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Khaohoen A, Powcharoen W, Sornsuwan T, Chaijareenont P, Rungsiyakull C, Rungsiyakull P. Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials. BMC Oral Health 2024; 24:359. [PMID: 38509530 PMCID: PMC10956322 DOI: 10.1186/s12903-024-04033-y] [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: 10/09/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
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.
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Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Warit Powcharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, 65000, Thailand
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Hatamleh MM, Maqableh AM, Al-Wahadni A, Al-Rabab'ah MA. Mechanical properties and bonding of maxillofacial silicone elastomer mixed with nano-sized anti-microbials. Dent Mater 2023; 39:677. [PMID: 37271602 DOI: 10.1016/j.dental.2023.05.009] [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: 05/13/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The antibacterial efficacy of silicone is improved by impregnating it with antimicrobials such as chlorohexidine and zinc oxide. The purpose of this study was to examine mechanical properties and bonding of maxillofacial silicone elastomer mixed with Zinc Oxide nanoparticles (ZnO-NP), and Chlorohexidine Diacetate Salt (CHX) at three different concentrations (1 %, 3 %, and 5 %). METHODS Specimens of a silicone elastomer (M511) were prepared and divided into 7 groups. Group 1 was control of no additive. Groups 2-4 included silicone elastomer mixed with ZnO-NP (surface area = 67 m2/g) at 3 different concentrations (by weight %); 1 %, 3 % and 5 %. Groups 5-7 included silicone elastomer mixed with CHX at the same concentrations. Tear and tensile strengths, elongation percentage, modulus of elasticity, and shear bond strength to primed acrylic resin surfaces were evaluated. Data was analyzed with 1-way ANOVA, Bonferroni, and Dunnett's T3 post-hoc tests (P < 0.05). RESULTS There was significant effect of the additives on the tensile strength, elongation percentage, tear strength, and shear bond strength (P < 0.05). Shear bond strengths ranged from 0.55 to 0.96 MPa. Silicone elastomer mixed with CHX (5 %) resulted in the highest shear bond strength (P < 0.05). Non-linear regressions between tensile strength and ZnO and CHX additives were 0.95 and 0.96 respectively. SIGNIFICANCE All additives reduced the tensile strength of the silicone. However, CHX at 5 % optimized shear bond strength and thus is proposed in order to fabricate maxillofacial prostheses of sufficient mechanical properties, bonding and antimicrobial activity.
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Affiliation(s)
- Muhanad M Hatamleh
- School of Applied Medical Science, Luminus Technical University College (LTUC), Amman, Jordan.
| | - Ayman M Maqableh
- School of Electro-Mechanical Engineering, Luminus Technical University College (LTUC), Amman, Jordan
| | - Ahed Al-Wahadni
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
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Chen W, Al-Taezi KA, Chu CH, Shen Y, Wu J, Cai K, Chen P, Tang C. Accuracy of dental implant placement with a robotic system in partially edentulous patients: A prospective, single-arm clinical trial. Clin Oral Implants Res 2023. [PMID: 37167364 DOI: 10.1111/clr.14083] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES This clinical study aimed to assess the accuracy of implant positions using a robotic system in partially edentulous patients. MATERIALS AND METHODS Twenty-eight partially edentulous patients received 31 implants using the robotic system. Deviations between the planned and placed implants were calculated after surgery. The deviations were compared with objective performance goals (OPGs) from reported studies of fully guided static computer-assisted implant surgery (CAIS) and dynamic CAIS. A multiple linear regression analysis was performed to investigate the possible effects of the type and side of the arch, implant location, and implant dimensions on the deviations. RESULTS The evaluation of 31 implants resulted in a mean angle deviation of 2.81 ± 1.13° (95% confidence interval (CI): 2.40-3.23°), while the 3D deviations at the implant shoulder and apex were 0.53 ± 0.23 mm (95% CI 0.45-0.62 mm) and 0.53 ± 0.24 mm (95% CI 0.44-0.61 mm), respectively. The upper limits of the 95% CI of 3D deviations were lower than those of the corresponding OPGs; however, the angle deviation was similar to that of the OPG. No statistically significant differences were found for the type and side of the arch, implant location, and implant dimensions to the deviations (p > .05). CONCLUSIONS The robotic system appears to achieve higher accuracy in implant positions than static and dynamic CAIS in partially edentulous patients (Chinese Clinical Trial Registry ChiCTR2300067587).
