The accuracy of guided surgery via mucosa-supported stereolithographic surgical templates in the hands of surgeons with little experience

Influence of clinical expertise and practical experience on transfer accuracy in guided dental implant placement - an in vitro study

PURPOSE

To investigate whether inexperienced users applying a static navigation system can perform in-vitro a fully guided implant placement protocol and achieve similar results in terms of accuracy compared to experienced clinicians.

METHODS

Based on 36 identical resin models, a computer-assisted implant planning was performed and a surgical guide was produced accordingly. Three study groups were composed with 12 operators, each: control group with experienced surgeons (DOC), test group 1 with dental technicians (TEC) and test group 2 with non-specialists (OFC). Using a fully guided drilling protocol, two implants were placed into each of the 36 models. Subsequently, the differences between the virtually planned and final implant positions were determined and the transfer accuracy was evaluated.

RESULTS

For the control group DOC, the mean value of axial deviation was 1.90 ± 1.15 degrees, for 3-dimensional deviation at the implant base 0.52 ± 0.33 mm, for 3-dimensional deviation at the implant tip 0.76 ± 0.39 mm and for vertical deviation at the implant tip - 0.11 ± 0.51 mm. For corresponding parameters, the mean values of test group TEC were 1.99 ± 0.87 degrees, 0.42 ± 0.21 mm, 0.68 ± 0.30 mm and - 0.03 ± 0.33 mm and for test group OFC 2.29 ± 1.17 degrees, 0.63 ± 0.35 mm, 0.89 ± 0.43 mm and - 0.24 ± 0.57 mm, respectively. The results did not reveal any statistically significant differences between the control and the 2 test groups (p˃0.05).

CONCLUSION

The results of the present in-vitro study demonstrated that inexperienced users applying a static navigation system can perform a fully guided implant placement protocol and achieve similar results in terms of accuracy compared to experienced clinicians in this specific in vitro setup.

Verification of the accuracy of dynamic navigation for conventional and mouthpiece methods: in vivo study

BACKGROUND

Dynamic navigation for implant placement is becoming popular under the concept of top-down treatment. The purpose of this study is to verify the accuracy of a dynamic navigation system for implant placement.

METHODS

Implant placement was performed on 38 patients using 50 implant fixtures. Patients in group C were treated using a conventional method, in which thermoplastic clips were fixed to the teeth, and patients in group M were treated using thermoplastic clips fixed to a mouthpiece attached to the teeth. The groups were compared to verify whether an accuracy difference existed. A treatment planning support program for dental implants was used to superimpose the postoperative computed tomography data on the preoperative implant design data to measure the entry point, apex point, and angular deviation.

RESULTS

The accuracy of group C was 1.36 ± 0.51 mm for entry point, 1.30 ± 0.59 mm for apex point, and 3.20 ± 0.74° for angular deviation. The accuracy of group M was 1.06 ± 0.31 mm for the entry point, 1.02 ± 0.30 mm for the apex point, and 2.91 ± 0.97° for angular deviation. Significant differences were observed in the entry and apex points between the two groups.

CONCLUSIONS

The results indicate that group M exhibited better accuracy than group C, indicating that the stability of the thermoplastic clip is important for ensuring the accuracy of the dynamic navigation system. No previous studies have verified the accuracy of this system using the mouthpiece method, and additional data is required to confirm its accuracy for dental implant placement. The mouthpiece method improves the accuracy of implant placement and provides a safer implant treatment than the conventional method.

TRIAL REGISTRATION

University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Registration Number: UMIN000051949, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view_his.cgi on August 21, 2023.

Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

Effects of a modified surgical protocol on the positional accuracy of dental implants placed using fully guided implant surgery in the partially edentulous posterior ridge with distal extension: a dentiform model study

PURPOSE

The present experiment aimed to evaluate the placement accuracy of fully guided implant surgery using a mucosa-supported surgical guide when the protocol of osteotomy and installation was modified (MP) compared to when the protocol was sequentially and conventionally carried out (CP).

MATERIALS AND METHODS

For 24 mandibular dentiform models, 12 dentists (6 experts and 6 beginners) performed fully guided implant placements two times at the right first and second molar sites using a mucosa-supported surgical guide, once by the CP (CP group) and at the other time by the MP (MP group). The presurgical and postsurgical stereolithographic images were superimposed, and the deviations between the virtually planned and actually placed implant positions and the procedure time were compared statistically (P < .05).

RESULTS

The accuracies were similar in the CP and MP groups. In the CP group, the mean platform and apex deviations at the second molar site for the beginners were +0.75 mm and +1.14 mm, respectively, which were significantly larger than those for the experts (P < .05). In the MP group, only the mean vertical deviation at the second molar site for the beginners (+0.53 mm) was significantly larger than that for the experts (P < .05). The procedure time was significantly longer for the MP group (+94.0 sec) than for the CP group (P < .05).

CONCLUSION

In fully guided implant surgery using a mucosa-supported guide, the MP may improve the placement accuracy when compared to the CP, especially at sites farther from the most-posterior natural tooth.

Accuracy of autonomous robotic surgery for dental implant placement in fully edentulous patients: A retrospective case series study

OBJECTIVES

This study evaluated the accuracy of dental implant placement using the robotic computer-assisted implant surgery (r-CAIS) technology in fully edentulous patients.

MATERIALS AND METHODS

Fully edentulous and terminal dentition patients were enrolled for r-CAIS technology. Based on the cone-beam computed tomography (CBCT) examination, a customized positioning marker and a preoperative surgical plan were created before surgery. During the implant surgery, the implant osteotomy and placement were automatically performed using an autonomous robotic surgery system under the surgeon's supervision. A postoperative CBCT scan was used to determine the discrepancies between the planned and placed implants.

RESULTS

Ten patients with 59 implants underwent autonomous robotic surgery. No adverse surgical events occurred. The deviations of global coronal, global apical, and angular were 0.67 ± 0.37 mm (95% CI: 0.58-0.77 mm), 0.69 ± 0.37 mm (95% CI: 0.59-0.78 mm), and 1.27° ± 0.59° (95% CI: 1.42°-1.11°), respectively.

