highest in Group B with a mean of 0.5036 ± 0.1118 and the least was observed in Group A with a mean of 0.0228 ± 0.0154 and Group C was almost similar to Group A with mean of 0.0710 ± 0.0381. The results showed there was a significant difference between Group B with Group A and C, respectively (P < 0.05). The results showed that there was no significant difference regarding the wear observed between Groups A and C (P > 0.05).

CONCLUSION

The wear observed in the guide with a metal sleeve and carbon fiber reinforced without a metal sleeve was almost similar. The carbon fiber-reinforced guide showed better tolerance to guide drill equivalent to metal sleeve. Thus, carbon fiber nanoparticles reinforced in 3D printing resin have shown improved strength and can be used as a good replacement for a metal sleeve for an accurate placement of the implant.

Analysis of implant precision in guided surgery: comparison of two methods

BACKGROUND

Implantology represents the therapy of choice for the rehabilitation of a partially or totally edentulous jaw in a healthy patient. Nowadays, it is possible to exploit of modern preoperative planning software, increasingly precise radiographic examinations (CBCT) and CAD/CAM technologies that allow designing devices directly on the computer to be sent to a milling center which produces the desired product, such as stereolithographic templates.

METHODS

The prospective clinical study in question aims to evaluate the accuracy between two different surgical guides using peek and metal guide bushings. Twenty-nine implants were placed: for the control group, 17 3i, T3 implants were used, while for the test group, 12 Xive S plus implants were used.

RESULTS

The result obtained shows that the deviations in the distribution of the control group and the test group are the same in the apical-coronal, vestibulo-palatal and mesio-distal direction. For the control group, the mean deviation was 1.394±0.644923 at the entry point of the implants and 1.85655±1.0765 at the most apical point of the implants. For the test group the mean deviation was 1.10157±0.312721 at the entry point of the implants and 1.54514±0.572100 at the most apical point of the implants.

CONCLUSIONS

The peek guide bushings have the same deviation as the metal ones. There is no difference in the method used, but precision must be sought in other elements, such as the patient's anatomy and maximum precision in the guide production phase.

Integration of conventional and digital surgical guide fabrication techniques for the partially edentulous patient: Reducing the number of surgical procedures for a complete arch implant-supported prosthesis

Surgical procedures on partially edentulous patients for complete arch implant-supported prostheses involve remaining tooth extraction, alveolar bone reduction, and implant placement. Traditionally, partially edentulous patients undergo multiple surgeries, which extends the healing time and results in an extensively prolonged total treatment timeline. This technical article focuses on the fabrication of a more stable and predictive surgical guide to perform multiple surgical procedures in a single surgical appointment and planning a complete arch implant-supported prosthesis for the partially edentulous patient.

Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review

In the field of modern dentistry, ideal three-dimensional positioning of dental implant with optimal prosthetic fit offers successful long-term outcomes. To achieve such accurate implant placement, presurgical evaluation of hard and soft tissue matters the most. Their efforts can be attained using various application programs such as digital imaging, implant planning software, laboratory- or computer-assisted surgical guides, and dynamic navigation approach. To overcome different opinions and choices regarding guided surgery, this article explains an evidence-based literature review to assess its various outcomes and allowing informed choices before using various guided surgical techniques based on its expectation and reality outcomes. This highlights a clinician's choice to guide his successful implant surgery without causing distress in the midway of treatment. An online search was done on PubMed/Medline database to bring in accuracy to the expertise. This review includes reference of publications from 2000 to 2019, which is related to promising outcomes using computer-assisted static or dynamic navigation system for the placement of implant. Out of these, 809 were related to the computer-guided implant placement. Relevant papers were chosen in accordance with the inclusion and exclusion criteria. This review article contemplates to reflect the fact that computer-guided approach is considered to offer more predictable, safer, and faster implant placement with the predetermined final prosthetic outfit. Thus, digital planning and placing of dental implants in the correct position keep escalating to a higher achievement levels than a classical freehand approach. Nevertheless, this guided surgical approach also holds some errors and risks, which must be identified and rectified.