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Affiliation(s)
- Wei Chen
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Khulood Ali Al-Taezi
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Catherine Huihan Chu
- Department of Orthodontic, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yue Shen
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Jin Wu
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Kunzhan Cai
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Peng Chen
- Hangzhou Lancet Robotics Company Ltd, Hangzhou, China
| | - Chunbo Tang
- Department of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
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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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Chandran S, Sers L, Picciocchi G, Luongo F, Lerner H, Engelschalk M, Omar S. Guided implant surgery with R2Gate®: A multicenter retrospective clinical study with 1 year of follow-up. J Dent 2022; 127:104349. [PMID: 36283626 DOI: 10.1016/j.jdent.2022.104349] [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: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To present the results obtained with a novel sleeveless and keyless guided implant surgery system. METHODS Inclusion criteria for this multicenter clinical retrospective study were fully or partially edentulous patients who had been treated with a sleeveless and keyless guided implant surgery system (R2Gate®, Megagen), and who had been rehabilitated with fixed restorations, with a minimum follow-up of 1 year. All surgeries and prosthetic procedures were conducted following the same protocol, and data were obtained from the patients' medical records. The outcomes were the fit and stability of the surgical guide, any intra-operative and immediate post-operative complications, any biologic and prosthetic complications that occurred during the 1-year follow-up period, implant survival, and prosthetic success. RESULTS Sixty patients were selected for the installation of 124 implants, through a guided procedure: 66 sleeveless, keyless surgical guides were manufactured. The incidence of immediate intra-operative (lack of space: 12.1%; lack of implant stability 2.6%) and immediate post-operative (pain and discomfort: 6.6%; mild swelling 3.3%) complications was low. In total, 112/124 implants (90.3%) were successfully placed with a guided procedure, in 52 patients; among them, 82 (73.2%) were placed with a flapless procedure. Thirty fixtures supported single crowns (SCs), 42 fixed partial dentures (FPDs) and 52 full-arch (FA) restorations. Sixty-two fixed prosthetic restorations (30 SCs, 22 FPDs and 10 FAs) were delivered; among these restorations, 15 (24.1%) were subjected to immediate functional loading. All implants (100%) survived. Two implants had peri‑implant mucositis (1.6%), two SCs had abutment screw loosenings (1.6%), two FAs and one FPD had ceramic chipping/fracture (2.4%), for an overall prosthetic success amounting to 88.7%. CONCLUSIONS Within the limits of this study, this novel guided surgery system appeared to be clinically reliable; further studies are needed to confirm these results. STATEMENT OF CLINICAL RELEVANCE The use of sleveless and keyless surgical guides can be clinically reliable and may be represent a valid option for the surgeon.
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Affiliation(s)
- Segin Chandran
- Research Fellow, Santosh University, No.1 Santosh Nagar, Pratap Vihar, Ghaziabad, Uttar Pradesh 201009, India
| | - Laurent Sers
- Private Practitioner, 54 Rue d'Antibes, Cannes 06400, France
| | - Guido Picciocchi
- Private Practitioner, via Brigata Liguria 3, Genova 16121, Italy
| | | | - Henriette Lerner
- Department of Oral, Maxillofacial and Plastic Surgery, Goethe University, Frankfurt, Germany
| | | | - Sam Omar
- Private Practitioner, OneDay Clinic, Shalz Mall, G2C4 2nd floor, El Sheikh Zayed City 7th District, Mogawra 2, Giza, Governorate 12593, Egypt; OneDay Digital Academy, Shalz Mall, G2C13 2nd Floor, El Sheikh Zayed City 7th District, Mogawra 2, Giza, Governorate 12593, Egypt.
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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: 37] [Impact Index Per Article: 18.5] [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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Filipov I, Bolognesi F, Chirila L, Cristache CM, Corinaldesi G, Park KB. Preliminary Study with the Use of a Titanium Mesh as Space Maker and Implant Primary Stabilization for One-Stage Sinus Lift in Cases with Less Than 1.5 mm Residual Bone. J Clin Med 2021; 10:jcm10214853. [PMID: 34768375 PMCID: PMC8584652 DOI: 10.3390/jcm10214853] [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: 09/13/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
(1) Background: In the lateral area of the maxilla, the alveolar bone can lose significant volume due to maxillary sinus pneumatization following teeth extractions. This preliminary study evaluated the effectiveness of a novel technique for one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm residual alveolar bone. The subsequent survival rate at 1-year post-occlusal loading was assessed. (2) Methods: 15 patients were selected, the main inclusion criteria were the partially edentulous area in the posterior maxilla with alveolar bone height of less than 1.5 mm below the sinus. All of the patients underwent one-stage sinus lifting, along with simultaneous implant placement using a “butterfly” anchorage device to optimize the primary stability and xenograft bone as graft material. At 6 to 9 months after surgery, the anchorage device was removed and implants were loaded. Panoramic x-ray images were used to assess the new bone formation, while the biological stability was measured using resonance frequency analysis. (3) Results: 15 implants were inserted. The mean implant stability quotient (ISQ) value was 71.3 (SD = ±2.51) and the mean healing period was 7.3 (SD = ±1.23) months. The mean bone height after the healing period was 14.4 (SD = ±2.05). A statistically significant correlation was found between the healing period and the ISQ value (Spearman rho = 0.684, sig. = 0.005). No statistically significant correlation was found between the ISQ value and the new regenerated bone height (Person r = 0.389, sig. = 0.152). Smoking was identified as a risk factor involved in postoperative complications. (4) Conclusions: The results of the present preliminary study demonstrated that the proposed “butterfly” technique was effective when performing one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm of residual alveolar bone. The survival rate was 100% at 1-year post occlusal loading.
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Affiliation(s)
- Iulian Filipov
- Department of Oral and Maxillofacial Surgery, “Queen Maria” Military Emergency Hospital, 9 Pietii Str., 500007 Brasov, Romania
- Department of Dental Techniques, Faculty of Midwifery and Medical Assisting (FMAM), “Carol Davila” University of Medicine and Pharmacy, 8, Eroilor Sanitari Blvd, 050474 Bucharest, Romania
- Correspondence: (I.F.); (C.M.C.)
| | - Federico Bolognesi
- Oral and Maxillo-Facial Surgery Unit, IRCCS Policlinico di Sant’Orsola, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 59 Via S. Vitale, 40100 Bologna, Italy;
| | - Lucian Chirila
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 19 Plevnei Ave., 010221 Bucharest, Romania;
| | - Corina Marilena Cristache
- Department of Dental Techniques, Faculty of Midwifery and Medical Assisting (FMAM), “Carol Davila” University of Medicine and Pharmacy, 8, Eroilor Sanitari Blvd, 050474 Bucharest, Romania
- Correspondence: (I.F.); (C.M.C.)
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 59 Via S. Vitale, 40100 Bologna, Italy;
| | - Kwang Bum Park
- Department of Implantology and Periodontology, Daegu Mir Dental Hospital, Jung-gu, Daegu 41934, Korea;
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