CONCLUSIONS

The autonomous r-CAIS technology proved an accurate surgical approach for implant placement in fully edentulous patients due to the control of the angular deviation. Autonomous robotic surgery seems promising as an accurate technology for treating fully edentulous patients. However, further trials are required to provide more hard clinical evidence.

Comparison of accuracy between free-hand and surgical guide implant placement among experienced and non-experienced dental implant practitioners: an in vitro study

PURPOSE

This study investigated the accuracy of free-hand implant surgery performed by an experienced operator compared to static guided implant surgery performed by an inexperienced operator on an anterior maxillary dental model arch.

METHODS

A maxillary dental model with missing teeth (No. 11, 22, and 23) was used for this in vitro study. An intraoral scan was performed on the model, with the resulting digital impression exported as a stereolithography file. Next, a cone-beam computed tomography (CBCT) scan was performed, with the resulting image exported as a Digital Imaging and Communications in Medicine file. Both files were imported into the RealGUIDE 5.0 dental implant planning software. Active Bio implants were selected to place into the model. A single stereolithographic 3-dimensional surgical guide was printed for all cases. Ten clinicians, divided into 2 groups, placed a total of 60 implants in 20 acrylic resin maxillary models. Due to the small sample size, the Mann-Whitney test was used to analyze mean values in the 2 groups. Statistical analyses were performed using SAS version 9.4.

RESULTS

The accuracy of implant placement using a surgical guide was significantly higher than that of free-hand implantation. The mean difference between the planned and actual implant positions at the apex was 0.68 mm for the experienced group using the free-hand technique and 0.14 mm for the non-experienced group using the surgical guide technique (P=0.019). At the top of the implant, the mean difference was 1.04 mm for the experienced group using the free-hand technique and 0.52 mm for the non-experienced group using the surgical guide technique (P=0.044).

CONCLUSIONS

The data from this study will provide valuable insights for future studies, since in vitro studies should be conducted extensively in advance of retrospective or prospective studies to avoid burdening patients unnecessarily.

Performances of novel custom 3D-printed cutting guide in canine caudal maxillectomy: a cadaveric study

Introduction

Caudal maxillectomies are challenging procedures for most veterinary surgeons. Custom guides may allow the procedure to become more accessible.

Methods

A cadaveric study was performed to evaluate the accuracy and efficiency of stereolithography guided (3D-printed) caudal maxillectomy. Mean absolute linear deviation from planned to performed cuts and mean procedure duration were compared pairwise between three study groups, with 10 canine cadaver head sides per group: 3D-printed guided caudal maxillectomy performed by an experienced surgeon (ESG) and a novice surgery resident (NSG), and freehand procedure performed by an experienced surgeon (ESF).

Results

Accuracy was systematically higher for ESG versus ESF, and statistically significant for 4 of 5 osteotomies (p < 0.05). There was no statistical difference in accuracy between ESG and NSG. The highest absolute mean linear deviation for ESG was <2 mm and >5 mm for ESF. Procedure duration was statistically significantly longer for ESG than ESF (p < 0.001), and for NSG than ESG (p < 0.001).

Discussion

Surgical accuracy of canine caudal maxillectomy was improved with the use of our novel custom cutting guide, despite a longer duration procedure. Improved accuracy obtained with the use of the custom cutting guide could prove beneficial in achieving complete oncologic margins. The time increase might be acceptable if hemorrhage can be adequately controlled in vivo. Further development in custom guides may improve the overall efficacy of the procedure.

Training of novice surgeons using dynamic computer assisted dental implant surgery: An exploratory randomized trial

BACKGROUND

Dynamic Computer Assisted Implant Surgery (CAIS) systems have been shown to improve accuracy of implant placement, thus training in the use of such systems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate university education.

PURPOSE

To determine the effectiveness of two modes of CAIS training programs on motor skill acquisition of novice surgeons.

MATERIALS AND METHODS

Thirty-six postgraduate students without experience in dynamic CAIS systems were randomly assigned to a distributed training program (3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level.

RESULTS

Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference-0.4, 95% confidence interval-0.7-0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference-95.0, 95% confidence interval-178.8 to -11.2).

CONCLUSIONS

Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of different days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002. This clinical trial was not registered prior to participant recruitment and randomization.

Clinical study of precision analysis and deviation control of a domestic guide plate-assisted edentulous implant surgery

PURPOSE

To evaluate the accuracy of a domestic digital implant guide plate to assist edentulous implant surgery, analyze the sources of deviation, and reduce the deviation of the guide plate.

METHODS

In total, 14 edentulous patients were selected, and 100 implant sites were measured. The preoperative cone beam computerized tomography (CBCT) data were imported into the software to design and fabricate the guide plate. After implant surgery,the data were imported for 3D reconstruction and alignment model was exported into the Geomagic Studio software for deviation measurement.

RESULTS

Analysis of the overall accuracy of the domestic guide plate showed deviation of the implant neck center, horizontal direction, implant base center, depth, and angle of 0.83 ± 0.27 mm, 0.39 ± 0.17 mm, 1.11 ± 0.35 mm, 0.45 ± 0.19 mm, and 3.16 ± 1.73°. There were not statistically significant difference (p>0.05) between the tooth/mucosa-supported guide plate and the mucosa-supported, mandibular guide plate and maxillary, vertical implantation and inclined, anterior implant sites and posterior teeth. There was a statistically significant difference (p<0.05) between the use of the modified non-pressure plate tool box and the pressure plate tool box.

CONCLUSION

First, the domestic implant guide plate can significantly improve the accuracy and efficiency in edentulous implant surgery. Second, the accuracy of the tooth/mucosa-supported guide plate is higher than mucosa-supported guide plate. Third, the accuracy of the new tool box without pressure plate is improved.

Linear dimensional accuracy of stereolithographic surgical guide after chemistry and physics sterilization

OBJECTIVES

The purpose of this study was to evaluate the dimensional stability of prototyped surgical guides after autoclave and 2% glutaraldehyde sterilization processes.