Использование хирургических шаблонов при дентальной имплантации

Реабилитация стоматологических пациентов с использованием дентальных имплантатов в настоящее время становится все более востребованной и успешной как в нашей стране, так и во всем мире. Наряду с успехами есть также и осложнения, связанные с ошибками на разных этапах имплантологического лечения. Многие осложнения возникают на хирургическом этапе во время установки дентальных имплантатов. Достижение прогнозируемого успеха дентальной имплантации подразумевает использование передающего устройства, которое позволяет реализовать запланированное лечение с наибольшей точностью. Таким устройством является хирургический шаблон. Цель исследования. Провести аналитический обзор литературы, посвященной использованию хирургических шаблонов при дентальной имплантации. Объекты и методы. Для анализа были отобраны научные статьи по проблеме использования хирургических шаблонов при дентальной имплантации за период 1987–2019 гг. Поиск источников выполнялся с помощью библиографических баз данных PubMed, MedLine, Scopus, Республиканской научной медицинской библиотеки, поисковой системы Google. Результаты исследования и их обсуждение. Проведенный детальный анализ отечественной и зарубежной научной литературы показал эффективность метода дентальной имплантации с применением хирургических шаблонов. Заключение. Известные методы лечения с использованием хирургических шаблонов имеют ряд недостатков, которые затрудняют проведение предсказуемой и точной дентальной имплантации у пациентов с концевыми дефектами зубных рядов на верхней и нижней челюсти.

Freehand Versus Guided Surgery: Factors Influencing Accuracy of Dental Implant Placement

INTRODUCTION

Patient anatomy, practitioner experience, and surgical approach are all factors that influence implant accuracy. However, the relative importance of each factor is poorly understood. The present study aimed to identify which factors most critically determine implant accuracy to aid the practitioner in case selection for guided versus freehand surgery.

METHODS

One practitioner's ideal implant angulation and position was compared with his achieved position radiographically for 450 implants placed using a conventional freehand method. The relative contribution of 11 demographic, anatomical, and surgical factors to the accuracy of implant placement was systematically quantified.

DISCUSSION

The most important predictors of angulation and position accuracy were the number of adjacent implants placed and the tooth-borne status of the site. Immediate placement also significantly increased position accuracy, whereas cases with narrow sites were significantly more accurate in angulation. Accuracy also improved with the practitioner's experience.

CONCLUSION

These results suggest tooth-borne, single-implant cases performed later in the practitioner's experience are most appropriate for freehand placement, whereas guided surgery should be considered to improve accuracy for multiple-implant cases in edentulous or partially edentulous sites.

In-Office Guided Implant Placement for Prosthetically Driven Implant Surgery

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office guided implant placement (iGIP) to decrease the cost by using available devices in office and enhance the applicability of surgical stents. A customized surgical stent was fabricated based on prosthetic, soft- and hard-tissue parameters by taking into account the amount of available bone (using the computed tomographic [CT] data), soft-tissue thickness and contour (using a composite-covered radiographic stent), and position of the final crown (by diagnostic cast wax up and marking the final crown position with composite). The efficacy of iGIP, in terms of the accuracy of the three-dimensional position of the implant placed in the study cast and in patient's mouth, was confirmed by direct observation and postoperative CT. The iGIP can enhance implant placement in the prosthetically desired position in various types of edentulism. Using this technique minimizes the risk of unwanted consequences, as the soft-tissue thickness and contour are taken into account when fabricating a surgical stent.

Surgical templates for dental implant positioning; current knowledge and clinical perspectives

Dental implants have been used in a variety of different forms for many years. Since the mid-20^th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.

Designing a custom made gauge device for application in the access hole correction in the dental implant surgical guide

Anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an esthetic outcome. The predictability of success can be increased, if the implants are placed properly. During oral implant placement, the drill must be guided by the surgeon according to the final form of the restoration. A surgical template would be helpful in more accurate placement of the dental implants. Surgical guides fabricated in laboratory are still being used. But these guides often need correction after computed tomography (CT) scan evaluation. For their correction and reducing the possibility of error, a scaled milling machine is usually required. But this scaled milling machine is not available omnipresent. In this article a simple device is described that can be attached to any milling machine and surveyor. The presented device can correct the diagnostic template easily and predicts dental implants placement with more favorable esthetic and occlusal outcome.

Reliability of implant surgical guides based on soft-tissue models

The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides.

