Positional accuracy during the sequence of static computer-assisted implant surgery in three alveolar ridge morphologies: An in vitro study

PURPOSE

This in vitro study aimed to assess the positional accuracy during the sequence of static computer-assisted implant surgery (sCAIS) according to the anatomical characteristics of the alveolar ridge.

MATERIAL AND METHODS

Maxillary bone models with six single tooth gaps including clinical scenarios of healed alveolar ridge (HR), single-rooted (SRS), and three-rooted socket (TRS) morphologies were used in this study. Positional deviations during implant placement procedures were evaluated after the pilot osteotomy (PD), final osteotomy (FD), and implant placement with respect to the pre-planned implant position by using a software package. ANOVA and post hoc analyses were performed.

RESULTS

A total of 90 implants were included in this study. Higher mean angular, crestal, and apical deviations were found after the PD and FD (3.5 ± 2.4°, 0.7 ± 0.3 mm, and 1.4 ± 0.8 mm versus 3.6 ±2.2°, 0.6 ± 0.3 mm, and 1.2 ± 0.6 mm) compared to IP (2.8 ± 1.6°, 0.7 ± 0.3 mm, and 1.2 ± 0.5 mm, p ≤ 0.004). Implants placed in TRS demonstrated higher mean angular, crestal, and apical deviations (4.0 ± 1.7°, 0.8 ± 0.3 mm, and 1.6 ± 0.5 mm) compared to implants placed in SRS (2.5 ± 1.2°, 0.7 ± 0.3 mm, and 1.1 ± 0.4 mm) or HR (2.0 ± 0.9°, 0.5 ± 0.3 mm, and 0.8 ± 0.4 mm, p < 0.001).

CONCLUSIONS

Positional deviations during sCAIS procedures are initiated with the first implant osteotomy and persist throughout the drilling sequence. However, deviations slightly decreased after implant placement. The alveolar ridge morphology is strongly associated with positional deviations. Higher deviations were observed in three-rooted and single-rooted sockets simulating an immediate approach compared to healed sites simulating a delayed protocol.

Accuracy of implant placement in the posterior maxillary region depending on the alveolar residual bone height and sinus morphology: An in vitro study

OBJECTIVES

The primary aim of this in vitro study was to assess the effect of alveolar residual bone height in the posterior maxilla on the accuracy of the final implant position via free-handed and static Computer-Assisted Implant Placement (sCAIP). The secondary aim was to evaluate the influence of the maxillary sinus morphology on the accuracy of final implant position.

MATERIALS AND METHODS

Partially edentulous standardized maxillary models simulating three different residual bone heights and different sinus floor morphologies were investigated. One-hundred eighty equally distributed implants, which were placed either free-handed or sCAIP, constituted the study sample. 3D digital deviations were obtained by superimposing the post-surgical scans on the initial treatment plan.

RESULTS

Angular and linear deviation assessment demonstrated higher implant position accuracy in the sCAIP group. sCAIP revealed similar outcomes independently of the alveolar bone height and sinus floor morphology. Contrarily, in the free-handed group, alveolar bone height and sinus morphology statistically affected the final implant position. Non-parametric three-way ANOVA showed significance for implant placement protocol (p < .0001) and alveolar bone height (p ≤ .02) when angular, and linear deviations were evaluated. Sinus morphology was statistically significantly associated with angular deviation (p = .0009).

CONCLUSIONS

sCAIP demonstrated higher 3D implant position accuracy. Alveolar bone height (strongly) and sinus morphology are associated with the accuracy of final implant position when the free-handed implant protocol is followed. However, these anatomical factors did not affect final implant position during sCAIP.