MATERIAL AND METHODS

Twenty prototyped surgical guides were prepared and submitted to two sterilization processes (n = 10): Physics - sterilization by autoclave (saturated water vapor under pressure, temperature of 126 to 130 °C, pressure of 1,7 at 1.9 kgf/cm², 16 min); Chemistry - sterilization by 2% glutaraldehyde for 10 h. Six pre-established points were measured in the prototyped surgical guides, before and after sterilization, using a digital caliper rule. The comparisons were made using orthogonal contrasts using the linear model of mixed effects (random and fixed).

RESULTS

there are no significant differences between autoclave and glutaraldehyde 2% (p>0.05) there are significant differences after autoclave sterilization (p<0.05) and there are not significant differences after 2% glutaraldehyde sterilization (p>0.05).

CONCLUSION

autoclave promoted dimensional alteration of the prototyped surgical guides, and the chemical sterilization by glutaraldehyde 2% did not cause dimensional alteration of the prototype surgical guides, being a favorable choice for sterilization.

CLINICAL SIGNIFICANCE

the sterilization of surgical guides can be performed through the chemical process with 2% glutaraldehyde without changing the linear precision of the prototype surgical guides.

Can computer-assisted implant surgery improve clinical outcomes and reduce the frequency and intensity of complications in implant dentistry? A critical review

Computer-assisted implant surgery (CAIS), either static or dynamic, is well documented to significantly improve the accuracy of implant placement. Whether the increased accuracy leads to a corresponding improvement in clinical outcomes has not yet been systematically investigated. The aim of this critical review was to investigate whether the use of CAIS can lead to reduction of complications as well as improved clinical and patient-reported outcomes (PROs) when compared with conventional freehand implant surgery. A comprehensive online search was conducted to identify studies where implants were installed with static computer-assisted implant surgery (s-CAIS)or dynamic computer-assisted implant surgery(d-CAIS) or combinations of the two, either compared with conventional free-hand implant placement or not. Seventy-seven studies were finally included in qualitative analysis, while data from three studies assessing postsurgical pain were suitable for a meta-analysis. Only a small number of the available studies were comparative. The current evidence does not suggest any difference with regard to intraoperative complications, immediate postsurgical healing, osseointegration success, and survival of implants placed with CAIS or freehand protocols. Intraoperative and early healing events as reported by patients in randomized clinical trials (RCTs) did not differ significantly between CAIS used with flap elevation and conventional implant placement. There is limited evidence that increased accuracy of placement with CAIS is correlated with superior esthetic outcomes. Use of CAIS does not significantly reduce the length of surgeries in cases of single implants and partially edentulous patients, although there appears to be a more favorable impact in fully edentulous patients. Although CAIS alone does not seem to improve healing and the clinical and PRO, to the extent that it can increase the utilization of flapless surgery and predictability of immediacy protocols, its use may indirectly lead to substantial improvements in all of the above parameters.

Biopsies of osseous jaw lesions using 3D-printed surgical guides: a clinical study

Background

Bone biopsies are often necessary to make a diagnosis in the case of irregular bone structures of the jaw. A 3D-printed surgical guide may be a helpful tool for enhancing the accuracy of the biopsy and for ensuring that the tissue of interest is precisely removed for examination. This study was conducted to compare the accuracy of biopsies performed with 3D-printed surgical guides to that of free-handed biopsies.

Methods

Computed tomography scans were performed on patients with bony lesions of the lower jaw. Surgical guides were planned via computer-aided design and manufactured by a 3D-printer. Biopsies were performed with the surgical guides. Bone models of the lower jaw with geometries identical to the patients’ lower jaws were produced using a 3D-printer. The jaw models were fitted into a phantom head model and free-handed biopsies were taken as controls. The accuracy of the biopsies was evaluated by comparing the parameters for the axis, angle and depth of the biopsies to the planned parameters.

Results

Eight patients were included. The mean deviation between the biopsy axes was significantly lower in guided procedures than in free-handed biopsies (1.4 mm ± 0.9 mm; 3.6 mm ± 1.0 mm; p = 0.0005). The mean biopsy angle deviation was also significantly lower in guided biopsies than in free-handed biopsies (6.8° ± 4.0; 15.4° ± 3.6; p = 0.0005). The biopsy depth showed no significant difference between the guided and the free-handed biopsies.

Conclusions

Computer-guided biopsies allow significantly higher accuracy than free-handed procedures.

Accuracy of a guided implant system with milled surgical templates

PURPOSE

This in vitro study analyzed the accuracy of a computer-assisted design (CAD)/computer-assisted manufacturing (CAM) guided implant surgery system by comparing linear, angular, and coronal deviations between the planned and final implant placement.

METHODS

By using a fully guided surgery workflow, 32 dental implants were placed in 16 partially edentulous models. After virtual design of the restorations, radiological and CAD files were matched and implant positions were planned by using dedicated implant planning software (Galileo Implant version 1.9.2.). Templates were designed (Cerec Omnicam) and milled (Cerec MC XL) by using chairside workflow. Galileo Implant version 1.9.2. was used to evaluate accuracy.

RESULTS

Mean horizontal and angular-coronal total deviation values were 0.2 mm (SD = 0.126) and 1.1º (SD = 0.834) respectively. Multivariate analysis of variance showed significant differences in horizontal and angular-coronal total deviation in the 32 implants (P = 0.0001). Multivariate analysis with one-factor interaction showed no statistical difference in implant position or implant type (P = 0.139) between eight maxilla models and eight jaw models.

CONCLUSION

Horizontal and angular-coronal deviations of implants placed with chairside digital workflow were within the recommended safety margin for fully guided surgery.