Prosthodontic rehabilitation of malpositioned implants after ameloblastoma followed by mandibulectomy and costal bone graft: a clinical report

This clinical report describes the rehabilitation with costal bone graft reconstruction and 3 implants of a patient with a partial mandibular defect as a result of a partial mandibulectomy due to ameloblastoma of the left mandible. Due to the altered shape of the graft bone, the implants were malpositioned in the buccolingual plane. The prosthodontic rehabilitation was successfully completed by using an implant-supported milled bar combined with telescopic crown-retained dentures. This tooth implant-supported prosthesis successfully restored function and esthetics. Aspects that deal with the repair of the buccal soft tissues are discussed.

Types of Implant Surgical Guides in Dentistry: A Review

Various techniques have been proposed for the fabrication of surgical guide templates in implant dentistry. The objective of this paper is to review the associated literature and recent advancements in this field, based on design concept. An electronic and hand search of the literature revealed 3 categories, namely, nonlimiting, partially limiting, and completely limiting design. Most clinicians still adopt the partially limiting design due to its cost-effectiveness and credibility. Moreover, clinicians use cross-sectional imaging during the preimplant assessment of surgical sites.

Presurgical planning in implant restorations: correct interpretation of cone-beam computed tomography for improved imaging

Contemporary implant dentistry is a primarily prosthetically driven treatment. The implant position is defined during the diagnostic phase, and the radiographic guide (template) indicates accurately the area of concern on the cone-beam computed tomography (CBCT). CBCT is an essential diagnostic key to a successful treatment plan in many cases. The aim of this paper was to underline the importance of proper alignment of the scanning levels in CBCT in order to avoid distorted cross-sectional images. As demonstrated with two clinical cases in this preliminary study, the initial scanning images of the CBCT must be drawn parallel to the occlusal plane, as defined by the diagnostic wax-up of the final restoration. The radiographic template offers valuable information about the planned location and inclination of the implant and the restoration. Proper image reconstruction following the dental scan can contribute significantly to accurate cross-sectional images and detailed presurgical planning.

Fabrication of a cast-based implant surgical guide using guide sleeves

A unique method for fabricating cast-based surgical guides is presented. A proposed position and mesiodistal angulation of the implant are verified with periapical radiography and registered with a commercially available guide sleeve. The sleeve is attached to a surgical guide made of light-polymerized acrylic resin. The surgical guide can be used in a broad range of situations and allows for accurate implant placement in a prosthetically driven position with surgical access and visibility, simplicity, and cost efficiency.

Use of diagnostic and surgical stent: a simplified approach for implant placement

Dental implantology has emerged as a practical alternative to traditional prosthodontics. Since the beginning, placement of implant in the bone to achieve a prosthetic solution that fulfils biologic, aesthetic and biomechanical requirements has been a challenge. In the past, implant site and inclination were dictated by residual bone quality. The desire for predictable prosthesis led to the development of prosthetically guided implantology. This concept establishes the correct implant position during the diagnostic stage according to planned definitive restoration. In prosthetically guided implantology where ideal placement of implant is determined by the definitive restoration, use of radiographic and surgical stent in conjunction with dental CT scan can play an important role. A stent is an appliance used for radiographic evaluation during treatment planning for implant placement and during surgical procedures to locate optimal implant placement site. The stent with dental CT scan enables the dental team to identify specific sites of prospective implant surgery and hence determines the optimal position and angulation of implant relative to occlusal load. Aided by stent the surgeon can avoid undesirable implant site preparation and minimize unnecessary osteotomy, resulting in favorable design of prosthesis, reduced surgical trauma, reduced surgical time and increased patient comfort. This case report is an insight into the method of fabrication of simple and cost effective stent for implant placement and its advantages over the other techniques of stent fabrication.

