Article

Comparison of the accuracy of implant position for two-implants supported fixed dental prosthesis using static and dynamic computer-assisted implant surgery: A randomized controlled clinical trial

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: Computer-assisted implant surgery (CAIS) can facilitate accuracy of single implant placement, but little is known with regards to parallelism between multiple implants. Purpose: To compare the accuracy of position and parallelism of two implants, using static and dynamic CAIS systems. Materials and methods: Thirty patients received two implants (60 implants) randomly allocated to two different CAIS systems. Optimal implant position and absolute parallelism was planned based on preoperative cone beam CT (CBCT). Patients received implants with a surgical guide (static CAIS, n = 30) or real-time navigation (dynamic CAIS, n = 30). Implant three-dimensional deviation and parallelism was calculated after surgery. Results: The mean 3D deviation in the static and dynamic CAIS group at implant platform were 1.04 ± 0.67 vs 1.24 ± 0.39 mm, at apex were 1.54 ± 0.79 vs 1.58 ± 0.56 mm and angulation were 4.08° ± 1.69° vs 3.78° ± 1.84°, respectively. The angle deviations between two placed implants (parallelism) in static and dynamic CAIS groups were 4.32° ± 2.44° and 3.55° ± 2.29°, respectively. There were no statistically significant differences in all parameters between groups. Conclusion: Static and dynamic CAIS provides similar accuracy of the 3D implant position and parallelism between two implants.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Removing the duplicates and screening the titles and abstracts resulted in 58 articles eligible for full-text assessment, which led to excluding 25 studies. As a result, 33 clinical studies were included in this network metaanalysis (Lorwicheanrung et al. 2023;Søndergaard et al. 2021;Yotpibulwong et al. 2023;Sun, Lee, and Lan 2020;Jorba-García et al. 2023;Smitkarn et al. 2019;Kaewsiri et al. 2019;Vercruyssen et al. 2014;Varga et al. 2020;Sarhan, Khamis, and El-Sharkawy 2021;Han et al. 2021;Ochandiano et al. 2021;Geng et al. 2015;Lou et al. 2021;Ayman, Elkhadem, and Elkerdawy 2021;Aydemir and Arısan 2020;Block, Emery, Cullum, et al. 2017;Block, Emery, Lank, et al. 2017;Chandran et al. 2023;Farley et al. 2013;Feng et al. 2022;Huang et al. 2023;Jaemsuwan et al. 2023;Magrin et al. 2020;Ngamprasertkit, Aunmeungthong, and Khongkhunthian 2022;Nomiyama et al. 2023;Schneider et al. 2019;Shen et al. 2015;Wei et al. 2022;Wu et al. 2021;Yaqin et al. 2021;Yimarj et al. 2020;Younes et al. 2018). Figure 1 is the PRISMA flowchart of the search process. ...
... The included studies were published between 2013 and 2023. Twenty-five articles were randomized clinical trials (RCTs) (Søndergaard et al. 2021;Yotpibulwong et al. 2023;Jorba-García et al. 2023;Smitkarn et al. 2019;Kaewsiri et al. 2019;Vercruyssen et al. 2014;Varga et al. 2020;Sarhan, Khamis, and El-Sharkawy 2021;Han et al. 2021;Lou et al. 2021;Ayman, Elkhadem, and Elkerdawy 2021;Aydemir and Arısan 2020;Chandran et al. 2023;Farley et al. 2013;Feng et al. 2022;Magrin et al. 2020;Ngamprasertkit, Aunmeungthong, and Khongkhunthian 2022;Nomiyama et al. 2023;Schneider et al. 2019;Shen et al. 2015;Wei et al. 2022;Wu et al. 2021;Yaqin et al. 2021;Yimarj et al. 2020;Younes et al. 2018) and eight were controlled clinical trials (CCTs) (Lorwicheanrung et al. 2023;Sun, Lee, and Lan 2020;Ochandiano et al. 2021;Geng et al. 2015;Block, Emery, Cullum, et al. 2017;Block, Emery, Lank, et al. 2017;Huang et al. 2023;Jaemsuwan et al. 2023). The included studies recruited fully edentulous FIGURE 1 | PRISMA flowchart of the search process. ...
... Thirty-three investigations were analyzed (Lorwicheanrung et al. 2023;Søndergaard et al. 2021;Yotpibulwong et al. 2023;Sun, Lee, and Lan 2020;Jorba-García et al. 2023;Smitkarn et al. 2019;Kaewsiri et al. 2019;Vercruyssen et al. 2014;Varga et al. 2020;Sarhan, Khamis, and El-Sharkawy 2021;Han et al. 2021;Ochandiano et al. 2021;Geng et al. 2015;Lou et al. 2021;Tahmaseb et al. 2014;Ayman, Elkhadem, and Elkerdawy 2021;Aydemir and Arısan 2020;Block, Emery, Cullum, et al. 2017;Block, Emery, Lank, et al. 2017;Chandran et al. 2023;Farley et al. 2013;Feng et al. 2022;Huang et al. 2023;Jaemsuwan et al. 2023;Magrin et al. 2020;Nomiyama et al. 2023;Schneider et al. 2019;Shen et al. 2015;Wei et al. 2022;Wu et al. 2021;Yaqin et al. 2021;Yimarj et al. 2020;Younes et al. 2018). High heterogeneity (I 2 = 94.6%) and inconsistency (Q = 506.6) ...
Article
Objective Computer‐assisted implant surgery (CAIS) has been introduced as a tool to aid in reaching a more accurate implant position. The aim of this network meta‐analysis was to compare all the available CAIS techniques and obtain collective evidence on the method that offers the highest accuracy compared to freehand implant placement. Materials and Methods Database search was done in PubMed, Scopus, and Cochrane library in addition to extensive search in the gray literature and related systematic reviews, aiming to find clinical studies that compared any CAIS technique with another, or with freehand implant placement. The outcomes evaluated were angle, platform, and apex deviation. The search process ended on March 18, 2024. Results Thirty‐three studies were included. All CAIS techniques (static with partial or full guidance, dynamic with partial or full guidance, the combination of static and dynamic CAIS) showed significantly less deviation than freehand implant placement, except for the static CAIS with guidance for the pilot drill only. The combination of static and dynamic CAIS ranked best among all other methods. Based on the GRADE system, the certainty of evidence in the outcomes of the meta‐analysis was judged as low or moderate. Conclusions The current study demonstrates that computer‐assisted implant surgery provides significantly higher accuracy in implant placement, with the combination of static and dynamic CAIS being the most precise. Nevertheless, future studies are needed, considering the different types, locations, and extents of edentulism in the analyzed investigations, as well as the necessity of obtaining stronger evidence. Trial Registration PROSPERIO number: CRD42023482030
... Static computer-assisted implant surgery (s-CAIS) [1][2][3] and dynamic navigation (DN) [4][5][6] represent different but clinically reliable solutions for inserting dental implants in the desired position, inclination and depth, according to a three-dimensional (3D) surgical and prosthetic plan. Studying bone anatomy in 3D can prevent the invasion of structures such as the inferior alveolar nerve and the maxillary sinus, the dangerous perforation of cortical bones and damage to the periodontal tissues of adjacent teeth [7,8]. ...
... With DN, an optical system tracks the movement of the patient and surgical instruments [4,5]. Therefore, the surgeon can perform edentulous site preparation and implant placement according to the real-time relative position of the patient and surgical instruments [5,6]. Since there are no surgical templates, space is not limited, the surgeon can operate without visual impediment, irrigation is guaranteed, and it is always possible to modify the surgical plan intra-operatively [6,23]. ...
... Therefore, the surgeon can perform edentulous site preparation and implant placement according to the real-time relative position of the patient and surgical instruments [5,6]. Since there are no surgical templates, space is not limited, the surgeon can operate without visual impediment, irrigation is guaranteed, and it is always possible to modify the surgical plan intra-operatively [6,23]. However, the operator is forced to look at the computer screen and not at the patient; this represents an objective difficulty, which may lead to miss important cues in either the surgical field or the DN system, thereby increasing the risk of errors [24], and requires a particular learning curve. ...
... Static computer-assisted implant surgery (s-CAIS) [1][2][3] and dynamic navigation (DN) [4][5][6] represent different but clinically reliable solutions for inserting dental implants in the desired position, inclination and depth, according to a three-dimensional (3D) surgical and prosthetic plan. Studying bone anatomy in 3D can prevent the invasion of structures such as the inferior alveolar nerve and the maxillary sinus, the dangerous perforation of cortical bones and damage to the periodontal tissues of adjacent teeth [7,8]. ...
... With DN, an optical system tracks the movement of the patient and surgical instruments [4,5]. Therefore, the surgeon can perform edentulous site preparation and implant placement according to the real-time relative position of the patient and surgical instruments [5,6]. Since there are no surgical templates, space is not limited, the surgeon can operate without visual impediment, irrigation is guaranteed, and it is always possible to modify the surgical plan intra-operatively [6,23]. ...