Accuracy of Computer-Assisted Flapless Implant Placement by Means of Mucosa-Supported Templates in Complete-Arch Restorations: A Systematic Review

The aim of this study was to systematically review the current scientific literature regarding the accuracy of fully guided flapless implant positioning for complete-arch rehabilitations in edentulous patients and to assess if there was any statistically significant correlation between linear deviation at shoulder point, at apex point and angular deviation. The electronic and manual literature search of clinical studies was carried out using specified indexing terms. A total of 13 studies were eligible for qualitative analysis and 277 edentulous patients were rehabilitated with 1556 implants patients by means of fully guided mucosa-supported template-assisted flapless surgery. Angular deviation was 3.42° (95% CI 2.82–4.03), linear deviation at shoulder point 1.23 mm (95% CI 0.97–1.49) and linear deviation at apex point 1.46 mm (95% CI 1.17–1.74). No statistically significant correlations were found between the linear and angular deviations. A statistically significant correlation was found between the two linear deviations (correlation coefficient 0.91) that can be summarized by the regression equation y = 0.03080 + 0.8254x. Computer-assisted flapless implant placement by means of mucosa-supported templates in complete arch restorations can be considered a reliable and predictable treatment choice despite the potential effects that flapless approach could bring to the overall treatment.

Prosthetic Surgical Templates and Dental Implant Site Time Preparation: An In Vitro Study

Numerous types of prosthodontics surgical guides, with and without metallic sleeves, have been found to be useful in clinical studies. The aim of this in vitro research was to compare the time required to complete the surgical procedure with two differently designed surgical prosthetic templates. Ten identical prototype models of mandible based on a CBCT and optical scan of a partially edentulous patient with missing teeth numbers 37, 46, and 47 were prepared and then printed. Five of these models were used for implant site preparation with a surgical guide without metal sleeves and dedicated surgical kit, and the other five models were used for the same procedure performed with a surgical guide with metal sleeves and a dedicated surgical kit. The time of implant site preparation was measured and recorded. Statistical analysis was performed using Student’s t-test for independent samples. Differences between groups were found to be statistically significant (t = −9.94; df = 28; p = 0.0000) with a lower value in favor of the surgical templates without metallic sleeves. Different types of prosthodontics surgical guides, with or without metallic sleeves, seemed to be an important factor which can significantly impact the time of implant site preparation and, therefore, the overall surgical procedure.

Accuracy of static digital surgical guides for dental implants based on the guide system: A systematic review

In the present study, we tried to review the current literature, focusing on the effect of different guide systems on the accuracy of the digital surgical guides. A search in PubMed's database, without any date restriction, was performed using keywords based on the PICO question. 54 of the 2378 articles' were chosen for full-text assessment. Articles were screened using predetermined inclusion and exclusion criteria. 21 articles were included in the qualitative assessment. Descriptive analysis was performed for numeric parameters using mean ± standard deviation. Six types of guide systems were used in the included articles. The commonest guide system was SimPlant (45.64%) followed by NobleGuide (23.00%). The pooled mean angle deviation, global coronal deviation, and global apical deviation were 3.43 mm (95% CI = 2.96, 3.90), 1.16 mm (95% CI = 0.98, 1.24) and 1.35 mm (95% CI = 1.11, 1.59), respectively. The maximum mean(SD) of angle deviation, global coronal deviation, and global apical deviation happened in Stent Cad 4.1(1.86) degrees, NobleGuide 1.86(0.56) mm, and OnDemend3d 1.56(1.48) mm, respectively. Although a final statement could not be made on which system is better, it is certain that the software affects the deviation and could be as important as the implant itself. CLINICAL SIGNIFICANCE: The choice of guide systems used for the production of static guide systems which was studied in this article could affect the accuracy of the implant placement procedure.

Accuracy of surgical templates with and without metallic sleeves in case of partial arch restorations: A systematic review

INTRODUCTION

The aim of the present systematic review was to evaluate whether there were any differences in the three-dimensional accuracy and the implant survival rate of implants placed using computer-assisted planning and surgical templates with or without metallic sleeves.

SOURCES

This systematic review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered to the PROSPERO (International prospective register of systematic reviews) database.

STUDY SELECTION

PICOS (population, intervention, control, outcomes, and studies) question was assessed, too. Search strategy encompassed the online (MedLine) literature from 1990 up to December 2020 published in English, and evaluating the accuracy of surgical templates with and without metallic sleeves in partial or complete patients. Only in vivo, randomized controlled trial and observational studies were included. Quality assessment of selected full text articles was performed according to the CONSORT (CONsolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement guidelines, respectively. For data analysis, the three-dimensional accuracy and the overall implant survival rate was calculated and compared between implants placed using surgical templates with or without metallic sleeves.

DATA

A total of 12 articles fulfilled the inclusion/exclusion criteria. Data from 264 patients with 614 implants were subjected to quality assessment (templates with metallic sleeves: 279 implants and 136 patients; templates without metallic sleeves: 335 implants and 128 patients). In all the three deviation parameters (angular, vertical, and horizontal), the differences in average accuracy were noticed (angular 2.33° ± 2.01° versus 3.09° ± 1.65°, vertical: 0.62 ± 0.36 [mm] versus 0.95 ± 0.42 [mm]; and horizontal: 0.62 ± 0.41 [mm] and 1.11 ± 0.57 [mm]. No differences was found regarding overall implant survival rate (0.4891).

CONCLUSIONS

With the limitations of the present study, the surgical templates without metallic sleeves demonstrated high level of accuracy in all the three-dimensional measurements, when used to rehabilitate partially edentulous patients. Further randomized controlled trials, reporting according to the CONSORT guidelines are needed to confirm that the differences in accuracy depended on the type of used templates.

A Retrospective Study on the Transferring Accuracy of a Fully Guided Digital Template in the Anterior Zone

The accuracy of implant placement with a fully guided digital template can be influenced by many factors, such as arch difference, alveolar bone density, timing of implant placement and open flap. The purpose of this article was to evaluate the factors presumptively affecting the accuracy of implant placement assisted by the fully guided template in the anterior zone. In 40 patients with missing anterior teeth, a total of 52 implants were placed with tooth-borne, fully guided templates after CBCT evaluation, in West China Hospital of Stomatology, Sichuan University. After overlapping the pre-and post-operative DICOM data, measurements were taken in the dental implant planning software (Nobel Clinician^®) to calculate linear and angular deviations between virtual placement plan and actual implant placement. Grouping was categorized according to three factors that possibly have an influence on accuracy: arch type (maxilla/mandible), timing of implant placement (immediate/delayed), surgical technique (open flap/flapless). The data was analyzed with independent sample t-test (p < 0.05). The results showed that the apical, coronal, depth and angular mean deviations of implant positions in anterior zone were 1.13 ± 0.39 mm, 0.86 ± 0.33 mm, 0.41 ± 0.66 mm, 3.32 ± 1.65° with the fully guided templates. The accuracy at apex level, coronal level and the angulation were similar between the maxilla and mandible, and the magnitude of all four deviations between immediate and delayed implantation, open flap and flapless technique were small. No statistically significant difference was observed (p > 0.05). Whereas there was significant difference in depth deviation between maxilla and mandible (p < 0.05). Conclusively, the implant site, alveolar bone density, timing of implant placement and surgical techniques merely compromise the implant placement accuracy under the assistance of a fully guided template.

