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Xu Z, Zhou L, Han B, Wu S, Xiao Y, Zhang S, Chen J, Guo J, Wu D. Accuracy of dental implant placement using different dynamic navigation and robotic systems: an in vitro study. NPJ Digit Med 2024; 7:182. [PMID: 38971937 PMCID: PMC11227595 DOI: 10.1038/s41746-024-01178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Computer-aided implant surgery has undergone continuous development in recent years. In this study, active and passive systems of dynamic navigation were divided into active dynamic navigation system group and passive dynamic navigation system group (ADG and PDG), respectively. Active, passive and semi-active implant robots were divided into active robot group, passive robot group and semi-active robot group (ARG, PRG and SRG), respectively. Each group placed two implants (FDI tooth positions 31 and 36) in a model 12 times. The accuracy of 216 implants in 108 models were analysed. The coronal deviations of ADG, PDG, ARG, PRG and SRG were 0.85 ± 0.17 mm, 1.05 ± 0.42 mm, 0.29 ± 0.15 mm, 0.40 ± 0.16 mm and 0.33 ± 0.14 mm, respectively. The apical deviations of the five groups were 1.11 ± 0.23 mm, 1.07 ± 0.38 mm, 0.29 ± 0.15 mm, 0.50 ± 0.19 mm and 0.36 ± 0.16 mm, respectively. The axial deviations of the five groups were 1.78 ± 0.73°, 1.99 ± 1.20°, 0.61 ± 0.25°, 1.04 ± 0.37° and 0.42 ± 0.18°, respectively. The coronal, apical and axial deviations of ADG were higher than those of ARG, PRG and SRG (all P < 0.001). Similarly, the coronal, apical and axial deviations of PDG were higher than those of ARG, PRG, and SRG (all P < 0.001). Dynamic and robotic computer-aided implant surgery may show good implant accuracy in vitro. However, the accuracy and stability of implant robots are higher than those of dynamic navigation systems.
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Affiliation(s)
- Zonghe Xu
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Lin Zhou
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Bin Han
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | | | - Yanjun Xiao
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Sihui Zhang
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Jiang Chen
- Fujian Provincial Engineering Research Center of Oral Biomaterial, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Jianbin Guo
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
| | - Dong Wu
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Research Center of Dental and Craniofacial Implants, Fujian Medical University, Fuzhou, 350001, China.
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Pozzi A, Carosi P, Laureti A, Mattheos N, Pimkhaokham A, Chow J, Arcuri L. Accuracy of navigation guided implant surgery for immediate loading complete arch restorations: Prospective clinical trial. Clin Implant Dent Relat Res 2024. [PMID: 38967100 DOI: 10.1111/cid.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES To assess navigation accuracy for complete-arch implant placement with immediate loading of digitally prefabricated provisional. MATERIALS AND METHODS Consecutive edentulous and terminal dentition patients requiring at least one complete-arch FDP were treated between December 2020 and January 2022. Accuracy was evaluated by superimposing pre-operative and post-operative cone beam computed tomography (CBCT), recording linear (mm) and angular (degrees) deviations. T-tests were performed to investigate the potential effect of the registration algorithm (fiducial-based vs. fiducial-free), type of references for the fiducial-free algorithm (teeth vs. bone screws), site characteristic (healed vs. post-extractive), implant angulation (axial vs. tilted), type of arch (maxilla vs. mandible) on the accuracy with p-value <0.05. RESULTS Twenty-five patients, 36 complete-arches, and 161 implants were placed. The overall mean angular deviation was 2.19° (SD 1.26°). The global platform and apex mean deviations were 1.17 mm (SD 0.57 mm), and 1.30 mm (SD 0.62 mm). Meaningful global platform (p = 0.0009) and apical (p = 0.0109) deviations were experienced only between healed and post-extraction sites. None of the analyzed variables significantly influenced angular deviation. Minor single-axis deviations were reported for the type of jaw (y-axis at implant platform and apex), registration algorithm (y-axis platform and z-axis deviations), and type of references for the fiducial-free algorithm. No statistically significant differences were found in relation to implant angulation. CONCLUSIONS Within the study limitations navigation was reliable for complete-arch implant placement with immediate loading digitally pre-fabricated FDP. AI-driven surface anatomy identification and calibration protocol made fiducial-free registration as accurate as fiducial-based, teeth and bone screws equal as references. Implant site characteristics were the only statistically significant variable with healed sites reporting higher accuracy compared to post-extractive. Live-tracked navigation surgery enhanced operator performance and accuracy regardless of implant angulation and type of jaw. A mean safety room of about 1 mm and 2° should be considered.
