A novel conversion method for radiographic guide into surgical guide

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods

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.

Accuracy of a milled digital implant surgical guide: An in vitro study

STATEMENT OF PROBLEM

An accurate surgical template for guided implant surgery is essential for the success of an implant restoration. However, reports on the accuracy of digitally designed and computer numeric controlled (CNC) machine-milled surgical templates are sparse.

PURPOSE

The purpose of this in vitro study was to investigate the accuracy of an implant surgical guide digitally designed by using data from cone beam computed tomography (CBCT) scans and milled with a 5-axis CNC machine.

MATERIAL AND METHODS

Six representative radiographic templates were prepared from radiopaque resin plates. For each guide, a CBCT scan was made, and the extracted Digital Imaging and Communications in Medicine (DICOM) data were imported into a planning software program (ORGANICAL Dental Implant). Nine implants were virtually designed for each guide. The design data were imported into a 5-axis CNC machine, and the radiographic guides were fixed onto the CNC machine (Organical Multi S). Bore holes for surgical guide sleeves were milled directly in the radiographic template, which was converted into a surgical template. After the milling process, the surgical guides were scanned by using a laboratory cast scanner. The deviation between the position of the sleeve bore hole in the milled template and that in the virtual implant planning was digitally calculated.

RESULTS

The mean global deviation of the surgical guide was 0.16 ±0.06 mm in the circle center of the sleeve top, and the mean angular deviation was 0.61 ±0.40 degrees. The sleeve-implant distance and the sleeve axis angle showed no significant influence on the in vitro accuracy of the implant surgical guide.

CONCLUSIONS

The mean deviation of the surgical guide prepared by using the virtual planning software and 5-axis CNC milling procedure in this study was 0.16 ±0.06 mm in the center of the sleeve top. Thus, the guide had acceptable precision.

Accuracy of implant surgical guides fabricated using computer numerical control milling for edentulous jaws: a pilot clinical trial

Background

To evaluate the accuracy of a computer numerical control (CNC) milled surgical guide for implant placement in edentulous jaws.

Methods

Edentulous patients seeking implants treatment were recruited in this prospective cohort study. Radiographic guides with diagnostic templates were fabricated from wax-up dentures. Patients took cone-beam computed tomography (CBCT) wearing the radiopaque radiographic guides. Implant positions were virtually designed in the planning software based on the CBCT data, and the radiographic templates were converted into surgical guides using CNC milling technique. Forty-four implants were placed into 12 edentulous jaws following guided implant surgery protocol. Post-surgery CBCT scans were made for each jaw, and the deviations between the planned and actual implant positions were measured. Deviation of implant position was compared between maxilla and mandible, and between cases with and without anchor pins using independent t-test.

Results

Nine patients (3 males and 6 females) with 12 edentulous jaws were recruited. The mean age of patients was 59.2 ± 13.9 years old. All 44 implants was placed without complication and survived, the mean three dimensional linear deviation of implant position between virtual planning and actual placement was 1.53 ± 0.48 mm at the implant neck and 1.58 ± 0.49 mm at the apex. The angular deviation was 3.96 ± 3.05 degrees. No significant difference was found in the deviation of implant position between maxilla and mandible (P = 0.28 at neck, 0.08 at apex), nor between cases with and without anchor pins (P = 0.87 at neck, 0.06 at apex).

Conclusions

The guides fabricated using the CNC milling technique provided comparable accuracy as those fabricated by Stereolithography. The displacement of the guides on edentulous arch might be the main contributing factor of deviation.

Trial registration: Chinese Clinical Trial Registry, ChiCTR-ONC-17014159 (July 26, 2017).

Fabricating a chairside CAD-CAM radiographic and surgical guide for dental implants: A dental technique

The conventional method of diagnosing and treatment planning an implant-supported restoration involves making a diagnostic alginate impression and fabricating a radiographic and surgical guide. The procedure described uses an intraoral scanner and milling unit to fabricate a chairside computer-aided design and computer-aided manufacturing radiographic and surgical guide for use with a cone beam computed tomography system.

[Research advances in the use of digital surgical guides in implantology]

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.

A novel guided surgery system with a sleeveless open frame structure: a retrospective clinical study on 38 partially edentulous patients with 1 year of follow-up

Background

This retrospective clinical study aims to present results of experience with a novel guided surgery system with a sleeveless, open-frame structure, in which the surgical handpiece (not the drills used for preparation) is guided.

Methods

This study was based on an evaluation of the records of partially edentulous patients who had been treated with a sleeveless open-frame guided surgery system (TWIN-Guide®, 2Ingis, Brussels, Belgium), between January 2015 and December 2017. Inclusion criteria were patients with good systemic/oral health and a minimum follow-up of 1 year. Exclusion criteria were patients who had been treated without a guide, or with a guide with sleeves, patients with systemic/oral diseases and who did not have a follow-up of 1 year. The main outcomes were surgical (fit and stability of the surgical guide, duration of the intervention, implant stability, and any intra-operative or immediate post-operative complication), biologic, and prosthetic.

Results

Thirty-eight patients (24 males, 14 females; mean age 56.5 ± 14.0 years) were included in the study. These patients had been treated with 110 implants inserted by means of 40 sleeveless, open-frame guides. With regard to fit and stability, 34 guides were excellent, 4 acceptable, and 2 inadequate for use. The mean duration of the intervention was 23.7 (± 6.7) minutes. Immediately after placement, 2 fixtures were not stable and had to be removed. Two patients experienced pain/swelling after surgery. The 108 surviving implants were restored with 36 single crowns and 32 fixed partial prostheses (24 two-unit and 8 three-unit bridges); these restorations survived until the 1-year follow-up, with a low incidence of biologic and prosthetic complications.

Conclusions

Within the limits of this study, this novel guided surgery system with sleeveless, open frame–structure guides seems to be clinically reliable; further studies on a larger sample of patients are needed to confirm these outcomes.

Evaluation of marginal adaptation of Co-Cr-Mo metal crowns fabricated by traditional method and computer-aided technologies

Background/purpose

The purpose of this study was to evaluate the marginal gaps of dental restorations manufactured using conventional loss wax and casting, computer-aided design/computer-aided manufacturing (CAD/CAM), and 3D printing methods.

Materials and methods

A zirconia master die model with an upper right first molar resin crown was prepared as a standardized model. A total of 30 resin master die models were duplicated from this standard model. Simultaneously, 10 Co—Cr—Mo metal crowns were individually obtained using the conventional loss wax and casting method (Group A), selective laser sintering (Group B), and CAD/CAM (Group C), respectively. The marginal gaps between the crowns fabricated conventional and digital methods with master die models were calculated using a 3D replica and mapping technique.

Results

Statistical analyses revealed there were significant differences in the marginal gaps in the group A with group B and C (p < 0.05). The mean marginal gaps between dental crowns with die models were 76 ± 61 μm, 116 ± 92 μm, and 121 ± 98 μm for groups A, B, and C, respectively.

Conclusion

Within the limitations of this study, the marginal gaps were clinical acceptable in conventional and digital techniques.