Accuracy of half-guided implant placement with machine-driven or manual insertion: a prospective, randomized clinical study

OBJECTIVES

To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol.

MATERIALS AND METHODS

Implant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated.

RESULTS

Forty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group.

CONCLUSION

No significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming.

CLINICAL RELEVANCE

Optimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion.

TRIAL REGISTRATION

ID: NCT04854239.

Computer-assisted surgery in medical and dental applications

INTRODUCTION

Computer-assisted surgery (CAS) is a broad surgical methodology that utilizes computer technology to both plan and execute surgical intervention. CAS is widespread in both medicine and dentistry as it allows for minimally invasive and precise surgical procedures. Key innovations in volumetric imaging, virtual surgical planning software, instrument tracking, and robotics have assisted in facilitating the transfer of surgical plans to precise execution of surgical procedures. CAS has long been used in certain medical specialties including neurosurgery, cardiology, orthopedic surgery, otolaryngology, and interventional radiology, and has since expanded to oral and maxillofacial application, particularly for computer-assisted implant surgery.

AREAS COVERED

This review provides an updated overview of the most current research for CAS in medicine and dentistry, with a focus on neurosurgery and dental implant surgery. The MEDLINE electronic database was searched and relevant original and review articles from 2005 to 2020 were included.

EXPERT OPINION

Recent literature suggests that CAS performs favorably in both neurosurgical and dental implant applications. Computer-guided surgical navigation is well entrenched as standard of care in neurosurgery. Whereas static computer-assisted implant surgery has become established in dentistry, dynamic computer-assisted navigation is newly poised to trend upward in dental implant surgery.

Accuracy of computer-assisted, template-guided implant placement compared with conventional implant placement by hand-An in vitro study

Objectives

To compare free‐hand to computer‐assisted implant planning and placement (CAIPP) regarding planned to achieved implant position.

Material and methods

Forty‐eight cast/bone models were mounted in mannequin heads. On each side, a tooth gap of different sizes was created. In the test group (T), study implants were placed using a CAD‐CAM guide based on virtual planning. In the control (C), free‐hand implant placement was performed. After CBCT scanning, the implant position was compared with the planned position. Descriptive statistics were applied, and ANOVA was used to identify differences between groups and gaps. (p < .05).

Results

In C, mean lateral deviations at the implant base amounted to 0.7 mm (max. 1.8) (large gap) and 0.49 mm (1.22) (small gap). In T, 0.18 mm (0.49) and 0.24 mm (0.52) were recorded. At the apex, 0.77 mm (2.04) (large gap) and 0.51 mm (1.24) (small gap) were measured in C, and 0.31 mm (0.83)/0.34 mm (0.93) in T. Mean vertical deviations in C measured 0.46 mm (1.26) (large gap) and 0.45 mm (1.7) (small gap). In T, 0.14 mm (0.44) and 0.28 mm (0.78) were recorded. Mean angular deviations of 1.7° (3.2°) were observed in C (large gap) and 1.36° (2.1°) (small gap). In T, mean values were 1.57° (3.3°) and 1.32° (3.4°). Lateral and vertical deviations were significantly different between groups (not gaps), angular between gaps (not groups).

Conclusions

CAIPP protocols showed smaller deviations irrespective of the size of the tooth gap. In C, the gap size had an influence on the error in angulation only.

The implant position accuracy between using only surgical drill guide and surgical drill guide with implant guide in fully digital workflow: a randomized clinical trial

BACKGROUND

To evaluate and compare accuracy in position and inclination of a single-tooth implant placement using tooth-supported surgical drill guide (SDG) and surgical drill guide with implant insertion guide (SDIG) in fully digital workflow.

MATERIALS AND METHODS

Thirty partially single edentulous patients were recruited. After randomization, participants were divided into 2 groups equally. The first group underwent implant placement through SDG only, while the second group was subjected to SDIG. All procedure proceeded under a fully digital workflow as the combination of digital scanning from an intraoral scanner, 3D radiographic images from cone-beam computed tomography (CBCT), implant planning software, and a 3D manufacturing machine. A post-operative CBCT was performed to compare the deviations (7 parameters) between planned and actual implant positions.

RESULTS

The mean global deviations at the shoulder and apex were 0.74 ± 0.36 and 1.29 ± 0.61 mm, respectively in the SDG group and 0.48 ± 0.22 mm and 0.71 ± 0.31 mm, respectively in the SDIG group. Likewise, the other parameters in the SDIG group showed fewer deviations than SDG for all measurements. Statistically significant differences were indicated by all parameters except for the horizontal deviation at the implant shoulder (p < .05).

CONCLUSION

In single-tooth implant placement with a tooth-supported guide using a computer-assisted (static) system with the SDIG could reduce deviations of actual implant position when compared with using SDG only. Besides, guided implant surgery by fully digital workflow is a practical procedure and provides precise implant position regarding the prosthetic-driven concept.

Multivariate analysis of causal factors influencing accuracy of guided implant surgery for partial edentulism: a retrospective clinical study

Abstract

Background

In dental implant treatment, the placement position of the implant body is important. The hypothesis is that there are factors that have a greater impact than the factors that have been studied so far.

