Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study

Impact of 3D imaging techniques and virtual patients on the accuracy of planning and surgical placement of dental implants: A systematic review

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.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report

OBJECTIVE

complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis.

METHODS

A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered.

RESULTS

Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort.

CONCLUSIONS

Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.

Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report

Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.

Computer-Aided Design and Computer-Aided Modeling (CAD/CAM) for Guiding Dental Implant Surgery: Personal Reflection Based on 10 Years of Real-Life Experience

Traditional dental implant surgery has been challenged by the phenomenal progression in computer-assisted surgery (CAS) that we have been witnessing in recent years. Among the computer-aided technologies, computer-aided design and computer-aided manufacturing (CAD/CAM) techniques represent by far the most attractive and accepted alternatives over their dynamic counterpart, navigational assistance. Based on many years of experience, we have determined that CAD/CAM technology for guiding dental implant surgery is valuable for rehabilitation of the anterior maxillary region and the management of complete or severe partial edentulism. The technology also guarantees the 3D parallelism of implants. The purpose of the present report is to describe indications for use of CAD/CAM dental implant guided surgery. We analyzed the clinical and radiological data of thirteen consecutive edentulous patients treated using CAD/CAM techniques. All of the patients had stable cosmetic results with a high rate of patient satisfaction at the final follow-up examination. No intra- and/or postoperative complications were encountered during any of the steps of the procedure. The application of CAD/CAM techniques produced successful outcomes in the patients presented in this series.

Accuracy of markerless registration methods of DICOM and STL files used for computerized surgical guides in mandibles with metal restorations: An in vitro study

STATEMENT OF PROBLEM

Digital imaging and communications in medicine (DICOM) files together with surface scans must be accurately registered in virtual implant planning software programs to match real-life dimensions and ensure correct plan transfer through computer-aided manufactured surgical guides.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of 3 different registration methods of DICOM data with and without metal restorations and a metal artifact reduction (MAR) tool for surface scans.

MATERIAL AND METHODS

Thirteen dentate mandibles were assigned to each group of this study (n=39). Baseplate wax was adapted to the bone surfaces of each mandible, and 5 radiopaque markers were attached. A desktop scanner was used to obtain control scans. The groups of metal-free mandibles (MFM) and mandibles with metal restorations (MRM) were scanned to obtain DICOM data without a MAR tool. Additional DICOM data for the MRM were obtained with the MAR tool (MRM-MAR). Point-based registration (PBR), best-fit registration (BFR), and automatic registration (AR) were used to align standard tessellation language (STL) and DICOM data, and 3 data sets were exported. Radiographic markers on each data set were compared with those on the control scan, and positional deviations were calculated and statistically evaluated with 1-way ANOVA followed by multiple pairwise comparisons, independent samples t test, and 2-way ANOVA (α=.05).

RESULTS

Within each group, PBR had the lowest deviation values with statistical significance in the MFM and the MRM-MAR groups (P<.001). AR showed failure in the MRM and the MRM-MAR groups. Statistically significant differences were found on comparing the average deviations among the 3 groups for PBR only (P<.001). No association was found between deviation values and the presence or absence of metal restoration, while a positive association was found with the type of registration method (P<.001).

CONCLUSIONS

PBR had the highest accuracy level compared with AR and BFR methods. An increase in the number of calculations resulted in more deviation values. The MAR tool had a positive effect on PBR in mandibles with metal restorations.

Risk of root damage after using lateral cephalogram and intraoral scan for guided insertion of palatal miniscrews

Background

Guided insertion of palatal miniscrews using a lateral cephalogram instead of cone beam computed tomography (CBCT) significantly reduces the radiation level for the patient. Till now no data are available on the risk of hitting the incisors in this regard, which is one of the worst clinical complications when inserting a paramedian miniscrew. Hence, this study aims to investigate the distance between the mini-implant and the roots of the central and lateral incisors.

Methods

Lateral cephalogram, an intraoral scan, and CBCT of 20 patients were superimposed. After a miniscrew (1.7 × 8 mm) placement based on intraoral scan and lateral cephalogram, the CBCT was used as control for the distance between the miniscrews and the roots of the incisors.

Results

The mean value of the shortest distance between the miniscrew and roots of the incisors in the lateral cephalogram was 4.74 ± 1.67 mm. The distance between both miniscrews and the central incisors measured in the CBCT was 5.03 ± 2.22 mm and 5.26 ± 2.21 mm and between the two miniscrews and the lateral incisors was 4.93 ± 1.91 mm and 5.21 ± 2.64 mm. No significant differences between the distances in the CBCT and the lateral cephalogram could be observed. In one case, the CBCT control revealed the penetration of two palatally displaced canines after insertion based on intraoral scan and lateral cephalogram.

Conclusions

The use of an intraoral scan and a lateral cephalogram for guided paramedian insertion of palatal miniscrews can prevent incisor root damage. This may reduce the radiation since no CBCT seems necessary. The current investigation focuses on the anterior paramedian area of the palate. Outside that region and in complex cases with displaced teeth in the palatal area, a CBCT might be indicated.