Effect of surgical guide design and surgeon's experience on the accuracy of implant placement

Implant position is a key determinant of esthetic and functional success. Achieving the goal of ideal implant position may be affected by case selection, prosthodontically driven treatment planning, site preparation, surgeon's experience and use of a surgical guide. The combined effect of surgical guide design, surgeon's experience, and size of the edentulous area on the accuracy of implant placement was evaluated in a simulated clinical setting. Twenty-one volunteers were recruited to participate in the study. They were divided evenly into 3 groups (novice, intermediate, and experienced). Each surgeon placed implants in single and double sites using 4 different surgical guide designs (no guide, tube, channel, and guided) and written instructions describing the ideal implant positions. A definitive typodont was constructed that had 3 implants in prosthetically determined ideal positions of single and double sites. The position and angulation of implants placed by the surgeons in the duplicate typodonts was measured using a computerized coordinate measuring machine and compared to the definitive typodont. The mean absolute positional error for all guides was 0.273, 0.340, 0.197 mm in mesial-distal, buccal-lingual, vertical positions, respectively, with an overall range of 0.00 to 1.81 mm. The mean absolute angle error for all guides was 1.61° and 2.39° in the mesial-distal and buccal-lingual angulations, respectively, with an overall range of 0.01° to 9.7°. Surgical guide design had a statistically significant effect on the accuracy of implant placement regardless of the surgeon's experience level. Experienced surgeons had significantly less error in buccal-lingual angulation. The size of the edentulous sites was found to affect both implant angle and position significantly. The magnitude of error in position and angulation caused by surgical guide design, surgeon's experience, and site size reported in this study are possibly not large enough to be clinically significant; however, it is likely that errors would be magnified in clinical practice. Future research is recommended to evaluate the effect of surgical guide design in vivo on implant angulation and position error.

Role of surgical stents in determining the position of implants

AIM

Demand from implant patients for quality and efficient treatment is increasing. Fortunately dental implant treatment is evolving with patients expectations.

MATERIALS AND METHODS

The study comprised of 45 patients for whom 89 implants were placed at different sites. Efficacy of the stents is evaluated in determining the position and diameter of the implants.

CONCLUSION

this study shows the extreme accuracy of this surgical stents in implant installation in terms of position and diameter.

A surgical guide for dental implant placement in edentulous posterior regions

Proper implant placement is crucial for successful implant-supported restorations. This article describes a simple technique for fabricating a vacuum-formed surgical guide to assist in dental implant placement in edentulous posterior regions.

Using transitional implants as fixation screws to stabilize a surgical template for accurate implant placement: A clinical report

This article describes a method of using transitional implants as surgical fixation screws to orient a surgical template predictably during the placement of implants in the anterior mandible for an implant-supported bar-retained overdenture. Ridge reduction, transitional implant placement, implant placement, and removal of the transitional implants were completed in a single surgical appointment. Details of the template fabrication, incorporating transitional implants and surgical techniques, are described.

Implant surgical guide fabrication for partially edentulous patients

This article presents an innovative method for the fabrication of implant drill guides for partially edentulous patients. Using a light-polymerized composite material and drill blanks placed in the prosthodontically driven implant position, surgical guides for each implant drill are constructed on the diagnostic cast. In addition to the size-customized implant surgical guides, a ridge crest preparation guide showing the proposed crown contour is used to adjust the tissue contour, if needed, during implant surgery.

An Instrument for the Optimal Guiding of Osseointegrated Dental Implants

The purpose of this study was to design an instrument for the optimal guiding of osseointegrated implants intraoperatively to achieve parallelism or desired angulations. Seven patients (4 males and 3 females) were enrolled in the investigation. They ranged in age from 44 to 61 years. Using an instrument designed by the senior author that permitted optimal guiding of the osteotomy instruments (33 Osteofix Oy, Oulu, Finland) we placed in these patients, root form, single stage implants. The difference in angulations between the first and the remaining implants was measured using the abutment replicas on the working models. It was found that the mean deviation angle between the first and the adjacent implant replicas was 2.2° (SD = 0.4°). The largest deviation angles were 2.3° (SD = 0.5°) and 3.1° (SD = 0.8°). The study indicated that the instrument had been designed in a functional manner and that all implants in such relationships can be inserted into their desired positions, either parallel to one another or with the desired angle for the planned prostheses.

Retrieval and replacement of a malpositioned dental implant: a clinical report

This clinical report describes the retrieval of a malpositioned mandibular implant with a severe lingual inclination. A replacement implant was inserted with an emphasis on its relationship with the maxillary antagonist, resulting in a buccal inclination of approximately 10 degrees. The treatment review highlights the importance of thorough communication among all members of the dental implant team.