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Affiliation(s)
- Alessandro Pozzi
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Harbor, USA
- Department of Restorative, Sciences Augusta University, Augusta, Georgia, USA
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Paolo Carosi
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Laureti
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - James Chow
- Brånnemark Osseointegration Centre, Hong Kong, China
| | - Lorenzo Arcuri
- Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Martins J, Rangel J, de Araújo Nobre M, Ferro A, Nunes M, Almeida R, Moura Guedes C. A New Full Digital Workflow for Fixed Prosthetic Rehabilitation of Full-Arch Edentulism Using the All-on-4 Concept. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:720. [PMID: 38792903 PMCID: PMC11123051 DOI: 10.3390/medicina60050720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
(1) Background: Recent digital workflows are being developed for full-arch rehabilitations supported by implants with immediate function. The purpose of this case series is to describe a new digital workflow for the All-on-4 concept. (2) Methods: The patients were rehabilitated using the All-on-4 concept with a digital workflow including computerized tomography scanning, intra-oral scanning, and CAD-CAM production of the temporary prosthesis, with the 3D printing of stackable guides (base guide, implant guide, and prosthetic guide). The passive fit of the prostheses and the time to perform the rehabilitations were evaluated. (3) Results: The digital workflow allowed for predictable bone reduction, the insertion of implants with immediate function, and the connection of an implant-supported prosthesis with immediate loading. The time registered to perform the full-arch rehabilitations (implant insertion, abutment connection, prosthesis connection) was below 2 hours and 30 min. No passive fit issues were noted. (4) Conclusions: within the limitation of this case series, the digital workflow applied to the All-on-4 concept using stackable base-, implant-, and prosthetic guides constitutes a potential alternative with decreased time for the procedure without prejudice of the outcome.
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Affiliation(s)
- João Martins
- Prosthodontic Department, Malo Clinic, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisbon, Portugal; (J.M.); (J.R.); (R.A.); (C.M.G.)
| | - João Rangel
- Prosthodontic Department, Malo Clinic, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisbon, Portugal; (J.M.); (J.R.); (R.A.); (C.M.G.)
| | - Miguel de Araújo Nobre
- Research, Development and Education Department, Malo Clinic, Avenida dos Combatentes, 43, Level 11, 1600-042 Lisbon, Portugal
| | - Ana Ferro
- Oral Surgery Department, Malo Clinic, Avenida dos Combatentes, 43, Level 9, 1600-042 Lisbon, Portugal; (A.F.); (M.N.)
| | - Mariana Nunes
- Oral Surgery Department, Malo Clinic, Avenida dos Combatentes, 43, Level 9, 1600-042 Lisbon, Portugal; (A.F.); (M.N.)
| | - Ricardo Almeida
- Prosthodontic Department, Malo Clinic, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisbon, Portugal; (J.M.); (J.R.); (R.A.); (C.M.G.)
| | - Carlos Moura Guedes
- Prosthodontic Department, Malo Clinic, Avenida dos Combatentes, 43, Level 10, 1600-042 Lisbon, Portugal; (J.M.); (J.R.); (R.A.); (C.M.G.)