... Therefore, the surgeon can perform edentulous site preparation and implant placement according to the real-time relative position of the patient and surgical instruments [5,6]. Since there are no surgical templates, space is not limited, the surgeon can operate without visual impediment, irrigation is guaranteed, and it is always possible to modify the surgical plan intra-operatively [6,23]. However, the operator is forced to look at the computer screen and not at the patient; this represents an objective difficulty, which may lead to miss important cues in either the surgical field or the DN system, thereby increasing the risk of errors [24], and requires a particular learning curve. ...
... Compared to static navigation, relatively few clinical studies on dynamic navigation have been published to date [26,[37][38][39][40][41][42][43][44][45] [26,[37][38][39][40][41][42][43][44][45]. The 3D deviation at the implant emergence point varied between 0.67 ± 0.29 mm [44] and 1.37 ± 0.55 mm [39]. ...
... Compared to static navigation, relatively few clinical studies on dynamic navigation have been published to date [26,[37][38][39][40][41][42][43][44][45] [26,[37][38][39][40][41][42][43][44][45]. The 3D deviation at the implant emergence point varied between 0.67 ± 0.29 mm [44] and 1.37 ± 0.55 mm [39]. ...
... The 3D deviation at the implant emergence point varied between 0.67 ± 0.29 mm [44] and 1.37 ± 0.55 mm [39]. An unweighted mean value of 1.03 mm was calculated [26,[37][38][39][40][41][42][43][44][45]. The published data on the accuracy of dynamic navigation have so far been analyzed in a few systematic reviews [32,36,[46][47][48]. ...
Article
Full-text available
This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6–3.9°) than group A, with a value of 6.3° (95% CI 4.0–8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92–2.78 mm) and 1.62 mm for workflow B (95% CI 1.2–2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.
... 果见表2、3。纳入的CS [16][17][19][20][21][22][23]25] 均存在中等偏倚风 险,而RCT中3项 [18,24,26] 存在中等偏倚风险,1项 [27] 存在高偏倚风险。 2.3 Meta 分析结果 2.3.1 研究对象亚组分析 1) 种植体颈部中心偏 差。11篇文献 [16][17][18][19]21,[23][24][26][27] 报道了种植体颈部中心偏 差,Sun等 [20] 因测量方式不同而未进行数据合并。 [22] 和Zhou等 [25] ...
... 果见表2、3。纳入的CS [16][17][19][20][21][22][23]25] 均存在中等偏倚风 险,而RCT中3项 [18,24,26] 存在中等偏倚风险,1项 [27] 存在高偏倚风险。 2.3 Meta 分析结果 2.3.1 研究对象亚组分析 1) 种植体颈部中心偏 差。11篇文献 [16][17][18][19]21,[23][24][26][27] 报道了种植体颈部中心偏 差,Sun等 [20] 因测量方式不同而未进行数据合并。 [22] 和Zhou等 [25] ...
... Yimarj 等 [24] (2020) ...
Article
Full-text available
Objective To systematically evaluate and compare the accuracy between computer-aided dynamic implant surgery (dCAIS) and computer-aided static navigation (sCAIS) in implant surgery. Methods Databases in PubMed, Em-base, Cochrane Library, Web of Science, CNKI, and Wanfang from January 2000 to May 2022, were searched to identify controlled trials that compared dCAIS and sCAIS. The risk of bias in cohort studies (CS) and randomized controlled studies (RCTs) was assessed using NOS and Jadad scales, respectively. Data were analyzed using RevMan 5.4 and Stata 16 software. Results A total of 12 studies fulfilled the inclusion criteria, including 8 CS and 4 RCTs. Subgroup analysis, which was conducted according to object, edentulous category, navigation system, and registration method, indicated that dCAIS resulted in significantly less implant apical deviation (P<0.05) and angular deviation (P<0.05) than sCAIS, except for implant platform deviation (P>0.05). Conclusion Limited evidence implied that dCAIS could achieve higher accuracy in implant surgery than sCAIS. Further evidence from higher-quality clinical studies are needed to supervise the current performance in diverse edentulous category under the coherent navigation system and registration.
... In a retrospective cohort evaluation, it was reported that the accuracy associated with dynamic navigation was superior to that of static guidance and freehand placement [13]. In several other publications, no significant difference was found when comparing accuracy between dynamic navigation and static guidance [14][15][16]. Therefore, additional large sample randomized trials should be conducted in an attempt to address the accuracy between the two protocols. ...
... The characteristics of all the included studies are depicted in Table 2. Seven studies [14][15][16][21][22][23][24] compared dynamic computer-assisted implant surgery with static computer-assisted implant surgery. Six studies [13,14,[24][25][26][27] compared dynamic computer-assisted implant surgery with freehand placement. ...
... Six studies [28][29][30][31][32][33] documented dynamic computer-assisted implant surgery with no control group. Five trials [16,21,22,25,27] were RCTs and 12 studies [13][14][15]23,24,26,[28][29][30][31][32][33] were nonrandomized studies. Within the nonrandomized studies: seven were retrospective studies [15,23,24,28,29,31,32], four were prospective studies [13,14,26,33], and one was a case series [30]. ...
Article
Objectives: To evaluate the accuracy of dynamic computer-aided implant surgery (dCAIS) and compare it with static computer-aided implant surgery (sCAIS) and freehand implant placement (FH) in partially or fully edentulous patients. Data: Studies that analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients. Sources: This meta-analysis included studies published in English and Mandarin Chinese from January 2013 to February 2023 from MEDLINE/PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure). Study selection: Only clinical studies were included. Accuracy was the primary outcome. Seventeen studies met the inclusion criteria. A total of 2,025 implants were analyzed. Meta-regression was conducted to compare the six different navigation systems. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted as a collective grading of the evidence. Conclusions: Dynamic navigation is a clinically reliable method for implant placement. Significantly lower angular deviation was observed for dCAIS compared to both sCAIS and FH, while significantly lower global platform and apex deviations were displayed between dCAIS and FH. Overall, dynamic navigation allowed for higher accuracy compared to both sCAIS and FH in a clinical setting; however, additional large sample RCT studies should be conducted, and patient-reported outcome measures (PROMs) reported. Clinical significance: This systematic review analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients compared with static navigation. The results demonstrated that dynamic navigation could decrease implant placement deviations in two accuracy parameters, global apex and angular deviations.
... Planning for reconstructive surgery has been transformed by using virtual surgical planning (VSP), making it easier to fabricate models, cutting and drilling guides, and custom gear that can be patient-specific or pre-bent. These products contribute to significantly improved surgical outcomes by reducing operative times and increasing predictability and accuracy [27]. Use of this technology has recently expanded, including the predictive placement of endosseous dental implants. ...
... It is commonly referred to as "Jaw in a Day". A recent systematic review and meta-analysis compared computer-assisted and traditional freehand mandibular repair efficiency and accuracy metrics with a fibular free flap [8,11,27]. In the current case report, surgeons discussed the VSP option with the patient, but this treatment plan was rejected due to expense. ...
... Yimarj P (2020) cho rằng độ chính xác của phẫu thuật đặt implant với HDĐ phụ thuộc vào hai yếu tố (3) . Một là sự chính xác trong quá trình chập dữ liệu hợp nhất mẫu hàm và phim CBCT trên phần mềm. ...
... Kết quả nghiên cứu cho thấy độ lệch góc của hai implant song song của hai implant là 0,71 ± 0,33 độ. Kết quả này tốt hơn với độ lệch song song (3,55 ± 2,29 độ) trong nghiên của của Yimarj P (2020) (3) . Sự khác biệt này có thể do nghiên cứu của Yimarj được thực hiện trên lâm sàng và sử dụng hệ thống HDĐ khác với nghiên cứu này. ...
Article
Mục tiêu: Đánh giá độ chính xác của phẫu thuật đặt implant với hệ thống hướng dẫn động trong các trường hợp mất răng từng phần. Đối tượng - Phương pháp nghiên cứu: Nghiên cứu in vitro trên 8 mẫu hàm. 40 implant được đặt với sự hướng dẫn của hệ thống hướng dẫn động, đánh giá độ chính xác thông qua độ sai lệch về góc độ và khoảng cách giữa vị trí implant thực tế so với kế hoạch. Kết quả: Độ lệch góc trung bình là 1,18 ± 0,71 độ, độ lệch góc trung bình giữa hai implant được thiết kế song song là 0,71 ± 0,33 độ. Về khoảng cách, độ lệch trung bình ở cổ và chóp implant lần lượt là 0,82 ± 0,19 mm; 0,89 ± 0,27 mm; độ lệch trung bình theo chiều đứng ở cổ và chóp là 0,49 ± 0,27 mm. Không có sự khác biệt có ý nghĩa thống kê của hai nhóm implant được đặt ở hàm trên và hàm dưới. Kết luận: Phẫu thuật đặt implant trong trường hợp mất răng từng phần với hệ thống hướng dẫn động trên in vitro là chính xác và trong giới hạn an toàn. Từ khóa: độ chính xác, implant, hệ thống hướng dẫn động
... 9,20,21 To limit the intraoperative adjustments of the prefabricated immediate temporary FDP, an accurate implant placement is mandatory. At present, most of the investigated navigation systems have demonstrated similar performance levels and potential clinical applications, [22][23][24][25][26][27][28] with significantly higher accuracy than freehand implant placement and at least as much as static CAIS. [29][30][31][32][33][34] However, a scarcity of well-designed clinical trials investigating dynamic CAIS in complex clinical scenarios such as terminal dentition and edentulous patients remained to be addressed (Data S1). ...
