Morphometric Comparison of Two Implants with Different Macroscopy Placed Immediate in the Anterior Region of the Maxilla - A Randomized Clinical Trial with 6-Month of Follow Up

Purpose - Compare the morphometric results of immediate implants (Type 1C) with a cylindrical (conventional) or triangular neck, in the anterior region of the maxilla, during 6 months of osseointegration. Materials and Methods - Prospective randomized clinical trial with a sample of 20 individuals randomly assigned to each group (10 triangular neck implants and 10 cylindrical neck implants). Consecutively direct measurements were performed: before (T-1) and after tooth extraction (T0), after implant placement (T1), after 1 month of the submerged implant healing (T2), when placing the healing abutment (T3), after placing the definitive crown (T3), and after 6 months of osseointegration (T4). Results - A significant difference between T1 and T3 in the buccal cortical thickness was identified (0.49Å}0.86mm). Although there was a significant increase in the buccal cortical thickness in both implants, this increase was greater for the triangular neck implants (cylindrical shape: 0.08Å}0.59 vs. triangular neck 0.90Å}0.91mm). It was also observed that implants placed below the buccal bone crest (í-1mm) promote less vertical buccal bone loss than implants placed Ñ-1mm at crest level (-0.65Å}0.52mm vs. -1.42Å}0.86mm). This observation needs to be further investigated in additional studies. Conclusions - The triangular neck implants present an increase in the cortical buccal thickness compared to the cylindrical implants. However, this increase does not fully compensate the remodulation after tooth loss.

Surgical performance of dental students using computer-assisted dynamic navigation and freehand approaches

INTRODUCTION

Nowadays, the training of implant placement has shifted from once entirely instructor-student teaching to the increasing use of computer-assisted simulation. Based on computerized virtual planning, dynamic navigation has been used for implant placement with higher accuracy than the traditional freehand protocol. However, whether dynamic navigation benefits to the training of dental students in implant placement remains controversial. This study aimed to compare the surgical performance of dental students in implant placement using computer-assisted dynamic navigation and freehand approaches.

MATERIALS AND METHODS

A total of 20 dental students (6 males, 14 females, age: 25.6 ± 0.5 years) were enrolled in this study. With the traditional freehand approach (training 1) as the control protocol, computer-assisted dynamic navigation (training 2) was used in the training of dental students in implant placement. For each training, both the operating time (OT) of students and placement accuracy represented by the linear (at the implant platform, Dpl, and apex, Dap) and angular (Dan) deviations between the virtually planned and placed implants were recorded. Statistical comparisons were made between the two training protocols as well as male and female surgeons.

RESULTS

OT2 was around twice of OT1 (p < .0001), whereas Dan1 was almost three times of Dan2 (p < .0001). Dap1 and Dpl1 were significantly higher than Dap2 (p = .014) and Dpl2 (p = .033) respectively. Besides, male students showed statistically higher Dpl1 (p = .033) and Dan1 (p = .002) than females. No significant difference was found between male and female students in OT1, OT2, Dpl2, Dap1, Dap2 and Dan2.

CONCLUSIONS

Within the limitations of this study, the use of computer-assisted dynamic navigation in the preclinical training could improve the surgical performance of the dental students in implant placement. The combination of dynamic navigation with the traditional preclinical surgical training may benefit to dental students and could be applied in dental education.

AI-Assisted Treatment Planning for Dental Implant Placement: Clinical vs AI-Generated Plans

Background

Dental implant placement is a critical procedure in modern dentistry, requiring precise treatment planning to ensure successful outcomes. Traditionally, treatment planning has relied on the expertise of clinicians, but recent advancements in artificial intelligence (AI) have opened up the possibility of AI-assisted treatment planning.

Materials and Methods

Twenty patients requiring dental implant placement were included in this comparative study. For each patient, a clinical treatment plan was created by an experienced dentist, while an AI algorithm, trained on a dataset of implant placement cases, generated an alternative plan. Various parameters, including implant position, angulation, and depth, were compared between the two plans. Surgical templates were fabricated based on both plans to guide implant placement accurately.

Results

The results of this study indicate that AI-generated treatment plans closely align with clinical plans in terms of implant positioning, angulation, and depth. Mean discrepancies of less than 1 mm and 2 degrees were observed for implant position and angulation, respectively, between the two planning methods. The AI-generated plans also showed a reduction in planning time, averaging 10 min compared to the clinical planning, which averaged 30 min per case. Additionally, the surgical templates based on AI-generated plans exhibited similar accuracy in implant placement as those based on clinical plans.

Conclusion

AI-assisted treatment planning for dental implant placement demonstrates promising results in terms of accuracy and efficiency.