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Geng N, Ren J, Zhang C, Zhou T, Feng C, Chen S. Immediate implant placement in the posterior mandibular region was assisted by dynamic real-time navigation: a retrospective study. BMC Oral Health 2024; 24:208. [PMID: 38336661 PMCID: PMC10858590 DOI: 10.1186/s12903-024-03947-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Efficient utilization of residual bone volume and the prevention of inferior alveolar nerve injury are critical considerations in immediate implant placement (IIP) within the posterior mandibular region. Addressing these challenges, this study focuses on the clinical efficacy and implant accuracy of dynamic real-time navigation, an emerging technology designed to enhance precision in implantation procedures. METHODS This study included 84 patients with 130 implants undergoing immediate placement in the posterior mandibular region. Stratified into dynamic navigation, static guide plate, and freehand implant groups, clinical indicators, including initial stability, distance to the inferior alveolar nerve canal, depth of implant placement, and various deviations, were systematically recorded. Statistical analysis, employing 1- or 2-way ANOVA and Student's t-test, allowed for a comprehensive evaluation of the efficacy of each technique. RESULTS All 130 implants were successfully placed with an average torque of 22.53 ± 5.93 N.cm. In the navigation group, the distance to the inferior alveolar nerve and the depth of implant placement were significantly greater compared to the guide plate and freehand groups (P < 0.05). Implant deviation was significantly smaller in both the navigation and guide plate groups compared to the freehand group(P < 0.05). Additionally, the navigation group exhibited significantly reduced root and angle deviations compared to the guide plate group(P < 0.05), highlighting the superior precision of navigation-assisted immediate implant placement. CONCLUSIONS It is more advantageous to use dynamic navigation rather than a static guide plate and free-hand implant insertion for immediate posterior mandibular implant implantation.
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Affiliation(s)
- Ningbo Geng
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
| | - Jing Ren
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Chi Zhang
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Tianren Zhou
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Chongjin Feng
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Songling Chen
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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Saini RS, Bavabeedu SS, Quadri SA, Gurumurthy V, Kanji MA, Kuruniyan MS, Binduhayyim RIH, Avetisyan A, Heboyan A. Impact of 3D imaging techniques and virtual patients on the accuracy of planning and surgical placement of dental implants: A systematic review. Digit Health 2024; 10:20552076241253550. [PMID: 38726220 PMCID: PMC11080757 DOI: 10.1177/20552076241253550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
Aim The integration of advanced technologies, including three-dimensional (3D) imaging modalities and virtual simulations, has significantly influenced contemporary approaches to preoperative planning in implant dentistry. Through a meticulous analysis of relevant studies, this review synthesizes findings related to accuracy outcomes in implant placement facilitated by 3D imaging in virtual patients. Methods A comprehensive literature search was conducted across relevant databases to identify relevant studies published to date. The inclusion criteria were studies utilizing 3D imaging techniques, virtual patients, and those focusing on the accuracy of dental implant planning and surgical placement. The selected studies were critically appraised for their methodological quality. Results After a rigorous analysis, 21 relevant articles were included out of 3021 articles. This study demonstrates the versatility and applicability of these technologies in both in vitro and in vivo settings. Integrating Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM), cone bean computed tomography (CBCT), and advanced 3D reconstruction methodologies showcases a trend toward enhanced precision in implant planning and placement. Notably, the evaluation parameters varied, encompassing distances, discrepancies, and deviations in the implant placement. The ongoing integration of systems such as dynamic navigation systems, augmented reality, and sophisticated software platforms shows a promising trajectory for the continued refinement of virtual reality applications in dental implantology, providing valuable insights for future research and clinical implementation. Moreover, using stereolithographic surgical guides, virtual planning with CBCT data, and 3D-printed templates consistently demonstrates enhanced precision in dental implant placement compared to traditional methods. Conclusion The synthesis of the available evidence underscores the substantial positive impact of 3D imaging techniques and virtual patients on dental implant planning and surgical placement accuracy. Utilizing these technologies contributes to a more personalized and precise approach that enhances overall treatment outcomes. Future research directions and potential refinements to the application of these technologies in clinical practice should be discussed.