Material and Methods

The deviation between planned and actually placed implants was measured three-dimensionally by modified treatment evaluation method in 110 patients who underwent implant placement with guided surgery for partial edentulism. Ten factors that seemed to affect errors in placement were selected: the type of tooth, type of edentulism, distance from the remaining teeth, the type of implant, implant length, number of implants, method of guidance, the number of teeth supporting the surgical guide, number of anchor pins, and presence or absence of a reinforcement structure. The effect of each factor that corrected each confounding was calculated using multivariate analysis.

Results

In this study, 188 implant bodies were set to target, and the errors measurement data of the implant position were as follows: average Angle, 2.5 ± 1.6° (95% CI 2.25–2.69); Base, 0.67 ± 0.37 mm (95% CI 0.62–0.72); and Apex, 0.92 ± 0.47 mm (95% CI 0.86–0.98). As the result of multivariate analysis, larger errors were present in the partially guided group than the fully guided group. The number of teeth supporting the surgical guide significantly influenced the error in placement position. The error caused by the number of anchor pins was significantly different for the Angle. Similarly, the presence of the reinforcement structure influenced the error significantly for the Angle.

Conclusions

It was suggested that the smaller errors could be present by performing guided surgery with full guidance and devising the design of the guide such as the number of teeth supporting the surgical guide, the setting of the anchor pin, and the reinforcement structure.

In-house 3D-printed surgical guides for osseous lesions of the lower jaw: an experimental study

Background

The accuracy of computer-assisted biopsies at the lower jaw was compared to the accuracy of freehand biopsies.

Methods

Patients with a bony lesion of the lower jaw with an indication for biopsy were prospectively enrolled. Two customized bone models per patient were produced using a 3D printer. The models of the lower jaw were fitted into a phantom head model to simulate operation room conditions. Biopsies for the study group were taken by means of surgical guides and freehand biopsies were performed for the control group.

Results

The deviation of the biopsy axes from the planning was significantly less when using templates. It turned out to be 1.3 ± 0.6 mm for the biopsies with a surgical guide and 3.9 ± 1.1 mm for the freehand biopsies.

Conclusions

Surgical guides allow significantly higher accuracy of biopsies. The preliminary results are promising, but clinical evaluation is necessary.

Guided implant surgery workflow in edentulous patients: A precise and rapid technique

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

The Influence of Surgical Experience and Bone Density on the Accuracy of Static Computer-Assisted Implant Surgery in Edentulous Jaws Using a Mucosa-Supported Surgical Template with a Half-Guided Implant Placement Protocol-A Randomized Clinical Study

The aim of our randomized clinical study was to analyze the influence of surgical experience and bone density on the accuracy of static computer-assisted implant surgery (CAIS) in edentulous jaws using a mucosa-supported surgical template with a half-guided implant placement protocol. Altogether, 40 dental implants were placed in the edentulous jaws of 13 patients (novice surgeons: 18 implants, 6 patients (4 male), age 71 ± 10.1 years; experienced surgeons: 22 implants, 7 patients (4 male), age 69.2 ± 4.55 years). Angular deviation, coronal and apical global deviation and grey level measurements were calculated for all implants by a blinded investigator using coDiagnostiX software. 3DSlicer software was applied to calculate the bone volume fraction (BV/TV) for each site of implant placement. There were no statistically significant differences between the two study groups in either of the primary outcome variables. There was a statistically significant negative correlation between angular deviation and both grey level measurements (R-value: −0.331, p < 0.05) and BV/TV (R-value: −0.377, p < 0.05). The results of the study suggest that surgical experience did not influence the accuracy of implant placement. The higher the bone density at the sites of implant placement, the higher the accuracy of static CAIS.

Application of optimized digital surgical guides in mandibular resection and reconstruction with vascularized fibula flaps: Two case reports

RATIONALE

Currently, digital surgical techniques have been widely used in the precise treatment of mandibular resection and reconstruction with fibula flaps. Utilizing these innovative techniques in surgical planning and hardware fabrication before surgery has shown to provide great help. However, it is difficult for even experienced surgeons to place the preformed reconstruction plate in the same position as its preoperative design, causing surgical results to differ from preoperative planning. This study aims to solve these acknowledged challenges by creating newly designed equipment.

PATIENT CONCERNS

Two patients suffering from long-term expansion of the mandible were admitted to our department. Case I was a 39-year-old female patient who was concerned about the disease in the middle of the mandible, Case II was a 45-year-old female patient who was concerned about the disease at the left mandibular angle and ramus region.

DIAGNOSES

Two patients were diagnosed with the mandibular ameloblastoma based on computed tomography (CT) scan and pathological results.

INTERVENTIONS

Personalized 3-dimensional (3D) surgical guides were applied to 2 patients with mandibular ameloblastoma who underwent mandibular resection and reconstruction with vascularized fibula flaps using a specially optimized and designed reconstruction guide plate.

OUTCOMES

We achieved precise mandibular repair with such a guide in full accordance with the preoperative plan and ensured the restoration of patient facial symmetry.

LESSONS

Optimized reconstruction guide template could accurately locate the preformed reconstruction plate. This component had the ability to ensure that the location of the actual reconstruction plates were highly consistent with preoperative designed models.

Stereolithographic Surgical Guide with a Combination of Tooth and Bone Support: Accuracy of Guided Implant Surgery in Distal Extension Situation

A distal free-end situation could result in insufficient stability of the surgical guide, and could reduce accuracy of the static guided implant surgery (sGIS). The purpose of this study was to investigate the accuracy of sGIS using a combination tooth-and-bone supported stereolithographic (SLA) surgical guide in distal extension situation. Thirty dentists, each placed three implants at the Federal Dentaire Internationale (FDI) teeth positions #46, #47 (a distal extension situation), and #36 (a single tooth gap) via the surgical guide on a model fixed to a manikin. Pre- and post-operative computed tomography (CT) images of the models were superimposed, and the positional and angular deviations of the implants were measured with metrology software. An analysis of variance (ANOVA) test was performed to evaluate the intergroup differences. No significant differences were found for all the positional and angular deviations among the three implant sites, except the bucco-lingual deviation at the implant platform in the #47 position (0.43 ± 0.19 mm) that was significantly larger than the #46 (0.21 ± 0.14 mm) and #36 (0.24 ± 0.25 mm) positions (p < 0.0001). Within the limits of this study, we conclude that, in distal extension situation of missing mandibular molars, adding a bone-supported strut in the distal part of the surgical guide can be beneficial to the accuracy of the sGIS.