Assessment of the Accuracy of Two Different Dynamic Navigation System Registration Methods for Dental Implant Placement in the Posterior Area: An In Vitro Study

Purpose: To compare the U-tube and cusp dynamic navigation system registration methods in the use of dental implant placement, and to assess the influence of the location of missing teeth on these registrations. Methods: 32 resin mandible models and 64 implants were utilized, with implants being placed using one of the two registration methods selected at random. Accuracy was measured through the superimposition of the final and planned implant positions. Angular deviation, 3D entry deviation, and 3D apex deviation were analyzed. Results: The overall mean 3D deviation was 1.089 ± 0.515 mm at the entry point and 1.174 ± 0.531 mm at the apex point, and mean angular deviation was 1.970 ± 1.042 degrees. No significant difference (p > 0.05) was observed when comparing these two registration methods. However, the U-tube method showed significant difference when assessing the location of missing teeth (without distal-extension absence and distal-extension absence), whereas cusp registration was unaffected. Conclusions: Both the U-tube and cusp dynamic navigation system registration methods are accurate when implemented in vitro. Besides, the cusp registration technique can also overcome several of the limitations of the U-tube approach and the accuracy of it was not influenced by the location of the missing teeth, highlighting it as a method worthy of further clinical research.

Comparing patient-reported outcomes and experiences among static, dynamic computer-aided, and conventional freehand dental implant placement: A randomized clinical trial

OBJECTIVE

The purpose of this study was to compare patient-reported outcomes and experiences (PROs and PREs) among three techniques of dental implant placement, including (a) conventional freehand, (b) dynamic, and (c) static computer-aided implant surgery (CAIS).

MATERIAL AND METHODS

Ninety patients were randomly assigned to have dental implant placed with one of the three protocols. Participants were asked to fill in a series of self-administered questionnaires assessing (1) preoperative expectations, (2) postoperative healing events during the first week after surgery, and (3) experiences and overall satisfaction with the procedures at 2 weeks. Differences within the groups were analyzed by Wilcoxson signed-rank test. Kruskal-Wallis test was used for comparisons among the three groups.

RESULTS

Eighty-eight patients completed the study. Patients' expectations on chewing difficulty, the postoperative experience of duration of pain, speaking limitations, and impact on routine activities were significantly different among groups (p = 0.04, 0.01, 0.038, and 0.046, respectively). Overall, patients appeared to significantly underestimate the duration of postoperative pain (p = 0.035) and swelling (p = 0.001). No significant difference in magnitude of postoperative pain, swelling, and painkiller consumption was found among the groups. The short-term functional limitations after surgery were deemed acceptable by most participants and 89% were satisfied by the overall procedure.

CONCLUSIONS

Surgical placement of dental implant with conventional freehand, static, and dynamic CAIS techniques did not result in any difference in the level of postoperative pain and swelling, and appeared to lead to equal levels of satisfaction as expressed by the patients postoperatively.

An electromagnetic tracking implantation navigation system in dentistry with virtual calibration

BACKGROUND

Dental implant placement navigation systems based on optical tracking have been widely used in clinics. However, electromagnetic (EM) navigation method that does not suffer from problems of hidden line-of-light has not yet been described.

METHODS

This work proposes an EM-guided navigation method named TianShu-ESNS with virtual calibration. Model (12 implants) and animal experiments (pig head: six implants) were conducted to evaluate its performance and stability.

RESULT

The mean virtual calibration error was 0.83 ± 0.20 mm. The mean deviations at the entry point, end point and angle in the phantom experiment of TianShu-ESNS were 1.23 ± 0.17 mm, 1.59 ± 0.20 mm and 1.83 ± 0.27°, respectively. In the animal experiment, the same deviations were 1.25 ± 0.07 mm, 1.57 ± 0.35 mm and 1.90 ± 0.60°, respectively.

CONCLUSIONS

The experimental results show that TianShu-ESNS with the virtual calibration method could serve as a promising tool to eliminate the line-of-light hidden problem and simplify operation procedure in dental implant placement.

Visualization features of canalis sinuosus with cone beam computed tomography

Introduction

One of the key stages of evaluating an edentulous ridge prior to dental implant placement is the analysis of neighboring anatomical structures such as canalis sinuosus (CS) with cone-beam computed tomography (CBCT). CBCT visualization has its own features, such as the change of slice thickness. The aim of the study was to analyze CS prevalence in relation to the slice thickness and CS diameter according to CBCT scans.

Materials and Methods

In total, 100 CBCT scans of 39 males and 61 females in the age span of 46 to 81 years were retrospectively studied. Terminal alveolar part of CS was analyzed in Ez3D2009 (Vatech) software on panoramic and cross-sectional views with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses. The prevalence was documented with regard to the diameter and slice thickness and was statistically compared in age and gender groups.

Results

This CBCT study demonstrated 55.5% CS prevalence. There was no statistically significant difference in presence between age and gender groups regarding diameter as well as within different slice thickness. The study also showed the importance of the slice thickness choice for CS visualization: the best visualization was reached with 0.5 mm and 1 mm slice thicknesses. Visualization with 0.5 mm and 1 mm slice thicknesses was absolutely the same (55.5%). General CS prevalence with a 10 mm slice thickness (16.5%) was significantly lower (P < 0.05) than the prevalence with a 3 mm slice thickness (20.5%). The correlation between the slice thickness and a diameter more than 1.5 mm in size was not found.