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Affiliation(s)
- Ravinder S Saini
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | - Shashit Shetty Bavabeedu
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | | | - Masroor Ahmed Kanji
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | | | - Anna Avetisyan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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Pelekanos S, Ntovas P, Rizou V, Pozzi A. Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges. J ESTHET RESTOR DENT 2024; 36:197-206. [PMID: 37975525 DOI: 10.1111/jerd.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Despite the wide clinical use of translucent zirconia for full-arch implant prostheses, reduced flexural strength and fracture toughness compared with high-strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full-arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented. CLINICAL CONSIDERATIONS Computer-guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three-dimensional (3D)-printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft-tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart. CONCLUSIONS Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full-arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full-arch prosthesis. CLINICAL SIGNIFICANCE Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full-arch prosthesis.
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Affiliation(s)
| | - Panagiotis Ntovas
- Department of Prosthodontics, Tufts University, School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Alessandro Pozzi
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Restorative, Sciences Augusta University, Augusta, Georgia, USA
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Ma L, Ye M, Wu M, Chen X, Shen S. A retrospective study of dynamic navigation system-assisted implant placement. BMC Oral Health 2023; 23:759. [PMID: 37838655 PMCID: PMC10576318 DOI: 10.1186/s12903-023-03481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND To evaluate the accuracy of implant placement assisted by a dynamic navigation system, as well as its influencing factors and learning curve. METHODS At Macao We Care Dental Center, 55 cases of implant placement using dynamic navigation were retrospectively evaluated. To evaluate their accuracy, the apex, tip, and angle deviations of preoperatively planned and postoperatively placed implants were measured. The effects of the upper and lower jaws, different sites or lateral locations of dental implants, and the length and diameter of the implants on accuracy were analyzed, as well as the variation in accuracy with the increase in the number of surgical procedures performed by dentists. RESULTS The implant had an apex deviation of 1.60 ± 0.94 mm, a tip deviation of 1.83 ± 1.03 mm, and an angle deviation of 3.80 ± 2.09 mm. Statistical differences were observed in the tip deviation of implants at different positions based on three factors: jaw position, lateral location, and tooth position (P < 0.05). The tip deviation of the anterior teeth area was significantly greater than those of the premolar and molar areas. There were no statistically significant differences in apex deviation, tip deviation, or angle deviation between the implants of different diameters and lengths (P > 0.05). There were significant differences in the angle deviation between the final 27 implants and the first 28 implants. Learning curve analysis revealed that angle deviation was negatively correlated with the number of surgical procedures, whereas the regression of apex deviation and tip deviation did not differ statistically. CONCLUSIONS The accuracy of dynamic navigation-assisted dental implants meets the clinical needs and is higher than that of traditional implants. Different jaw positions, lateral locations, and implant diameters and lengths had no effect on the accuracy of the dental implants guided by the dynamic navigation system. The anterior teeth area had a larger tip deviation than the posterior teeth area did. As the number of dynamic implantation procedures performed by the same implant doctor increased, the angle deviation gradually decreased.
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Affiliation(s)
- Lijuan Ma
- Department of Stomatology, Affiliated Stomatological Hospital of Jinan University (Daliang Hospital Shunde District Foshan City), Foshan City, 528399, Guangdong Province, China
| | - Mingjun Ye
- School of Stomatology, Jinan University, Guangzhou City, 510620, Guangdong Province, China
| | - Mingle Wu
- Department of Stomatology, Affiliated Stomatological Hospital of Jinan University (Daliang Hospital Shunde District Foshan City), Foshan City, 528399, Guangdong Province, China
| | - Xiaolei Chen
- School of Stomatology, Jinan University, Guangzhou City, 510620, Guangdong Province, China
| | - Shan Shen
- Department of Stomatology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, 510632, Guangdong Province, China.
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Pozzi A, Carosi P, Gallucci GO, Nagy K, Nardi A, Arcuri L. Accuracy of complete-arch digital implant impression with intraoral optical scanning and stereophotogrammetry: An in vivo prospective comparative study. Clin Oral Implants Res 2023; 34:1106-1117. [PMID: 37485737 DOI: 10.1111/clr.14141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To assess accuracy of intraoral optical scanning (IOS) and stereophotogrammetry (SPG), complete-arch digital implant impressions in vivo. MATERIALS AND METHODS Consecutive patients needing implant-supported screw-retained zirconia complete-arch fixed-dental prostheses (ISZ-FDP) were recruited. For each patient, three impressions were taken: IOS, SPG (tests), and open-tray plaster (reference). Linear (ΔX, ΔY, and ΔZ), three-dimensional (ΔEUC), and angular deviations (ΔANGLE) were evaluated and stratified according to scanning technology for each implant. Potential effects of impression device (IOS and SPG), arch (maxilla and mandible), and implant number (4 and 6) were evaluated through multivariable analysis. Significance level was set at .05. RESULTS A total of 11 complete arches (5 maxillae, 6 mandibles) in 11 patients were rehabilitated with ISZ-FDPs supported by 4 (n = 8) and 6 implants (n = 3). A total of 50 implants and 100 implant positions were captured by two investigated devices and compared to respective reference (mean ΔEUC IOS 137.2, SPG 87.6 μm; mean ΔANGLE 0.79, 0.38°). Differences between measurements (SPG-IOS) were computed for each implant, with negative values indicating better SPG accuracy. Significant mean ΔEUC difference of -49.60 μm (p = .0143; SD 138.15) and mean ΔANGLE difference of -0.40° (p < .0001; SD 0.65) were observed in favor of SPG. Multivariable analysis showed significant effect on ΔEUC (p = .0162) and ΔANGLE (p = .0001) only for impression devices, with SPG performing better. CONCLUSIONS SPG experienced significantly higher linear and angular accuracy. No effect of type of arch or implant number was detected. Higher extreme deviations were experienced for IOS. SPG can be feasible for complete-arch digital impressions with caution, and rigid prototype try-in is recommended before screw-retained prosthesis manufacturing.
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Affiliation(s)
- Alessandro Pozzi
- Department of Clinical Sciences and Translational Medicine, School of Dentistry, University of Tor Vergata, Rome, Italy
- Departement of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta, USA
| | - Paolo Carosi
- Department of Chemical Science and Technologies, PhD in Materials for Health, Environment and Energy - Dentistry, University of Rome Tor Vergata, Rome, Italy
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Katalin Nagy
- Department of Oral Surgery, Faculty of Dentistry, University of Szeged Tisza L. Krt, Szeged, Hungary
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Arcuri
- Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Pomares-Puig C, Sánchez-Garcés MA, Jorba-García A. Dynamic and static computer-assisted implant surgery for completely edentulous patients. A proof of a concept. J Dent 2023; 130:104443. [PMID: 36720424 DOI: 10.1016/j.jdent.2023.104443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To assess the accuracy and patient reported outcome measures (PROMs) of the computer-guided "double factor" technique for treating fully edentulous patients. METHODS A proof of concept prospective study was designed. Ten consecutive patients requiring full arch dental implant supported rehabilitation in a private practice were enrolled between October 2021 and March 2022. All patients were treated by means of an All-on-four®, and implants were planned and placed according to the "double factor" technique. This technique merges the static and dynamic computer-guided surgical approach in the same surgery. The primary outcome was the accuracy of implant placement, measured by overlapping post- and pre-operative cone-beam computerized tomography with the implant planning. Additionally, PROMs and patient quality of life after surgery were evaluated using different questionnaires. Descriptive and bivariate data analyses were performed. Statistical significance was considered for p < 0.05. RESULTS A total of 48 implants were placed using the "double factor" technique, and 12 full-arch immediate loading prostheses were delivered. The mean angular deviation was 3.74° (standard deviation [SD]: 2). The total linear deviation at the apex and platform of the implant was 1.25 mm (SD: 0.55) and 1.42 mm (SD: 0.64), respectively. No statistically significant differences were found between tilted and axial implants, the upper and lower jaw, or the right and left side. High self-reported satisfaction was registered, and the Oral Health Impact Profile-14 (OHIP-14) score improved postoperatively (p = 0.002). CONCLUSIONS The "double factor" technique is a valid and accurate treatment approach for fully edentulous patients. CLINICAL SIGNIFICANCE The double factor technique merges the advantages of both the dynamic and static computer assisted surgery approaches, affording accurate and predictable results when treating fully edentulous patients in a minimally invasive manner.
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Affiliation(s)
| | - M Angeles Sánchez-Garcés
- Faculty of Medicine and Health Sciences, University of Barcelona, Researcher at the IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain.
| | - Adrià Jorba-García
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Block MS. How to Avoid Errors When Using Navigation to Place Implants - A Narrative Review. J Oral Maxillofac Surg 2023; 81:299-307. [PMID: 36481276 DOI: 10.1016/j.joms.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation. METHODS Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer-reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic. RESULTS The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°. CONCLUSION The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.
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Affiliation(s)
- Michael S Block
- Private Practice, Metairie, LA, Clinical Professor, LSU School of Dentistry, Department of Oral and Maxillofacial Surgery, Metairie, LA.
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11
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Carosi P, Lorenzi C, Di Gianfilippo R, Papi P, Laureti A, Wang HL, Arcuri C. Immediate vs. Delayed Placement of Immediately Provisionalized Self-Tapping Implants: A Non-Randomized Controlled Clinical Trial with 1 Year of Follow-Up. J Clin Med 2023; 12:jcm12020489. [PMID: 36675417 PMCID: PMC9861545 DOI: 10.3390/jcm12020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
This study aimed to examine the clinical and esthetic outcomes of immediately provisionalized self-tapping implants placed in extraction sockets or healed edentulous ridges one year after treatment. Sixty patients in need of a single implant-supported restoration were treated with self-tapping implants (Straumann BLX) and immediate provisionalization. The implant stability quotient (ISQ) and insertion torque were recorded intraoperatively. After one year in function, the implant and prosthesis survival rate, pink esthetic score (PES), white esthetic score (WES), and marginal bone levels (MBL) were assessed. Sixty patients received 60 self-tapping implants. A total of 37 implants were placed in extraction sockets and 23 in edentulous ridges, and then all implants were immediately provisionalized. All implants achieved a high implant stability with a mean insertion torque and ISQ value of 58.1 ± 14.1 Ncm and 73.6 ± 8.1 Ncm, respectively. No significant differences were found between healed vs. post-extractive sockets (p = 0.716 and p = 0.875), or between flap vs. flapless approaches (p = 0.862 and p = 0.228) with regards to the insertion torque and ISQ value. Nonetheless, higher insertion torque values and ISQs were recorded for mandibular implants (maxilla vs. mandible, insertion torque: 55.30 + 11.25 Ncm vs. 62.41 + 17.01 Ncm, p = 0.057; ISQ: 72.05 + 8.27 vs. 76.08 + 7.37, p = 0.058). One implant did not osseointegrate, resulting in an implant survival rate of 98.3%. All implants achieved PES and WES scores higher than 12 at the 1-year follow-up. The clinical use of newly designed self-tapping implants with immediate temporization was safe and predictable. The implants achieved a good primary stability, high implant survival rate, and favorable radiographic and esthetic outcomes, regardless of the immediate or delayed placement protocols.
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Affiliation(s)
- Paolo Carosi
- Department of Chemical Science and Technologies, PhD in Materials for Health, Environment and Energy–Dentistry, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Claudia Lorenzi
- Department of Chemical Science and Technologies, PhD in Materials for Health, Environment and Energy–Dentistry, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Piero Papi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Laureti
- Department of Chemical Science and Technologies, PhD in Materials for Health, Environment and Energy–Dentistry, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Claudio Arcuri
- Department of Clinical Sciences and Translational Medicine, School of Dentistry, University of Tor Vergata, 00133 Rome, Italy
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12
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Pimkhaokham A, Jiaranuchart S, Kaboosaya B, Arunjaroensuk S, Subbalekha K, Mattheos N. Can computer-assisted implant surgery improve clinical outcomes and reduce the frequency and intensity of complications in implant dentistry? A critical review. Periodontol 2000 2022; 90:197-223. [PMID: 35924457 PMCID: PMC9805105 DOI: 10.1111/prd.12458] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand
| | - Sirimanas Jiaranuchart
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryChulalongkorn UniversityBangkokThailand,Department of Dental MedicineKarolinska InstituteStockholmSweden
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13
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Chen C, Lai H, Zhu H, Gu X. Digitally prefabricated versus conventionally fabricated implant-supported full-arch provisional prosthesis: a retrospective cohort study. BMC Oral Health 2022; 22:335. [PMID: 35945572 PMCID: PMC9361685 DOI: 10.1186/s12903-022-02376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/03/2022] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate and compare the clinical outcomes of digitally prefabricated and conventionally fabricated implant-supported full-arch provisional prostheses. Methods In this retrospective study, a total of 39 patients (22 males and 17 females) who underwent implant-supported full-arch rehabilitation using the All-on-4 concept with an immediate loading protocol were included: 20 patients treated with digitally prefabricated provisional prostheses were assigned into Group A, and 19 patients treated with conventionally fabricated provisional prostheses were assigned into Group B. Implant/provisional prosthesis survival rates and complications were reviewed. Marginal bone loss (MBL) was investigated by CBCT. Surgical time, restorative time, and total operative time were analyzed. Postoperative pain and swelling were evaluated with the visual analog scale (VAS). The oral health impact profile (OHIP) questionnaire was administered before and after surgery. Results The implant/provisional prosthesis survival rate was 100%, and complications appeared with low frequency in both groups, while the mean MBL was 0.30 ± 0.29 mm in Group A and 0.31 ± 0.41 mm in Group B after 3~ 6 months (P > 0.05). The average restorative time in Group A (116.16 ± 16.61 min) was significantly shorter than that in Group B (242.11 ± 30.14 min) (P < 0.05). Patients in Group A showed lower pain/swelling VAS scores after surgery than Group B (P < 0.05). Low OHIP scores with high satisfaction with the overall effects were shown in both groups. Conclusion Prefabricated prostheses reduced the prosthetic time and postoperative discomfort in patients whose immediate rehabilitation was based on the All-on-4 concept. This prefabrication technology may be a predictable alternative to improve the short-term clinical outcome of implant-supported full-arch provisional rehabilitation.
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Affiliation(s)
- Chaoqun Chen
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Haiyan Lai
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Huiyong Zhu
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Xinhua Gu
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
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14
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Dynamic Navigation System for Immediate Implant Placement in the Maxillary Aesthetic Region. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
(1) Background: The achievement of an optimal implant position is still a critical consideration in implantology, especially in the aesthetic area. Dynamic navigation is a computer-aided procedure that allows the surgeon to follow on a screen the three-dimensional position of instruments in real time during implant site preparation. The aim of this proof-of-concept study was to assess the clinical and radiographical performance and accuracy of the surgical workflow during maxillary immediate implant placement assisted by DTX studio Implant software planning and X-Guide Navigation. (2) Methods: Twelve consecutive patients requiring at least one implant in the maxillary aesthetic region were treated. Clinical outcome measures were biological complications and implant or prosthetic success rate. The accuracy was measured by calculating the deviation between the real implant position obtained from the postoperative cone beam computed tomography (CBCT) scan and the planned implant position. (3) Results: The average deviation at the implant shoulder was 0.77 ± 0.25 mm and at the apical point was 1.2 ± 0.61 mm. The depth error was 0.5 ± 0.21 mm. The axis deviation was 2.5 ± 0.41 degrees. No biological complications or implant and prosthetic failures occurred after mean 6-month follow-up. (4) Conclusions: Within the limitations of this study, it seems that the dynamic navigation system for implant placement in the maxillary aesthetic region is accurate for prosthetically driven implant placement.