... The sample size was calculated using Wilcoxon-Mann-Whitney test based on means and standard deviation (SD) of 3-dimensional deviations at implant platform and apex of dynamic guided surgery previously published in a randomized clinical trial (RCT) study 24 ...
Article
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.
... Simultaneously, robotic CAIS (rCAIS) combines the benefits of avoiding the physical constraints of s-CAIS, the instantaneous feedback of d-CAIS, and the accurate control achieved by robotic arms [11]. Robot-assisted implant systems have been developed to improve precision and accuracy, lessen human-based errors, and eliminate the use of static guides [12]. Yomi [11] is the first robotic implant surgical system approved by the Food and Drug Administration (FDA). ...
... Comparisons between pre-and post-dental implant placements can be found among the three navigation types, namely, 43 studies on static systems [8,18,19,21,22,, 7 studies on dynamic systems [7,16,25,[68][69][70][71], and only 2 on robot-assisted surgery [11,13]. Nevertheless, 15 studies [12,15,26,[72][73][74][75][76][77][78][79][80][81][82][83] showed comparative data between systems. To be more precise, seven studies assessed the accuracy between freehand and static navigation, three studies compared freehand and dynamic navigation, three studies compared static and dynamic systems, and two studies reported the difference between freehand, static, and dynamic systems. ...
Article
Full-text available
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.
... DCAIS involves using dynamic navigation systems during the surgical phase of implant treatment [17,21]. This system increases the accuracy of implant placement and prevents damage to critical anatomical structures like the inferior alveolar nerve, the maxillary sinus, etc. [22]. With DCAIS, the dentist can make dynamic changes in implant positioning during surgery. ...
... With DCAIS, the dentist can make dynamic changes in implant positioning during surgery. Most disadvantages of SCAIS can be overcome using this system [17,22]. ...
Article
Full-text available
Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was −1.22 degrees (95% CI, −1.06–−1.39), the mean coronal deviation was −0.15 mm (95% CI, −0.24–−0.07), and the mean apical deviation was −0.19 mm (95% CI, −0.27–−0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.
... The sample size was calculated using PASS 15 software (NCSS, LLC) based on the previously reported total deviations at the apex of the marker-based registration (1.58 ± 0.56 mm; Yimarj et al., 2020) and marker-free registration (1.05 ± 0.34 mm; Stefanelli et al., 2020). ...
... In recent years, d-CAIS has been frequently used in implant surgery to improve implant placement accuracy and reduce drilling-related complications (Aydemir & Arısan, 2020;Pimkhaokham et al., 2022;Wei et al., 2022;Wu et al., 2020;Yimarj et al., 2020). This randomized clinical trial aimed to compare the clinical outcomes of d-CAIS using marker-free or marker-based registration methods for single dental implantation in the esthetic zone. ...
Article
Objectives To compare implant placement accuracy and patient‐centered results between the dynamic computer‐assisted implant surgeries (d‐CAISs) using marker‐based and marker‐free registration methods. Materials and Methods A double‐armed, single‐blinded randomized controlled trial was conducted, in which 34 patients requiring single implant placement at the esthetic zone were randomly assigned to the marker‐based ( n = 17) or marker‐free ( n = 17) groups. The marker‐based registration was performed using a splint containing radiopaque markers, while the marker‐free registration used natural teeth. The primary outcome assessed implant positioning accuracy via angular and linear deviations between preoperative and postoperative implant positions in CBCT. Patients were also surveyed about the intraoperative experience and oral health impact profile (OHIP). Results The global linear deviations at the implant platform (0.82 ± 0.28 and 0.85 ± 0.41 mm) and apex (1.28 ± 0.34 and 0.85 (IQR: 0.64–1.50) mm) for the marker‐based and marker‐free groups respectively showed no significant difference. However, the angular deviation of the marker‐free group (2.77 ± 0.92) was significantly lower than the marker‐based group (4.28 ± 1.58). There was no significant difference in the mean postoperative OHIP scores between the two groups ( p = .758), with scores of 2.74 ± 1.21 for marker‐based and 2.93 ± 2.18 for marker‐free groups, indicating mild oral health‐related impairment in both. Notably, patients in the marker‐free group showed significantly higher satisfaction ( p = .031) with the treatment procedures. Conclusions D‐CAIS with a marker‐free registration method for single implantation in the anterior maxilla has advantages in improving implant placement accuracy and patients' satisfaction, without generating a significant increase in clinical time and expenses.
... Static guided surgery, on the other hand, involves the use of surgical templates during osteotomy preparation and implant placement. While dynamic guided surgery has been found to be more accurate than freehand implant placement [10], static guided surgery is more practical [11] and provides similar accuracy to dynamic guided surgery [12][13][14][15]. ...
Article
Full-text available
This study aimed to evaluate the influence of the guidance level on the accuracy of immediately placed implants. Methods: Eighteen identical maxillary models (randomly split into three groups (n = 6): fully guided (FG), pilot-guided (PG), and freehand (FH)) were used to place 72 implants (n = 24). After placement, the mean global, angular, mesial–distal, buccal–palatal, and vertical deviation at the platform and apex of the placed implants, relative to the preoperatively planned positions, was calculated. Results: Significant differences in global and mesial–distal deviation were found between implants in the FG group and implants in the PG and FH groups. Significant differences were also found between the implants in the FG and FH groups as well as the implants in the PG and FH groups in terms of angular and mesial–distal apex deviation. Finally, significant differences were found between the implants in the FG and PG groups in terms of buccal–palatal platform deviation. Conclusions: The results of this in vitro study show that immediate implants placed using fully guided surgical guides have significantly less deviation, and are therefore more accurate, than implants placed freehand or using pilot guides, but this should be further validated in a clinical trial.
... While a significant body of positive evidence supports guided implant placement, it is important to acknowledge that the findings are not entirely consistent across studies. Studies examined by Yimarj P et al. [42] and Naeini E. et al. [43] did not find statistically significant differences in coronal and apical implant positions or angular deviations between static and dynamic computer-guided surgery. ...
... Numerous clinical studies have demonstrated the effectiveness of sCAIS in increasing the precision of implant placement, both as compared to freehand surgery 4 but also other CAIS technologies. 5 Apart from the surgical guide itself, each of the commercially available sCAIS systems utilizes a variety of components and designs to guide and control the drills during osteotomy. Two distinct concepts have emerged, namely systems which utilize a handheld "drill key" to fit the drills in the sleeve (often referred to as "sleeve-insleeve") and systems with a mount sleeve on drill or designs with integrated sleeve-on-drill. ...
Article
Full-text available
Background/purpose: Many designs of static computer-assisted implant surgery (sCAIS) are available for clinician to achieve proper implant position. However, there were not any studies that approached the design alone to evaluate whether sleeve-in-sleeve or sleeve-on-drill design provided most accuracy implant position. The purpose of this study was to investigate the precision of implant placement with sleeve-in-sleeve and sleeve-on-drill static computer assisted implant surgery (sCAIS) designs. Materials and methods: Thirty-two models were fabricated simulating a patient with bilateral missing first premolar. Eight models (sixteen implants) were assigned in each group: Group A, B and C represented sleeve-in-sleeve design with 2, 4 and 6 mm sleeve height respectively. Group D represented integrated sleeve-on-drill design with 4 mm sleeve height. 3D deviation at implant platform, apex and angular deviation were measured. Data were analyzed using one way ANOVA (P < 0.05). Results: The overall deviation at platform ranged from 0.40 AE 0.14 mm (group A) to 0.73 AE 1.54 mm (group C), at apex from 0.46 AE 0.16 mm (group A) to 1.07 AE 0.37 mm (group
... Additionally, it avoided visual limitations and operational fatigue, thereby minimizing human error to some extent. Yimarj reported significantly greater lingual platform deviation (P = 0.03) and distal apex deviation (P = 0.03) with the use of dynamic CAIS [44]. In this respect, the 3D deviations of most implants involved mesial, buccal, and apical deviations compared to the planned position, consistent with the findings of Chen W et al. [45] (Fig. 7). ...