Conclusion

CBCT analysis showed that the highest CS prevalence was detected with the use of 0.5/1 mm slice thickness. As well, the higher CS diameter, the better is its visualization.

[Morphology of mandibular lingual concavities]

AIM

The literature review on assessment of lingual concavities in posterior mandibula with CBCT to prevent complications such as perforations during dental implant placement.

METHODS

The electronic search of full-text articles on lingual concavity studies with CBCT was performed. The data on the prevalence, depth and angle of concavities was analyzed.

RESULTS

The analysis included 5 articles from 2011 to 2016 years. Totally 1713 mandibular concavities were evaluated in 1232 patients. The prevalence was 46.7-68%; mean depth was from 2.4 mm to 5.4 mm; and the mean angle varied from 143 to 156.6 degrees.

CONCLUSION

Though morphologic data of lingual concavities showed similar pattern it is necessary to provide CBCT evaluation prior to dental implant placement to define available bone and its morphology. It is recommended to use guided surgery if U-type is evident.

Histopathological comparative analysis of periimplant bone inflammatory response after dental implant insertion using flap and flapless surgical technique. An experimental study in pigs

AIM

To evaluate by histopathological analysis the peri-implant bone inflammation degree, in certain time intervals (7, 14, 21 and 28 days), following mini-incision flapless and flap implant placement.

MATERIAL AND METHODS

The experiment was conducted on four domestic pigs. Nine weeks prior to implant insertion, second and third mandibular premolars were extracted. Each animal received six implants in lower jaw. On one randomly chosen side of jaw flapless technique using mini-incision was performed, while on the other side implants were inserted after flap raising. After 7, 14, 21, and 28 days, the experimental animals were sacrificed. Following mandibular resection and decalcification, the samples for histopathological analysis of the peri-implant bone were obtained in the empty implant bed area, from the buccal side of the mandible, adjacent to implant neck region and parallel to crestal edge of implant bed. The degree of inflammatory response of the peri-implant bone was estimated through ordinal scores from 0 to 2.

RESULTS

Seven days after the surgery all samples in the flap group had score 2 indicating high inflammation degree, in contrast to lower inflammatory reaction in flapless group. On the 14th and 21st postoperative day decreasing of inflammation degree was noted in all samples of the flapless group (score 1), while in flap group samples presented scores 1 and 2. Twenty-eight days after the implant placement, further reduction of inflammation in the flapless group (33% of samples had score 0) was observed.

CONCLUSION

Flapless technique in comparison to conventional flap procedure minimizes postoperative bone inflammatory reactions.

Displacement of a dental implant into the maxillary sinus after internal sinus floor elevation: report of a case and review of literature

BACKGROUND

Dental implant placement in the posterior maxilla may be complicated by implant migration into the maxillary sinus.

PURPOSE

To report the clinical and radiological characteristics of a patient who experienced dental implant displacement into the maxillary sinus following sinus floor elevation, and to compare our findings with those of other published reports of the displacement of dental implants.

MATERIALS AND METHODS

Implant placement and maxillary sinus elevation were performed simultaneously. The location of the displaced implant was monitored for 8 years, until the ectopic implant was surgically removed using the lateral window approach. The contributing factors, treatment modality, and clinical outcome for our patient were compared with those of patients reported in the literature.

RESULTS

The clinical characteristics of our case were similar to those of patients with displaced implants who were also asymptomatic for long periods. The clinical outcome of our case was consistent with that of patients who underwent similar surgeries.

CONCLUSIONS

Transnasal endoscopic removal of an ectopic implant may be suitable in cases in which the ectopic implant is accessible. Transoral direct approaches are adequate in most cases in which endoscopic approaches may be confounded. The bony-window transoral technique may allow the removal of large implants.

Cerebellopontine angle mass mimicking lingual nerve injury after dental implant placement: a case report

This is a rare case report of a cerebellopontine angle (CPA) mass mimicking lingual nerve injury after a dental implant placement. Lingual nerve injury is a common complication following dental implant placement. CPA masses are likely to cause symptomatic trigeminal neuralgia, and thus can mimic and be easily confused with oral diseases. We experienced a case of CPA mass mimicking lingual nerve injury after dental implant placement. The patient was a 57-year-old Japanese female who complained of glossalgia. She underwent dental implant placement in the mandible before visiting our clinic. Panoramic x-ray radiography revealed no abnormalities; the salivary flow rate by gum test was 7.0 ml/10 min. She was diagnosed with lingual nerve injury and secondary burning mouth syndrome. Vitamin B12 and oral moisturizer did not provide relief; furthermore, numbness in the lower lip emerged. A Semmes Weinstein test demonstrated elevation of her sensitivity threshold. Finally, magnetic resonance imaging revealed a 20-mm diameter mass in the CPA. The patient is now being followed under conservative management. Our experience underscores the importance of including CPA mass in the differential diagnosis of dental diseases.

Histopathological comparative analysis of peri-implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs

AIM

The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis.

METHOD

The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3.

RESULTS

In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants.

CONCLUSION

Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery.

Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs

AIM

The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis.

METHOD

The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data.

RESULTS

Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433).

CONCLUSION

The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery.