Accuracy of Computer-Guided Template-Based Implant Surgery: A Computed Tomography-Based Clinical Follow-Up Study

Accuracy of a dynamic navigation system for dental implantation with two different workflows and intraoral markers compared to static-guided implant surgery: An in-vitro study

PURPOSE

To investigate the accuracy of a miniaturized dynamic navigation system with intraoral markers and two different workflows for dental implantation and to compare with static computer-assisted implant surgery (sCAIS) surgery.

MATERIALS AND METHODS

Two operators performed a total of 270 implant insertions in polyurethane mandibular models under simulated clinical conditions. Implants were placed after CBCT-based virtual planning in three different groups: two workflows utilizing dynamic computer-assisted implant surgery (dCAIS; DG1: marker in CBCT; DG2: 3D-printed marker) and the others with sCAIS (TG: template guided). Postoperative surface scans were matched to the planning data and allowed an evaluation of the angular and spatial deviation between the planned and the actually achieved implant position. Descriptive statistics were followed by a Mixed Model Analysis to determine the influence of the operator, the method, and operating area on different accuracy parameters and the random effect of the model number.

RESULTS

The mean angular deviation ranged from 2.26° (DG1) to 2.96° (TG). The mean 3D deviation at the implant's tip ranged from 1.08 mm (TG) to 1.51 mm (DG2) and at the implant's base from 0.69 mm (TG) to 1.49 mm (DG2). The operator showed no significant influence on the accuracy. The method showed significant influence on singular parameters and the operating area on all spatial accuracy parameters.

CONCLUSIONS

Dynamic navigation systems with intraoral markers enable accurate implant positioning, which is comparable to the static-guided implant surgery. 3D-printed markers provide less accurate results compared to prefabricated markers, attached before CBCT scan.

3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars

OBJECTIVES

This prospective study introduced a digitally designed sectioning guide and evaluated its feasibility for the extraction of horizontally impacted lower third molars.

MATERIALS AND METHODS

This study included 38 horizontally impacted lower third molars, randomly divided into experimental and control groups. The teeth were extracted using a 3D-printed titanium surgical guide in the experimental group; free-hand extractions were performed in the control group. The surgical duration, tooth sectioning duration, cortical bone perforation, and postoperative complications, including pain, swelling, trismus, dry socket, infection, and hemorrhage, were evaluated.

RESULTS

Although not statistically significant, guided surgery tended to reduce the number of tooth sectioning steps compared to free-hand extractions. There were no cases of cortical bone perforation in the experimental group. Although the surgical duration was greater in the experimental group (p < 0.05), there were no differences in postoperative pain, swelling, and trismus. There were no cases of postoperative infection and hemorrhage in either group.

CONCLUSIONS

3D-printed titanium surgical guides had superior accuracy and safety compared to free-hand surgery. Further studies with larger sample sizes are required to verify these findings.

CLINICAL RELEVANCE

The template improved the safety of tooth sectioning during impacted lower third molar surgery and resulted in a more predictable extraction. The narrow sectioning groove could fit comfortably with hypertrophic soft tissues in the posterior mandible.

Comparative Analysis of Implant Prosthesis Treatment Planning and Execution Following Bone Repair Procedures Using Dynamic Surgical Navigation in Augmented Areas

Successful implant placement in augmented sites depends on the appropriate bone volume and quality, as well as careful planning of the procedure. Minimizing risks during the surgical and healing phases is also of great importance. A very promising technique has been introduced, which partially meets the above criteria. This technique is designed to increase the precision and reduce the invasiveness associated with surgical procedures during implantation. The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery in augmented sites in patients treated with dental implants introduced using dynamic implant navigation. Eleven healthy patients who had planned and performed implant-prosthetic treatment after bone augmentation were analyzed. Twenty-three implants were placed with Navident dynamic navigation using the tissue punch flapless technique. This study evaluated the position of the inserted implant relative to the virtual plan and determined the correlation. The treatments were successful in all the treated patients, and the integration period (3 or 6 months) was uneventful and enabled implant-prosthetic treatment. The accuracy values provided in this study are comparable to, but not better than, data provided in the literature on dynamic and static computer-assisted surgery. Dynamic navigation may improve the quality and safety of surgical procedures and reduce the risk of complications.

Feasibility analysis of an ultrasound on line diagnostic approach for oral and bone surgery

During implant surgery procedures, surgical precision is an essential prerequisite for the functional and aesthetic success of the prosthetic crown to be placed on the dental implant. A modern implant surgical approach should be standardized as much as possible to guarantee extreme precision in the insertion of the implant into the upper and lower bone jaws. Among the most common surgical errors during implant surgery there is the over-preparation of the surgical alveolus with possible damage to the contiguous anatomical structures. To avoid this problem, in the recent years, there has been an increasing attention to the development of new control techniques. In this paper, we describe an innovative ultrasound approach, which exploits the integration of an electro-acoustic transducer with the surgical drill used for realizing the alveolus in the bone that will host the implant. Specifically, he proposed approach is based on the "time-of-flight" detection technique for measuring the thickness of the residual bone subjected to the drilling. In order to demonstrate the feasibility of the proposed approach, here we report on a detailed numerical analysis aimed at studying the propagation of ultrasonic waves through the drill-bit and through the involved tissues. The obtained results confirm the validity of our approach, and enable for a future first prototype implementation of a hi-tech surgical drill-bit, which in general is suitable not only for dental implant surgery but also for other uses in oral surgery, maxillofacial surgery and for bone surgery.

The Digital Abutment Check: An Improvement of the Fully Digital Workflow

By using modern digitalization techniques, an existing denture can be digitized and aid the provision of a new implant-supported denture according to a fully digital workflow. This includes fully navigated implant surgery and results in an immediately provided prosthetic restoration. However, even with the current digital workflow, it is challenging to achieve a definitive prosthetic restoration in a single treatment session. In order to achieve a definitive denture in as few treatment sessions as possible, we have implemented the digital abutment test. This test modified the existing data set and determined the final restoration. In the present case, the preexisting maxillary removable complete denture was converted into a fixed immediate restoration using the fully digital workflow. The workflow is divided into two treatment phases, each with three treatment sessions, where part of the second phase involves an innovative digital abutment check. The illustrated case shows an effective use of current digital possibilities. Special attention was also paid to a minimally invasive course of therapy.