Article
Full-text available
Objectives Robots are increasingly being used for surgical procedures in various specialties. However, information about the accuracy of robot-assisted dental implant surgery is lacking. This pilot clinical study aimed to investigate the accuracy of an autonomous dental implant robotic (ADIR) system in partially edentulous cases. Material and methods The ADIR system was used to place a total of 20 implants in 13 participants. Implant deviation from the planned positions was assessed to determine accuracy. The entry, apex, and angular deviations were described as means ± standard deviation. A two-sample t test was used to compare implant deviation between the flap and flapless groups and between maxillary and mandibular implants (α = .05). Results The entry, apex, and angular deviations were 0.65 ± 0.32 mm, 0.66 ± 0.34 mm, and 1.52 ± 1.01°, respectively, with no statistically significant difference between the flap and flapless approaches (P > .05). No adverse events were encountered in any of the participants. Conclusions DIR accuracy in this clinical series was comparable to that reported for static and dynamic computer-assisted implant surgery. Robotic computer-assisted implant surgery may be useful for dental implant placement, potentially improving the quality and safety of the procedure. Clinical relevance The findings of this study showed that the ADIR system could be useful for dental implant surgery.
... In recent years, the DN has been increasingly used to assist surgeons to improve the precision of surgery [9,10]. Studies have indicated that the accuracy of DN is similar to that of a static guide in assisting implant placement [17][18][19], and both of which are better than that of the free hand [20][21][22][23]. Currently, few reports about the application of DN in MSFE have been found after a throughout search [24,25]. ...
Article
Full-text available
Objective To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. Methods Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. Results Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). Conclusion In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.
... Dynamic navigation has been widely used as a method of student training in oral and maxillofacial surgery [7] and root canal treatment [8]. In implant dentistry, dynamic navigation is beneficial to improve the accuracy of implant placement [9][10][11][12] and provides an alternative to training in surgical procedures. Through dynamic navigation, students can design the three-dimensional implant position in software, visualize the implant site on a computer screen, receive real-time feedback and make adjustments, and compare the final implant position with the presurgical design. ...
Article
Full-text available
Objectives To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training. Methods Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire. Results A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training. Conclusions Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.
... The accuracy of dynamic navigation was 1.05 ± 0.44 mm for the entry point, 1.29 ± 0.50 mm for the apex point, and 3.06 ± 1.37° for angular deviation, and that for the static guide group was 0.97 ± 0.44 mm for the entry point, 1.28 ± 0.46 mm for the apex point, and 2.84 ± 1.71° for angular deviation, indicating only small differences in accuracy between the two. Yimarj et al. [15] compared the placement position and parallelism accuracy in 60 patients who required two consecutive implants using a static guide and dynamic navigation (IRIS-100). The accuracy of dynamic navigation was 1.24 ± 0.39 mm for the entry point, 1.58 ± 0.56 mm for the apex point, and 3.78 ± 1.84° for the angular deviation, while that of the static guide was 1.04 ± 0.67 mm for the entry point, 1.54 ± 0.79 mm for the apex point, and 4.08 ± 1.69° for angular deviation, indicating negligible differences. ...
Article
Full-text available
Background Dynamic navigation for implant placement is becoming popular under the concept of top-down treatment. The purpose of this study is to verify the accuracy of a dynamic navigation system for implant placement. Methods Implant placement was performed on 38 patients using 50 implant fixtures. Patients in group C were treated using a conventional method, in which thermoplastic clips were fixed to the teeth, and patients in group M were treated using thermoplastic clips fixed to a mouthpiece attached to the teeth. The groups were compared to verify whether an accuracy difference existed. A treatment planning support program for dental implants was used to superimpose the postoperative computed tomography data on the preoperative implant design data to measure the entry point, apex point, and angular deviation. Results The accuracy of group C was 1.36 ± 0.51 mm for entry point, 1.30 ± 0.59 mm for apex point, and 3.20 ± 0.74° for angular deviation. The accuracy of group M was 1.06 ± 0.31 mm for the entry point, 1.02 ± 0.30 mm for the apex point, and 2.91 ± 0.97° for angular deviation. Significant differences were observed in the entry and apex points between the two groups. Conclusions The results indicate that group M exhibited better accuracy than group C, indicating that the stability of the thermoplastic clip is important for ensuring the accuracy of the dynamic navigation system. No previous studies have verified the accuracy of this system using the mouthpiece method, and additional data is required to confirm its accuracy for dental implant placement. The mouthpiece method improves the accuracy of implant placement and provides a safer implant treatment than the conventional method. Trial registration University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Registration Number: UMIN000051949, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view_his.cgi on August 21, 2023.
... and distal apex deviation (P = .03) with the use of dynamic CAIS [37]. In this respect the 3D deviations of most implants reported with mesial, buccal and apical further deviation than the planned positon were consistent with the ndings of Chen W et al. [40] (Figs. 7). ...
Preprint
Full-text available
Objectives Robots have been increasingly being used for surgical procedures in different specialties. However, information about the accuracy of robot-assisted dental implant surgery is lacking. The purpose of this pilot clinical study was to investigate the accuracy of an autonomous dental implant robotic (ADIR) system in partially edentulous cases. Material and methods The ADIR system was used to place a total of 20 implants in 13 participants. Implant deviation from the planned positions was assessed to determine accuracy.The entry, apex, and angular deviations were described as means ± standard deviation. A 2-sample t test was used to compare implant deviation between the flap and flapless groups and between maxillary and mandibular implants (α = .05). Results The entry, apex, and angular deviations were 0.65 ± 0.32 mm, 0.66 ± 0.34 mm, and 1.52 ± 1.01 degrees, respectively, with no ststistically significant difference between the flap and flapless approaches (P > .05 ). No adverse events were encountered in any of the participants. Conclusions ADIR accuracy in this clinical series was comparable to that reported for static and dynamic computer-assisted implant surgery (CAIS). Robotic CAIS may be useful for dental implant placement, and may increase the quality and safety of the procedure. Clinical relevance The findings of this study shows that ADIR system might be a potential alternative for dental implant surgery.
... This suggests that dCAIS is a reliable and effective method for dental implant placement. [35][36][37] Similar to sCAIS protocols, becoming proficient in using a dCAIS takes time and practice. The learning curve for developing this proficiency can vary significantly and is influenced by the individual clinician's abilities and experience. ...
Article
Background The aim of this scoping review was to understand the development of robotics and its accuracy in placing dental implants when compared to other forms of guided surgery. Methods An electronic search was conducted on the electronic databases of PubMed, Cochrane, and Science direct with the following queries: ((robotics) AND (dental implant)) AND (accuracy). The search timeline was between 2017 and 2022. Results A total of 54 articles were screened for title and abstract, of which 16 were deemed eligible for inclusion. Thirty‐one articles were excluded mainly because they were out of topic (not relevant) or not in English. In total, 16 articles were included for analysis. Conclusions This review thoroughly analyses 5 years of literature concerning the evolution of robotics in dental implant surgery, underscoring the necessity for additional research on nascent technologies reported and a comparative study with static and dynamic systems for clinical efficacy evaluation.
... In implant-guided surgeries, surgical guides are important tools used for transferring the digitally planned implant depth and angulations from the design software program to the patient's mouth [3][4][5]. Many factors influence the accuracy of guided surgeries, such as the number of remaining natural teeth that will provide surgical guide support and the quality of the guide design, starting from virtual data acquisition from the patient, and data alignment to guide manufacture by either 3D printing or milling [6,7]. ...
Article
Full-text available
A technique for the design of a hybrid tooth and bone-supported implant drilling guide is described. The patient was scanned using cone beam computed tomography and an optical intraoral scanner. The dicom file was segmented according to the area of interest composed of bone and the remaining natural teeth. The Standard Tessellation Language (STL) file was trimmed to only the teeth providing support, followed by merging between the bone and teeth files in one STL. The implant drilling guide was designed with the Real Guide software program, and the file was 3-dimensionally printed in clear surgical guide resin. This technique offers an accurate, cost-effective digitally designed implant placement guide for patients with long-span distal extension edentulous areas and few remaining natural dentitions providing distal bone support. It can also be used in patients with hemi maxillectomy for zygomatic implant placement. This type of surgical guide provides more accuracy in implant surgeries that require flab elevation by gaining more support from the remaining natural dentition.
... Consistently, these studies reported that the neck, root, and angle deviations in dynamic navigation-assisted and static guide plate-assisted implantation were smaller than those in free-hand implantation, corroborating the findings of the present study. However, these studies did not identify significant differences in the accuracy between navigation-assisted and template-assisted implantation [30,31]. This may be attributed to the fact that these studies did not specifically focus on mandibular posterior dental implants and immediate implant placement (IIP). ...
Article
Full-text available
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.
... Dynamic navigation provides real-time feedback to assist the surgeon in completing the implant surgery (Kaewsiri et al., 2019;Yimarj et al., 2020). A prospective cohort study revealed that angular deviation of the actual implant position in navigation surgery is about 3° relative to the planned position, which is as accurate as fully guided static surgery (Block et al., 2017). ...