Accuracy of guided implant surgery: an experimental set-up

BACKGROUND

The aim of the study was to evaluate the opportunities of guided implant surgery compared to conventional implant surgery.

METHODS

For this purpose 7 mandibles were prepared, which were sectioned in order to have an edentulous area. Seven half-mandibles were assigned to guided implant surgery group (test) and an equal number to conventional surgery group (control).

RESULTS

The results of the test group were as follows: mean vertical implant level discrepancy 0.44±0.29 mm, buccolingual implant position discrepancy 1.31±0.65 mm, mesio-distal implant position discrepancy 0.68±0.42 mm, implant apex discrepancy 1.92±0.92 mm, mean distance between the two fixtures 0.26±0.19 mm. The results of the control group are as follows: mean vertical implant level discrepancy 1.1±0.4 mm, mean bucco-lingual implant position discrepancy 2.14±0.89 mm, mean mesio-distal implant position discrepancy 1.7±0.79 mm, mean implant apex discrepancy 2.91±0.50 mm, mean distance between the two fixtures 0.78±0.63 mm.

CONCLUSIONS

Within the limitations of an experimental set up, the results may demonstrate how the use of guided implant surgery may be a valid help for the clinician for a more accurate and safe implant placement.

Reliability and accuracy of skin-supported surgical templates for computer-planned craniofacial implant placement, a comparison between surgical templates: With and without bony fixation

INTRODUCTION

The purpose is to determine the accuracy of guided implant placement in the orbital, nasal, and auricular region using computer-aided designed stereolithographic skin-supported surgical templates with and without bone fixation pins.

MATERIALS AND METHODS

Preoperatively, cone-beam CT (CBCT) and multiple detector computed tomography (MDCT) scans were acquired from 10 cadaver heads, followed by virtual planning of implants in the orbital margin, auricular region and nasal floor. Surgical skin-supported templates were digitally designed to allow flapless implant placement. Fixation pins were used for stabilization comprising half of all templates in predetermined bone areas. The accuracy of the surgical templates was validated by comparing the achieved implant location to its virtual planned implant position by calculating the linear and angular deviations.

RESULTS

Surgical templates with the use of bone fixation pins produced statistically significant greater implant deviations as compared to the non-fixated surgical templates.

CONCLUSION

The results of this study indicate that significant deviation has to be taken into account when placing cranio-maxillofacial implants using skin-supported surgical templates. Surprisingly, the use of bone-fixated pins worsened the accuracy.

Role of three-dimensional printing in periodontal regeneration and repair: Literature review

Three-dimensional (3D) printing is the process of building 3D objects by additive manufacturing approach. It is being used in endodontics, periodontology, maxillofacial surgery, prosthodontics, orthodontics, and restorative dentistry, but our review article is focused on periodontal application. A detailed literature search was done on PubMed/Medline and Google Scholar using various key terms. A total of 45 articles were included in this study. Most of the studies were in vitro, preclinical, case reports, retrospective, and prospective studies. Few clinical trials have also been done. Periodontal applications included education models, scaffolds, socket preservation, and sinus and bone augmentation and guided implant placement. It showed better alveolar ridge preservation, better regenerative capabilities, greater reduction in pocket depth and bony fill, ease of implant placement in complex cases with greater precision and reduced time with improved outcome and an important tool for education and training using simulated models.

CAD/CAM implant surgical guides: maximum errors in implant positioning attributable to the properties of the metal sleeve/osteotomy drill combination

BACKGROUND

The purpose of this study is to provide the relevant equations and the reference tables needed for calculating the maximum errors in implant positioning attributed to the properties of the mechanical parts of any CAD/CAM implant surgical guide, especially the in-office manufactured ones.

METHODS

An algorithm was developed and implemented in C programming language in order to accurately calculate the maximum error at the apex, error at the neck, vertical error at the apex and deviation of implant axis, between the planned and the actual implant position. The calculations were based on the parameters of total length (= implant length + offset), offset (distance from neck of implant to the lip of the metal sleeve), clearance (space between the bur and the sleeve), sleeve length. The variability of the parameters was constrained: (1) implant length, 8-18 mm; (2) sleeve length, 4-7 mm; (3) clearance, 50-410 μm; and (4) offset values, 6-17 mm. Multiple regression analysis was conducted to quantify the relationship between the error at the apex and the error at the neck and various predictors.

RESULTS

The equations used for the bespoke estimation of the errors in implant positioning along with three reference tables of the various errors tabulated are presented. The maximum error at the apex of the implant was computed 2.8 mm, the maximum deviation of the implant axis 5.9° and the maximum error at the neck (entrance) of the implant was estimated 1.5 mm. The vertical error between the planned and actual implant position can be considered negligible (< 0.1 mm).

CONCLUSIONS

The results of this study compute part of the expected differences in final clinical implant position when any CAD/CAM surgical guide is used. Given that the implantologist, with the capability of an in-office digital designed and 3d printed surgical guide, can readily decide upon the dimensions of the metal sleeve, the clearance between the osteotomy bur and the sleeve, and the design of the guide in relation to the distance of the lip of the sleeve to the implant neck (offset), in order to minimise the inevitable errors.

