An in-vitro analysis of the accuracy of different guided surgery systems - They are not all the same

The effect on the performance of a dynamic navigation system of superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a cone beam computer tomograph (CBCT). An experimental in vitro study

OBJECTIVES

To compare the accuracy and operative time of implant placement using a dynamic computer assisted implant surgery (dCAIS) system based on a cone beam computer tomography (CBCT) image, with and without superimposing a standard tessellation language (STL) file of an intraoral scan of the patient.

METHODS

Ten identical resin models simulating an upper maxilla with posterior edentulism were assigned to two groups. In the CBCT+STL group, a CBCT file and an intraoral STL file were superimposed and used for registration; in the CBCT group, registration was performed using CBCT images. Six implants were placed in each model using the Navident® dynamic navigation system. Anatomy registration was performed by tracing points on the CBCT or STL image, depending on the group. Preoperative and postoperative CBCT images were overlaid to assess implant placement accuracy.

RESULTS

Sixty implants were analyzed (30 implants in each group). 3D platform deviation was significantly lower (mean difference (MD): 0.17 mm; 95% confidence interval (CI): 0.01 to 0.23; P = 0.039) in the CBCT+STL group (mean: 0.71mm; standard deviation (SD): 0.29) than in the CBCT group (mean: 0.88mm; SD: 0.39). The remaining accuracy outcome variables (angular deviation MD: -0.01; platform lateral deviation MD: 0.08mm; apex global MD: 0.01mm; apex depth MD: 0.33mm) and surgery time (MD: 3.383 min.) were similar in both groups (p>0.05).

CONCLUSIONS

The introduction of an intraoral scan (STL) seems to reduce deviations slightly in dental implant placement with dCAIS systems. However, the clinical repercussion of this improvement is questionable.

CLINICAL SIGNIFICANCE

Superimposing an intraoral scan on the CBCT image does not seem to increase the accuracy of dCAIS systems but can be useful when radiographic artifacts are present.

An in vitro analysis of the accuracy of static and robot-assisted implant surgery

OBJECTIVES

Robot-assisted implant surgery (RAIS) is purported to improve the accuracy of implant placement. The objective of this study was to compare RAIS with static computer-assisted implant surgery (sCAIS) in a controlled environment.

MATERIALS AND METHODS

A total of n = 102 implants were placed in the same modified typodont (n = 17 repeated simulated implant surgeries with each n = 3 implants per group) using robot-assisted or static computer-assisted implant surgery. The final implant positions were digitized utilizing cone-beam tomography and compared with the planned position. The angular deviation was the primary outcome parameter. 3D deviations at the implant platform level and the apex were secondary outcome parameters. Accuracy in terms of trueness and precision were assessed. Means, standard deviation, and 95%-confidence intervals were analyzed statistically.

RESULTS

The overall angular deviation was 2.66 ± 1.83° for the robotic system and 0.68 ± 0.38° for guided surgery using static guides (p < .001), the 3D-deviation of the implant platform at crest level was for sCAIS 0.79 ± 0.28 mm and RAIS 1.51 ± 0.53 mm (p < .001) and at the apex for sCAIS 0.82 ± 0.26 mm and for RAIS 1.97 ± 0.79 mm (p < .001), respectively.

CONCLUSIONS

Robotically guided implant surgery was less accurate in terms of trueness (planned vs. actual position) and precision (deviations among implants) than traditional static computer-assisted implant surgery in this in vitro study.

Accuracy of open-sleeved vs. closed-sleeved static computer-assisted implant systems in immediate maxillary molar implant placement: An in vitro study

OBJECTIVES

The objective of this study is (1) to compare the accuracy of an open-sleeved static computer-assisted implant system (sCAIS) with a closed-sleeve sCAIS and free-hand approach in immediate implant placement (IIP) of maxillary molar sites and (2) to investigate the influence of socket morphology on these approaches.

MATERIALS AND METHODS

Ninety partially edentulous duplicated maxillary models simulating three different molar sockets (type A, B, and C based on Smith and Tarnow's classification) were investigated. Three modalities, including sCAIS with open-sleeves, sCAIS with closed-sleeves, and free-hand approach, were applied separately to 30 models with 120 sockets. A customized Python script automatically measured the deviations between the virtual and actual implant positions for all 360 implants.