Article
Objectives This prospective clinical study aimed to evaluate the accuracy and 1‐year clinical follow‐up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full‐arch implant surgery. Materials and Methods Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP‐FC) were recorded. Results Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance ( p > .05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations ( p > .05). The periodontal parameters, the BBT, and IP‐FC remained stable during 1‐year follow‐up. Conclusion The ADIR system showed excellent positional accuracy. The 1‐year follow‐up after full‐arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full‐arch implant surgery.
... In this case, the deviation for shoulder displacement, apex displacement, and angular deviation were 0.42 mm, 0.42 mm, and 0.65°, respectively. These measurements indicate higher precision in comparison to reported errors from dynamic navigation (1.24 ± 0.39 mm, 1.58 ± 0.56 mm, 3.78° ± 1.84°), static navigation (0.87 ± 0.49 mm, 1.10 ± 0.53 mm, 2.41° ± 1.47°) and freehand methods (1.3 ± 0.7 mm, 2.2 ± 1.2 mm, 7.0° ± 7.0°) (29,30). Current researches show that several factors affect the accuracy of digital navigation systems, including the precision of CBCT and oral scanning (or die removal), flap design, implant positioning, interference from cortical bone, stability of the guide plate, length of the drill bit and stem, compatibility between the guide rail and the drill bit, and the errors procedural of operator (31,32). ...
Article
Full-text available
Background Immediate implant placement (IIP), which preserves gingival height and papilla shape while simultaneously accelerating the implant treatment period, has become a popular method due to its commendable clinical outcomes. Nonetheless, deploying immediate implants demands specific preconditions concerning the remaining alveolar bone. This poses a challenge to the accuracy of implant surgery. Case presentation In this report, we present the case of a 60-year-old woman with a left upper anterior tooth crown dislodged for over a month. Cone beam computed tomography (CBCT) revealed the absence of a labial bone wall on tooth 22, a remaining 1 mm bone wall on the labial side of the root apex, and a 17.2 mm*8.9 mm*4.7 mm shadow in the periapical region of the root apices of teeth 21 and 22, with the narrowest width on the sagittal plane being approximately 5 mm. After the surgeon removed the cyst, they completed the subsequent implantation surgery using an autonomous robot in a challenging aesthetic area. This method circumvented the potential exposure of the screw thread on the labial implant surface, assured initial implant stability. Conclusion Five months after the operation, the dental crown was restored. The implant remained stable, with yielding notable clinical results. To the best of our knowledge, this clinical case is the first to report the feasibility and precision of immediate implantation in anterior teeth site with periapical cyst removal, performed by an autonomous robotic surgical system. Autonomous robots exhibit exceptional accuracy by accurately controlling axial and angular errors. It can improve the accuracy of implant surgery, which may become a key technology for changing implant surgery. However, further clinical trials are still needed to provide a basis for the rapid development of robotic surgery field.
... Numerous studies have shown that both static guidance and dynamic navigation provide better accuracy than freehand implantation. [8][9][10][11] In 2018, during the ITI consensus discussion, it was reported that static computer-assisted implant surgery had a global platform deviation of 1.2 mm, a global apical deviation of 1.5 mm, and an angle deviation of 3.5° on average, meeting safety standards in most cases. [12] However, static guides have certain limitations: fabricating preoperative guide plates takes time and incurs cost; intraoperative surgical plans cannot be altered in real-time; there is a risk of bone burn; patient's mouth opening affects the procedure; specific implant surgical tools are required. ...
Article
Full-text available
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.
... CAIS has been widely applied to ensure accurate implant positioning, which affects subsequent aesthetic and prosthetic outcomes, such as occlusion, implant loading, and dental hygiene [10,32]. Numerous studies have investigated the accuracy of implant placement and patient-centered results of s-CAIS and d-CAIS at individual tooth sites or in partially edentulous jaws [33,34]. However, limited clinical studies have compared the accuracy of implant positioning and patient-centered results between s-CAIS and d-CAIS in fully edentulous patients receiving multiple implants. ...
Article
Full-text available
Objectives This study aimed to compare implant positioning accuracy and patient-centered results between static and dynamic computer-assisted implant surgery (s-CAIS and d-CAIS) in edentulous jaws. Material and methods The current study retrospectively evaluated a total of 110 implants placed in 22 fully edentulous patients via s-CAIS or d-CAIS (n = 11). The accuracy of implant positioning was assessed by measuring the implant’s angular deviation and deviation at the platform and apex from the preoperative design postoperatively. Patient-centered results, including preoperative and intraoperative patient-reported experiences and postoperative patient-reported outcomes, were extracted from the medical records. The nested t test and chi‐square test were used to compare accuracy and patient-centered results between s-CAIS and d-CAIS postoperatively. Results The implants in the s-CAIS group showed significantly smaller angular deviation (2.32 ± 1.23°) than those in the d-CAIS group (3.87 ± 2.75°). In contrast, the platform and apical deviation were significantly larger in s-CAIS (1.56 ± 1.19 mm and 1.70 ± 1.09 mm, respectively) than d-CAIS (1.02 ± 0.45 mm and 1.00 ± 0.51 mm, respectively). Furthermore, the implants in the s-CAIS group deviated significantly (p < 0.001) more toward the coronal direction than those in the d-CAIS group. Notably, all patients in the s-CAIS group reported an obvious foreign body sensation during surgery, representing a significant difference from the d-CAIS group. Conclusions Compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation and less foreign body sensation. Trial registration. The retrospective study was registered on the Chinese Clinical Trial Registry on August 8th, 2022, with registration number No. ChiCTR2200062484. Clinical relevance Despite the increasing use of computer- assisted implant surgery in fully edentulous patients, clinical evidence comparing implant positioning accuracy and patient-centered results between static and dynamic CAIS systems is scarce. Our study demonstrated that compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation.
... It is evident that freehand surgery can result in greater deviations between the planned and the real position of the implant compared to the results of implant positioning through a surgical template. In this sense, it would be interesting to compare different static guided surgery systems and their reported deviations or static guided surgery systems with dynamic navigation systems, as proposed by several authors [44,45]. In addition, the present study evaluated only the accuracy of immediate implant placement without a comparative evaluation of the clinical outcome, which may have more value for incorporation in clinical scenarios. ...
Article
Purpose: This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery. Methods: An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n=40 implants) and static guided surgery with R2Gate® (Megagen, Gyeongbuk, South Korea, test group, n=40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment. Results: In the freehand group (control), crestal deviations of 1.13 ± 0.89 mm and 1.00 ± 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 ± 0.26 mm (p<0.001) and 0.37 ± 0.24 mm (p=0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 ± 1.90 mm vs. 0.97 ± 0.55 mm, p=0.04) and buccolingual directions (3.46 ± 1.82 mm vs. 0.94 ± 0.67 mm, p=0.02). Freehand surgery had greater angular deviation (6.09° ± 3.23) compared to guided surgery (0.83° ± 0.53, p=0.02). However, depth deviation was similar in the freehand surgery group (2.24 ± 1.58 mm) and static guided surgery group (0.66 ± 0.43, p=0.09). Conclusions: Immediate implant placement with static guided surgery demonstrated better accuracy than freehand surgery. Statement of clinical relevance: Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.
... In vivo and in vitro studies have been performed for exploring influence factors in accurate implant placement. The results of these studies have promoted improvements in selection of assisted surgery systems [1][2][3], selection of implant macro designs [4], selection of guide types [5], guide template design [6], selection of surgical protocols [7] and application of dedicated surgical instruments [8]. However, those articles only focused on the implant insertion accuracy without notice of bony preparation accuracy during the surgery. ...
Article
Full-text available
A digital workflow to acquire actual position of the drill and assess bony preparation accuracy intraoperatively was described. Based on the widely used intraoral scanner, this digital workflow was a relatively practical and economical option for digital intraoperative measurement. As a result, it could help the clinician in accurate verification and immediate correction of the drill position and consequently facilitating the accurate implant placement in implant surgery.
... Regarding flap reflection, six studies [36][37][38][39][40][41] combined the flap and flapless approaches, while five studies placed all the implants after raising a flap [32,33,[42][43][44]. Four papers did not specify what approach was used [34,[45][46][47]. The year of publication of the investigations ranged between 2008 and 2020. ...
Article
Full-text available
(1) Background: Dynamic guided surgery is a computer-guided freehand technology that allows highly accurate procedures to be carried out in real time through motion-tracking instruments. The aim of this research was to compare the accuracy between dynamic guided surgery (DGS) and alternative implant guidance methods, namely, static guided surgery (SGS) and freehand (FH). (2) Methods: Searches were conducted in the Cochrane and Medline databases to identify randomized controlled clinical trials (RCTs) and prospective and retrospective case series and to answer the following focused question: “What implant guidance tool is more accurate and secure with regard to implant placement surgery?” The implant deviation coefficient was calculated for four different parameters: coronal and apical horizontal, angular, and vertical deviations. Statistical significance was set at a p-value of 0.05 following application of the eligibility criteria. (3) Results: Twenty-five publications were included in this systematic review. The results show a non-significant weighted mean difference (WMD) between the DGS and the SGS in all of the assessed parameters: coronal (n = 4 WMD = 0.02 mm; p = 0.903), angular (n = 4 WMD = −0.62°; p = 0.085), and apical (n = 3 WMD = 0.08 mm; p = 0.401). In terms of vertical deviation, not enough data were available for a meta-analysis. However, no significant differences were found among the techniques (p = 0.820). The WMD between DGS and FH demonstrated significant differences favoring DGS in three parameters as follows: coronal (n = 3 WMD = −0.66 mm; p =< 0.001), angular (n = 3 WMD = −3.52°; p < 0.001), and apical (n = 2 WMD = −0.73 mm; p =< 0.001). No WMD was observed regarding the vertical deviation analysis, but significant differences were seen among the different techniques (p = 0.038). (4) Conclusions: DGS is a valid alternative treatment achieving similar accuracy to SGS. DGS is also more accurate, secure, and precise than the FH method when transferring the presurgical virtual implant plan to the patient.
... CAIS can be performed using static guides or dynamic navigation (D'haese et al., 2017). The static guide has some limitations in that it requires additional fabrication time, has insufficient cooling in the surgical field and is not suitable for simultaneous grafting procedures, but dynamic navigation does not have these disadvantages (D'haese et al., 2017;Panchal et al., 2019;Yimarj et al., 2020). However, dynamic navigation has a certain learning curve . ...
Article
Objectives The aim of this study was to compare the accuracy of dental implant placement in a single tooth gap, including the postextraction site and healed site, using a task-autonomous robotic system and a dynamic navigation system. Materials and Methods Forty partially edentulous models requiring both immediate and conventional implant placement were randomly divided into a robotic system group and a navigation system group. The coronal, apical, and angular deviations of the implants were measured and assessed between the groups. Results The deviations in immediate implant placement were compared between the robotic system and dynamic navigation system groups, showing a mean (±SD) coronal deviation of 0.86 ± 0.36 versus 0.70 ± 0.21 mm (p = .101), a mean apical deviation of 0.77 ± 0.34 versus 0.95 ± 0.38 mm (p = .127), and a mean angular deviation of 1.94 ± 0.66° versus 3.44 ± 1.38° (p < .001). At the healed site, significantly smaller coronal deviation (0.46 ± 0.29 vs. 0.70 ± 0.30 mm, p = .005), apical deviation (0.56 ± 0.30 vs. 0.85 ± 0.25 mm, p < .001), and angular deviation (1.36 ± 0.54 vs. 1.80 ± 0.70 mm, p = .034) were found in the robotic system group than in the dynamic navigation group. Conclusions The position in both immediate and conventional implant placement was more precise with the task-autonomous robotic system than with the dynamic navigation system. Its performance in actual clinical applications should be confirmed in further trials.
Article
Implant placement for dental rehabilitation has gained more popularity among patients in the recent past. Dental Implants are the workhorse of dentistry. Previously, the implants were placed with the help of the traditional freehand approach. Even though the conventional technique was successful, it has his own shortcomings. Various methods have been introduced, like stent-guided implant placement and navigation guided implant placement, that enhance the precision of implant position. The three different methods for placing the implants are freehand approach, static navigation and dynamic navigation. Among these approaches, the dynamic navigation system is a promising technology in implant dentistry. The dynamic navigation system is being used successfully in various other fields and is well known for its accuracy. It gives an advantage to clinician by providing real-time three-dimensional position of implant and better clinical and patient related treatment outcomes. This review summarizes-the literature and evidence available on dynamic navigation, its potential application, advantages, disadvantages with future directions.
Article
Objectives To assess the efficacy of dynamic computer‐aided surgery (dCAS) in replacing a single missing posterior tooth, we compare outcomes when using registration‐and‐fixation devices positioned anterior or posterior to the surgical site. Registration is performed on either the anterior or opposite posterior teeth. Methods Forty individuals needing posterior single‐tooth implant placement were randomly assigned to anterior or posterior registration. Nine parameters were analyzed to detect the deviations between planned and actual implant placement, using Mann–Whitney and t ‐tests for nonnormally and normally distributed data, respectively. Results The overall average angular deviation for this study was 2.08 ± 1.12°, with the respective average 3D platform and apex deviations of 0.77 ± 0.32 mm and 0.88 ± 0.32 mm. Angular deviation values for individuals in the anterior and posterior registration groups were 1.58°(IQR: 0.98°–2.38°) and 2.25°(IQR: 1.46°–3.43°), respectively ( p = .165), with 3D platform deviations of 0.81 ± 0.29 mm and 0.74 ± 0.36 mm ( p = .464), as well as 3D apex deviations of 0.89 ± 0.32 mm and 0.88 ± 0.33 mm ( p = .986). No significant variations in absolute buccolingual (platform, p = .659; apex, p = .063), apicocoronal (platform, p = .671; apex, p = .649), or mesiodistal (platform, p = .134; apex, p = .355) deviations were observed at either analyzed levels. Conclusions Both anterior and posterior registration approaches facilitate accurate dCAS‐mediated implant placement for single missing posterior teeth. The device's placement (posterior‐to or anterior‐to the surgical site) did not affect the clinician's ability to achieve the planned implant location.
Article
The development of dynamic navigation system (DNS) has facilitated the development of modern digital medicine. In the field of dentistry, the cutting-edge technology is garnering widespread recognition. Based on the principles of 3-dimensional visualization, virtual design, and precise motion tracking, DNS is mainly composed of a computer, a tracking system, specialized tracer instruments, and navigation software. DNS employs a workflow that begins with preoperative data acquisition and imaging data reconstruction, followed by surgical instrument calibration and spatial registration, culminating in real-time guided operations. Currently, the system has been applied in a broad spectrum of dental procedures, encompassing dental implants, oral and maxillofacial surgery (such as tooth extraction, the treatment of maxillofacial fractures, tumors, and foreign bodies, orthognathic surgery, and temporomandibular joint ankylosis surgery), intraosseous anesthesia, and endodontic treatment (including root canal therapy and endodontic surgery). These applications benefit from its enhancements in direct visualization, treatment precision, efficiency, safety, and procedural adaptability. However, the adoption of DNS is not without substantial upfront costs, required comprehensive training, additional preparatory time, and increased radiation exposure. Despite challenges, the ongoing advancements in DNS are poised to broaden its utility and substantially strengthen digital dentistry.
Article
Full-text available
Objective This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. Methods A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. Results Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta‐analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. Conclusion Meta‐analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.
Article
Objectives To gauge the relative accuracy of the use of passive and active dynamic navigation systems when placing dental implants, and to determine how registration areas affect the performance of these systems. Materials and Methods Eighty implants were assigned to be placed into 40 total resin mandible models missing either the left or right first molars using either passive or active dynamic navigation system approaches. U‐shaped tube registration devices were fixed in the edentulous site for 20 models each on the left or right side. Planned and actual implant positions were superimposed to assess procedural accuracy, and parameters including 3D entry deviation, angular deviation, and 3D apex deviation were evaluated with Mann–Whitney U tests and Wilcoxon signed‐rank tests. Results Respective angular, entry, and apex deviation values of 1.563 ± 0.977°, 0.725 ± 0.268 mm, and 0.808 ± 0.284 mm were calculated for all included implants, with corresponding values of 1.388 ± 1.090°, 0.789 ± 0.285 mm, and 0.846 ± 0.301 mm in the active group and 1.739 ± 0.826°, 0.661 ± 0.236 mm, and 0.769 ± 0.264 mm in the passive group. Only angular deviation differed significantly among groups, and the registration area was not associated with any significant differences among groups. Conclusions Passive and active dynamic navigation approaches can achieve comparable in vitro accuracy. Registration on one side of the missing single posterior tooth area in the mandible can complete single‐tooth implantation on both sides of the posterior teeth, highlighting the promise of further clinical research focused on this topic.
Article
Statement of problem: Dynamic computer-assisted surgery for dental implant placement has become popular, but systematic comparisons of the accuracy of computer-assisted surgery with static surgery are lacking. Purpose: The purpose of this systematic review and meta-analysis was to determine evidence on the difference in the accuracy of dynamic computer-assisted surgery compared with the static method for dental implant placement. Material and methods: A systematic search was conducted in 3 electronic databases: PubMed, Ovid, and Cochrane. Studies conducted on dental implants that compared the accuracy of positioning implants with a dynamic system with that of a static system were included. Randomized clinical trials, prospective and retrospective cohort studies, and in vitro studies were included in the review. Review articles, case reports, letters, opinion articles, commentaries, and nonpeer-reviewed literature were excluded. Results: Of the 26 full-text articles, 14 fulfilled the inclusion criteria. Of these, 2 were randomized clinical trials, 2 were prospective studies, and 1 was a retrospective cohort study. The remaining 9 were in vitro studies. A total of 1633 implants were placed with the static and 902 with the dynamic method. A significant mean difference (-0.51 degrees [95% CI: -0.90, -0.13]) between dynamic and static systems was only observed in the angular deviation of in vitro studies (P=.009). Meta-analysis was performed using Review Manager statistical software and forest plots were generated. Conclusions: A difference was found in the angular deviation of implants placed with the dynamic approach compared with the static system. The dynamic system was better, but this difference was not demonstrable in clinical studies. No significant difference was found in the apical and coronal deviations of the dynamic and static systems.