The Use of Orientation Templates and Free-Hand Implant Insertion in Artificial Mandibles-An Experimental Laboratory Examination in Fifth-Year Dental Students

Implant dentistry is a growing field in the education of undergraduate dental students. The present laboratory study evaluates factors which may potentially influence the accuracy of free-hand implant insertion and the use of an orientation template. After three-dimensional planning using coDiagnostiX^TM, orientation templates, including sleeves for the pilot-drill in regions 41 and 45, were manufactured by thermoforming. Sixty-one fifth year dental students inserted one implant using the orientation template and another implant free-hand in an artificial mandible. Information regarding age, sex, handedness, education, and the time required for implant insertion were recorded. Subsequently, the mandibles were scanned using cone-beam-computed tomography and the accuracy of the implant position was assessed, while statistical analysis followed. The free-hand implant insertion resulted in a distal deviation of −1.34 ± 5.15° and a mesial mismatch of 0.06 ± 0.79 mm at the artificial bone level compared to the sleeves. When using the orientation templates, the deviation decreased to −0.67 ± 3.48° and a distal mismatch of −0.22 ± 0.62 mm was achieved. The difference was statistically significant for the mismatch (p < 0.049). Regarding the limitations of our study, it could be said that the accuracy level achieved by dental undergraduates using implant placement with orientation templates is comparable to that in other studies.

Clinical outcomes and cost effectiveness of computer-guided versus conventional implant-retained hybrid prostheses: A long-term retrospective analysis of treatment protocols

BACKGROUND

Computer-guided systems were developed to facilitate implant placement at optimal positions in relation to the future prosthesis. However, the time, cost and, technique sensitivity involved with computer-guided surgery impedes its routine practice. The aim of this study is to evaluate survival rates and complications associated with computer-guided versus conventional implant placement in implant-retained hybrid prostheses. Furthermore, long-term economic efficiency of this approach was assessed.

METHODS

Patients were stratified according to implant placement protocol into a test group, using computer-guided placement, and a control group, using traditional placement. Calibrated radiographs were used to measure bone loss around implants. Furthermore, the costs of the initial treatment and prosthetic complications, if any, were standardized and analyzed.

RESULTS

Forty-five patients (149 implants in the test group and 111 implants in the control group) with a minimum follow-up of 5 years, and a mean follow-up of 9.6 years, were included in the study. While no significant difference was found between both groups in terms of biologic and technical complications, lower incidence of implant loss was observed in the test group (P < 0.001). A statistically significant difference in favor of the non-guided implant placement group was found for the initial cost (P < 0.05) but not for the prosthetic complications and total cost (P > 0.05).

CONCLUSIONS

Computer-guided implant placement for an implant-supported hybrid prosthesis is a valid, reliable alternative to the traditional approach for implant placement and immediate loading. Computer-guided implant placement showed higher implant survival rates and comparable long-term cost to non-guided implant placement.

Accuracy of Guided Surgery via Stereolithographic Mucosa-Supported Surgical Guide in Implant Surgery for Edentulous Patient: a Systematic Review

Objectives

The purpose of the present study is to systematically review the accuracy of implant placement with mucosa-supported stereolithographic surgical guide and to find out what factors can influence the accuracy.

Material and Methods

An electronic literature search was performed through the MEDLINE (PubMed) and EMBASE databases. The articles are including human studies published in English from October 2008 to October, 2017. From the examination of selected articles, deviations between virtual planning and actual implant placement were analysed regarding the global apical, global coronal, and angulation position.

Results

A total of 119 articles were reviewed, and 6 of the most relevant articles that are suitable to the criteria were selected. The present data included 572 implants and 93 patients. The result in the present systematic review shows that mean apical global deviation ranges from 0.67 (SD 0.34) mm to 2.19 (SD 0.83) mm, mean coronal global deviation ranges from 0.6 (SD 0.25) mm to 1.68 (SD 0.25) mm and mean angular deviation - from 2.6° (SD 1.61°) to 4.67° (SD 2.68°).

Conclusions

It's clearly shown from most of the examined studies that the mucosa-supported stereolithographic surgical guide, showed not exceeding in apically 2.19 mm, in coronally 1.68 mm and in angular deviation 4.67°. Surgeons should be aware of the possible linear and angular deviations of the system. Accuracy can be influenced by bone density, mucosal thickness, surgical techniques, type of jaw, smoking habits and implant length. Further studies should be performed in order to find out which jaw can have better accuracy and how the experience can influence the accuracy.

Advanced dental implant placement techniques

The availability of in office Cone Beam CT (CBCT) scanners, dental implant planning software, CAD CAM milling, and rapid printing technologies allow for the precise placement of dental implants and immediate prosthetic temporization. These technologies allow for flapless implant placement, or open flap bone reduction for "All on 4" techniques with improved preoperative planning and intraoperative performance. CBCT permits practitioners in an office setting with powerful diagnostic capabilities for the evaluation of bone quality and quantity, as well as dental and osseous pathology essential for better informed dental implant treatment. CBCT provides the convenience of in office imaging and decreased radiation exposure. Rapid printing technologies provide decreased time and high accuracy for bone model and surgical guide fabrication.

A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars

PURPOSE

We performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS).

MATERIALS AND METHODS

A retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation.

RESULTS

All 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case.

CONCLUSIONS

We present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery.

Accuracy of a direct drill-guiding system with minimal tolerance of surgical instruments used for implant surgery: a prospective clinical study

PURPOSE

A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses.

MATERIALS AND METHODS

For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (α=.05).

RESULTS

The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually.

CONCLUSION

The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

Exploring Effectiveness of Computer-Aided Planning in Implant Positioning for a Single Immediate Implant Placement

The value of computer-aided implant planning using cone-beam computerized tomography (CBCT) for single immediate implants was explored. Eighteen patients requiring extraction of a tooth followed by a single immediate implant were enrolled. Small volume preoperative CBCT scans were used to plan the position of the implant. A taper screwed–type implant was immediately placed into a fresh socket using only the final 1 or 2 drills for osteotomy. Postoperative CBCTs were used for the analysis of actual implant placement positioning. Measurements of the planned and the actual implant position were made with respect to their position relative to the adjacent teeth. Mesio-distal displacements and the facial-lingual deviation of the implant from the planned position were determined. Changes in the angulation of the planned and actual implant position in relation to the clinical crown were also measured. To statistically summarize the results, box plots and 95% CIs for means of paired differences were used. The analysis showed no statistical difference between the planned position and final implant placement position in any measurement. The CBCT scans coupled with the computer-aided implant planning program along with a final 1-to-2 drill protocol may improve the accuracy of single immediate implant placement for taper screwed–type implants.