RESULTS

The 3D deviations of sCAIS were significantly influenced by the socket and sleeve types. Both guided groups exhibited significantly less deviation than the free-hand approach. Type A and C sockets resulted in better implant positions than type B socket sites. In type B sockets, the open-sleeve group achieved significantly less deviation compared to the closed-sleeve group, with respect to apical global (1.34 ± 0.53 vs. 1.84 ± 0.59 mm), coronal horizontal (0.68 ± 0.36 vs. 0.93 ± 0.34 mm), apical horizontal (1.21 ± 0.59 vs. 1.74 ± 0.63 mm), and angular (3.30 ± 1.41 vs. 4.41 ± 1.96°) deviations.

CONCLUSIONS

Guided implant surgery significantly reduces deviations during molar IIP compared to free-hand procedures. Furthermore, the use of open-sleeve sCAIS appears to be more effective in minimizing deviations in type B sockets when compared with the closed-sleeve guided system.

Comparative Evaluation of Accuracy of Adjacent Parallel Implant Placements Between Dynamic Navigation and Static Guide: A Prospective Study

Aim The study aims to compare the accuracy of dynamic navigation (DN) and static guides (SGs) for simultaneous adjacent parallel placement of implants, the time taken for the surgery, and the ease of handling the instruments. Materials and methods This prospective trial was carried out at the Department of Implantology of Saveetha Dental College from October 2022 to February 2023. A total of 20 patients who needed simultaneous adjacent dental implants were allocated randomly into two groups: Group 1 SG surgery and Group 2 DN surgery. Forty implants were placed, 20 under DN and 20 under SG. Bucco-lingual displacement, apico-coronal displacement, mesiodistal displacement, and mesiodistal angulation were compared between the two groups. The patients' data in both groups were evaluated by operating surgeons along with the surgical time taken and the ease of handling of instruments. Results The 20 patients who underwent implant placement in the DN and SG groups all had adjacent missing teeth in posterior sites, including lower posteriors (70%) and upper posteriors (30%). There was improved precision in relation to the mesiodistal displacement and angulation of the anterior implant of the adjacent parallel implants. The mesiodistal displacement in Group 1 (SG) was 5.61 + 3.1 mm, which was higher than Group 2 (DN), which was 0.55 + 0.56 mm. The mesiodistal angulation was 3.1 + 2.9 degrees in Group 2 and 0.42 + 0.5 degrees in Group 1. The second implant had a significant difference (p < 0.005) in mesiodistal displacement, mesiodistal angulation, and bucco-lingual displacement. The difference between the intergroup surgical time (mean + SD) in Group 1 was 30 + 4.5 mins and in Group 2 was 60.7 + 10.1 mins, with p < 0.05 statistically significant. The comfort of the operator was better in the SG group. Conclusion Any digitally aided implant placement technique can improve placement accuracy but each has its downfalls. Achieving the highest levels of precision and long-lasting prosthetic results hinges on both the suitability of the chosen case and the expertise of the surgeon performing the implant placement.

Accuracy of implant placement via dynamic navigation and autonomous robotic computer-assisted implant surgery methods: A retrospective study

OBJECTIVE

Optimal implant planning and placement allows the prosthesis to be well designed to achieve a satisfactory aesthetic and functional outcome. We aimed to compare deviations between implant planning and placement with the assistance of dynamic computer-assisted implant surgery (d-CAIS) or autonomous robotic computer-assisted implant surgery (r-CAIS) methods in a clinical setting.

METHODS

The retrospective analysis of medical records between 2021 July and 2022 December was conducted to compare the implantation accuracy of the d-CAIS and r-CAIS system in partially edentulous patients through cone-beam computed tomography. Patient-reported outcomes (PROs) were recorded using a visual analogue scale (VAS). The Kolmogorov-Smirnov test was used to check the data distribution. Student's t-test or Mann-Whitney U-test was used as appropriate, with a defined significant difference (p < .05).

RESULTS

Seventy-seven patients were analysed (124 implants), with 38 patients (62 implants) in the d-CAIS group and 39 patients (62 implants) in the r-CAIS group. The differences between d-CAIS and r-CAIS were 4.09 ± 1.79° versus 1.37 ± 0.92° (p < .001) in angular deviation; 1.25 ± 0.54 versus 0.68 ± 0.36 mm (p < .001) in coronal global deviation; 1.39 ± 0.52 versus 0.69 ± 0.36 mm (p < .001) in apical global deviation; the results of the PROMs showed no statistical difference between the two groups.

CONCLUSIONS

r-CAIS allows more accurate implant placement than the d-CAIS technology. And both groups achieved overall satisfactory outcomes via VAS (Chinese Clinical Trial Registry ChiCTR2300072004).

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.