Article
Objectives: To evaluate the accuracy of implant placement using a dynamic navigation system in fully edentulous jaws and to analyze the influence of implant distribution on implant position accuracy. Materials and methods: Edentulous patients who received implant placement using a dynamic navigation system were included. Four to six mini screws were placed in the edentulous jaw under local anesthesia as fiducial markers. Then patients received CBCT scans. Virtual implant positions were designed in the planning software based on CBCT data. Under local anesthesia, implants were inserted under the guidance of the dynamic navigation system. CBCTs were taken following implant placement. The deviation between the actual and planned implant positions was measured by comparing the pre- and postsurgery CBCT. Results: A total of 13 edentulous patients with 13 edentulous maxillae and 7 edentulous mandibles were included, and 108 implants were placed. The average linear deviations at the implant entry point and apex were 1.08 ± 0.52 mm and 1.15 ± 0.60 mm, respectively. The average angular deviation was 2.85 ± 1.20°. No significant difference was detected in linear and angular deviations between the maxillary and mandibular implants, neither between the anterior and posterior implants. Conclusions: The dynamic navigation system provides high accuracy for implant placement in fully edentulous jaws, while the distribution of the implants showed little impact on implant position accuracy.
Article
Full-text available
Background/purpose Computer-assisted dynamic navigation surgery could provide accurate implant placement. However, its low efficiency was always criticized by dental surgeons. The purpose of this study was to evaluate the accuracy and efficiency of a calibration approach with reflective wafers in dynamic navigation for implant placement. Materials and methods Eighty implants were placed in the standardized polyurethane mandibular models under dynamic navigation and divided into 2 groups according to the calibration methods (n = 40). The U-shaped tube (UT) group used a prefabricated U-shaped tube embedded with radiopaque markers. The reflective wafers (RW) group used a fixation with 3 round reflective wafers as markers. Postoperative cone beam computed tomography images were obtained for implants deviation analyses. The calibration time was used to evaluate the efficiency of the 2 methods. Results Significant differences were found in the trueness and efficiency between the 2 groups (P < 0.05). The 3D deviations at the implant platform and apex were smaller in UT group (0.89 ± 0.28 and 0.79 ± 0.30 mm, respectively) than in the RW group (0.99 ± 0.28 and 0.98 ± 0.30 mm, respectively). The angular deviation was larger in the UT group (2.16 ± 1.12°) than in the RW group (1.53 ± 0.88°). The calibration approach of RW group was more efficient than the UT group (2.05 ± 0.55 and 7.50 ± 0.71 min, respectively). Conclusion The calibration method of RW improved the efficiency significantly and achieved equivalent trueness with UT for dynamic navigation during implant placement.
Article
Background: The ameloblastoma is a benign but locally aggressive epithelial odontogenic neoplasm. Although rare, the ameloblastoma is the most common odontogenic tumor associated with the maxillofacial complex which possesses a significant propensity for local recurrence in the setting of conservative treatment. Concordantly, definitive therapy is predicated on wide surgical excision with reconstruction of ablative defects dictated by the resultant tissue defects. The purpose of this report is to highlight specific treatment and reconstructive challenges, emphasizing the essential need for collaborative patient care within a large multidisciplinary team. Case description: A 31-year-old Vietnamese-speaking male was referred for management of an extensive ameloblastoma associated with the left mandible. Management consisted of a bilateral composite mandibular resection and reconstruction via free tissue transfer utilizing an osteocutaneous fibular free flap. Histopathologic analysis confirmed the diagnosis of a conventional ameloblastoma. Delayed oral rehabilitation employing virtual surgical planning to facilitate the placement of endosseous implants with immediate loading of a fixed acrylic prosthesis was accomplished in the post-operative period without any evidence of recurrence. Practical implications: Multidisciplinary collaboration in the setting of advanced odontogenic tumors is paramount in enhancing treatment outcomes. This case strengthens the need for accurate and rapid diagnosis in the primary care setting with collaborative interprofessional management utilizing advances in digital technologies to optimize both functional and aesthetic outcomes which have significant influence over long-term quality-of-life.
Article
Background: Modern technological advancements have led to increase in the development of surgical robots in dentistry, resulting in excellent clinical treatment outcomes. Purpose: This study aimed to determine the accuracy of automatic robotic implant site preparation for different implant sizes by correlating planned and posttreatment positions, and to compare the performance of robotic and human freehand drilling. Method: Seventy-six drilling sites on partially edentulous models were used, with three different implant sizes (Ø = 3.5 × 10 mm, 4.0 × 10 mm, 5.0 × 10 mm). The robotic procedure was performed using software for calibration and step-by-step drilling processes. After robotic drilling, deviations in the implant position from the planned position were determined. The angulation, depth, and coronal and apical diameters on the sagittal plane of sockets created by human and robotic drilling were measured. Results: The deviation of the robotic system was 3.78° ± 1.97° (angulation), 0.58 ± 0.36 mm (entry point), and 0.99 ± 0.56 mm (apical point). Comparison of implant groups showed the largest deviation from the planned position for 5 mm implants. On the sagittal plane, there were no significant differences between robotic and human surgery except for the 5-mm implant angulation, indicating similar quality between human and robotic drilling. Based on standard implant measurements, robotic drilling exhibited comparable performance to freehand human drilling. Conclusions: A robotic surgical system can provide the greatest accuracy and reliability regarding the preoperative plan for small implant diameters. In addition, the accuracy of robotic drilling for anterior implant surgery can also be comparable to that of human drilling.
Article
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).
Article
Background: Dynamic Computer Assisted Implant Surgery (CAIS) systems have beenshown to improve accuracy of implant placement, thus training in the use of suchsystems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate universityeducation. Purpose: To determine the effectiveness of two modes of CAIS training programs onmotor skill acquisition of novice surgeons. Materials and methods: Thirty-six postgraduate students without experience indynamic CAIS systems were randomly assigned to a distributed training program(3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level. Results: Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference—0.4, 95% confidence interval—0.7–0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference—95.0, 95% confidence interval—178.8to �11.2). Conclusions: Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of differ� ent days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002.
Article
Full-text available
Objectives To assess the literature on the accuracy of static computer‐assisted implant surgery in implant dentistry. Materials and Methods Electronic and manual literature searches were conducted to collect information about the accuracy of static computer‐assisted implant systems. Meta‐regression analysis was performed to summarise the accuracy studies. Results From a total of 372 articles. 20 studies, one randomised controlled trial (RCT), eight uncontrolled retrospective studies and 11 uncontrolled prospective studies were selected for inclusion for qualitative synthesis. A total of 2,238 implants in 471 patients that had been placed using static guides were available for review. The meta‐analysis of the accuracy (20 clinical) revealed a total mean error of 1.2 mm (1.04 mm to 1.44 mm) at the entry point, 1.4 mm (1.28 mm to 1.58 mm) at the apical point and deviation of 3.5°(3.0° to 3.96°). There was a significant difference in accuracy in favour of partial edentulous comparing to full edentulous cases. Conclusion Different levels of quantity and quality of evidence were available for static computer‐aided implant surgery (s‐CAIS). Based on the present systematic review and its limitations, it can be concluded that the accuracy of static computer‐aided implant surgery is within the clinically acceptable range in the majority of clinical situations. However, a safety marge of at least 2 mm should be respected. A lack of homogeneity was found in techniques adopted between the different authors and the general study designs.
Article
Full-text available
Purpose: The aim of this systematic review was to analyze the accuracy of implant placement using computer-guided surgery and to compare virtual treatment planning and outcome in relation to study type (in vitro, clinical, or cadaver). A further objective was to compare the accuracy of half-guided implant surgery with that of full-guided implant surgery. Materials and methods: A PubMed search was performed to identify studies published between January 2005 and February 2015, searching the keywords "reliability AND dental implant planning" and "accuracy dental implant planning." Inclusion criteria were established a priori. Horizontal coronal deviation, horizontal apical deviation, angular deviation, and vertical deviation were analyzed. Results: A total of 186 articles were reviewed, and 34 fulfilled the inclusion criteria. Information about 3,033 implants was analyzed in 8 in vitro studies (543 implants), 4 cadaver studies (246 implants), and 22 clinical studies (2,244 implants). Significantly less horizontal apical deviation and angular deviation were observed in in vitro studies compared to clinical and cadaver studies, but there were no statistically significant differences in apical coronal deviation or vertical deviation between the groups. Compared to half-guided surgery, full-guided implant surgery showed significantly less horizontal coronal deviation for cadaver studies, significantly less horizontal apical deviation for clinical studies, and significantly less angular deviation for both clinical and cadaver studies. Conclusion: Implant placement accuracy was lower in clinical and cadaver studies compared with in vitro studies, especially in terms of horizontal apical deviation and angular deviation. Full-guided implant surgery achieved greater accuracy than half-guided surgery.