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Accuracy of Computer-Assisted Flapless Implant Placement by Means of Mucosa-Supported Templates in Complete-Arch Restorations: A Systematic Review. MATERIALS 2022; 15:ma15041462. [PMID: 35208002 PMCID: PMC8880344 DOI: 10.3390/ma15041462] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 01/10/2023]
Abstract
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.
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Pozzi A, Arcuri L, Kan J, Londono J. Navigation guided socket-shield technique for implant and pontic sites in the esthetic zone: A proof-of-concept 1-year prospective study with immediate implant placement and loading. J ESTHET RESTOR DENT 2022; 34:203-214. [PMID: 34994995 DOI: 10.1111/jerd.12867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess clinical, radiological performance of novel navigation guided socket-shield technique (NSS) with immediate implant placement and loading. MATERIALS AND METHODS Eighteen patients (12 females; age 52.54 ± 4.92; 33-72) treated between January 2018 and June 2019, were investigated, and followed for at least 1 year after definitive prosthesis placement (mean 20.1 months, 18-23). Primary outcomes: implant and prosthetic success rates, surgical, biologic, prosthetic complications. SECONDARY OUTCOMES marginal bone loss (MBL), implant stability quotient (ISQ), pink esthetic score (PES), plaque and bleeding indexes. RESULTS Sixty-nine navigation guided socket-shield procedures were performed (27 implant-sites and 42 pontic-sites) and 27 implants (NobelParallel, NobelBiocare AG) positioned and immediately loaded. Mean insertion torque and ISQ at implant positioning were 49 ± 5.34 Ncm (36-74), 73 ± 5.72 (68-81). No implant failure was experienced. Two root-shield exposures with mucositis, ulceration and bleeding were reported at two pontic-sites (2.9%) and successfully treated. No complications were experienced at implant-site leading to an overall NSS success-rate of 100%. No prosthetic complications occurred. Mean MBL was -0.72 ± 0.26 mm (-0.42 to -1.06 mm). PES final at the last follow-up 12.84 ± 0.92. The plaque and bleeding scores were 18.5 ± 6.12 and 3.15 ± 2.21. CONCLUSIONS Within study limitations, dynamic navigation was effective to streamline execution of socket-shield technique at implant and pontic sites, shortening treatment time and reducing complications. Navigation guided socket-shield technique was reliable to achieve digitally planned shield-to-implant distance, facilitate immediate implant placement and loading and establish the mucosal dimension needed for underlying bone-to-implant protection and esthetic integration. CLINICAL SIGNIFICANCE The investigated NSS technique overcomes the difficulties related to root preparation at implant and pontic-sites, facilitating immediate implant placement and loading. Dynamic guided surgery contributed to make socket-shield technique less technical-sensitive, shortening time for execution, reducing complication rate.
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Affiliation(s)
- Alessandro Pozzi
- Department of Restorative Sciences, Augusta University, Goldstein Center for Esthetic and Implant Dentistry, Augusta, Ga, USA
| | - Lorenzo Arcuri
- PhD Materials for Health, Environment and Energy, University of Tor Vergata, Rome, Italy
| | - Joseph Kan
- Advanced Dental Education Program in Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Jimmy Londono
- Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Ga, USA
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