Article
Full-text available
Purpose: The aim of this prospective study was to determine platform and angle accuracy for dental implants using dynamic navigation, a form of computer-assisted surgery. Three hypotheses were considered: (1) the overall accuracy for implant placement relative to the virtual plan is similar to that of static tooth-borne computerized tomography (CT)-generated guides; (2) the dynamic system is more accurate than freehand methods; and (3) there is a learning curve associated with this method. Materials and methods: This study involved three surgeons placing implants in the mandible and maxilla of patients using a dynamic navigation system (X-Guide, X-Nav Technologies). Virtual implants were placed into planned sites using the navigation system computer. Post-implant placement cone beam CT scans were taken on all patients. For each patient, this scan was mesh overlayed with the virtual plan and used to determine platform and angular deviations to the virtual plan. The primary outcome variables were platform and angular deviations, comparing the actual placement to the virtual plan. Secondary analyses included determination of accuracy related to case experience and freehand placement of implants. Comparisons to published accuracy studies were made for implant placement using static guides. Results: Accuracy deviations from the virtual plan were similar to those reported for static tooth-based guides using literature references as the comparison. The accuracy of dynamic navigation was superior compared to freehand implant placement. The three surgeons had similar accuracies after their learning curve was achieved. Proficiency based on case series was achieved by the 20th surgical procedure. Conclusion: Dynamic navigation can achieve accuracy of implant placement similar to static guides and is an improvement over freehand implant placement. In addition, there was a learning curve to achieve proficiency.
Article
Full-text available
The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed. © 2015 American Association of Oral and Maxillofacial Surgeons.
Article
Full-text available
Objectives: To implement and evaluate the accuracy of a prototype dynamic computer-assisted surgery (CAS) system for implant osteotomy preparation and compare its accuracy vs. three commercial static CAS systems and the use of an acrylic stent. Material and methods: Eight osteotomies were prepared in radiopaque partially edentulous mandible and maxilla typodonts. After cone-beam CT acquisition, DICOM files were imported into a prototype dynamic, and three static CAS systems (NobelClinician, Simplant, and CoDiagnostiX). Implant placements were planned to replicate the existing osteotomies and respective guides were requisitioned, along with one laboratory-made acrylic guide. The eight osteotomies per jaw were transferred to one typodont pair mounted in a manikin in a clinical setting and the process was repeated for four additional pairs. The 80 (two jaws × eight holes × five pairs) osteotomies were filled with radiopaque cement in-between the testing series. Three clinicians experienced with the use of the static CAS softwares used in this study prepared each 400 (80 holes × five modalities) osteotomies. One clinician repeated the experiment twice, resulting in a total of 2000 (five clinicians × 400) osteotomies. The lateral, vertical, total, and angular deviations of the actual vs. the original osteotomies in the master typodonts were measured using stereo optical tracking cameras. Linear regression statistics using generalized estimating equations were used for comparisons between the five modalities and omnibus chi-square tests applied to assess statistical significance of differences. Results: The prototype dynamic CAS system was as accurate as other implant surgery planning and transfer modalities. The dynamic and static CAS systems provide superior accuracy vs. a laboratory-made acrylic guide, except vertically. Both dynamic and static CAS systems show on average <2 mm and 5 degrees error. Large deviations between planned and actual osteotomies were occasionally observed, which needs to be considered in clinical practice. Conclusions: The prototype dynamic CAS system was comparably accurate to static CAS systems.
Article
Full-text available
Computer-aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer-aided dental implant surgery still requires improvement and should be considered as in the developmental stage.
Article
Full-text available
To assess the literature on accuracy and clinical performance of computer technology applications in surgical implant dentistry. Electronic and manual literature searches were conducted to collect information about (1) the accuracy and (2) clinical performance of computer-assisted implant systems. Meta-regression analysis was performed for summarizing the accuracy studies. Failure/complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 12-month proportions. Twenty-nine different image guidance systems were included. From 2,827 articles, 13 clinical and 19 accuracy studies were included in this systematic review. The meta-analysis of the accuracy (19 clinical and preclinical studies) revealed a total mean error of 0.74 mm (maximum of 4.5 mm) at the entry point in the bone and 0.85 mm at the apex (maximum of 7.1 mm). For the 5 included clinical studies (total of 506 implants) using computer-assisted implant dentistry, the mean failure rate was 3.36% (0% to 8.45%) after an observation period of at least 12 months. In 4.6% of the treated cases, intraoperative complications were reported; these included limited interocclusal distances to perform guided implant placement, limited primary implant stability, or need for additional grafting procedures. Differing levels and quantity of evidence were available for computer-assisted implant placement, revealing high implant survival rates after only 12 months of observation in different indications and a reasonable level of accuracy. However, future long-term clinical data are necessary to identify clinical indications and to justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.
Article
Full-text available
When dental implants are not placed parallel to adjacent teeth or contiguous implants, the clinician can use angled abutments to achieve proper restorative contours. However, increased stresses on implants and bone have been associated with use of angled abutments. In this regard, there are unresolved issues concerning implant survival and potential prosthetic complications that can arise when angled abutments are used to align prosthetic positions. The authors searched the dental literature for clinical trials that appraised the survival rate and complications (biological and technical) associated with pros-theses that are supported by angled abutments. The results of photoelastic stress assessments, finite element analysis and strain-gauge studies indicated that increased abutment angulations result in the placement of a greater amount of stress on prostheses and the surrounding bone than that associated with straight abutments. However, survival studies did not demonstrate a significant decrease of prostheses' longevity associated with angled abutments. Furthermore, there was no additional bone loss adjacent to implants that supported angled abutments compared with straight abutments, and angled abutments did not manifest an increased incidence of screw loosening. The use of angled abutments facilitates paralleling nonaligned implants, thereby making prosthesis fabrication easier. These abutments also can aid the clinician in avoiding anatomical structures when placing the implants. In addition, use of angled abutments can reduce treatment time, fees and the need to perform guided bone regeneration procedures.
Article
Full-text available
To investigate the micromotion between the implant and surrounding bone caused by the implementation of an angled abutment for an immediately loaded single dental implant located in the anterior maxilla. A simplified half premaxillary bone model was fabricated. The dimension of the alveolar ridge was adopted from a dry human skull. Based on Brånemark protocol for Mk IV implants in type-3 bone, an immediate loading model was developed by press-fitting a 4-mm-diameter cylinder implant into a 3.15-mm osteotomy site in a numeric model. Material properties were assigned to the simulated model, and the model was meshed. A bite force of 89 N was applied to the tops of the 0-degree, 15-degree, and 25-degree angled abutments at a 120-degree angle to the abutment long axis. The micromotion between the bone-implant interfaces was calculated using ANSYS 9.0 software featuring a nonlinear contact algorithm. The micromotion values for 15-degree and 25-degree angled abutments were 119% and 134%, respectively, compared to the corresponding values for straight abutments. Compared to straight abutments, the 25-degree abutments resulted in increased maximum von Mises stresses to a level of 18%. Most of the stresses were concentrated within the cortical bone around the neck of the implants. Within the limits of the present finite element analysis study, abutment angulation up to 25 degrees can increase the stress in the peri-implant bone by 18% and the micromotion level by 30%.
Article
Data from cone beam computed tomography (CBCT) and optical scans (intraoral or model scanner) are required for computer-assisted implant surgery (CAIS). This study compared the accuracy of implant position when placed with CAIS guides produced by intraoral and extraoral (model) scanning. Forty-seven patients received 60 single implants by means of CAIS. Each implant was randomly assigned to either the intraoral group (n=30) (Trios Scanner, 3Shape) or extraoral group (n=30), in which stereolithographic surgical guides were manufactured after conventional impression and extraoral scanning of the stone model (D900L Lab Scanner, 3Shape). CBCT and surface scan data were imported into coDiagnostiX software for virtual implant position planning and surgical guide design. Postoperative CBCT scans were obtained. Software was used to compare the deviation between the planned and final positions. Average deviation for the intraoral vs. model scan groups was 2.42°±1.47° vs. 3.23°±2.09° for implant angle, 0.87±0.49mm vs. 1.01±0.56mm for implant platform, and 1.10±0.53mm vs. 1.38±0.68mm for implant apex; there was no statistically significant difference between the groups (P>0.05). CAIS conducted with stereolithographic guides manufactured by means of intraoral or extraoral scans appears to result in equal accuracy of implant positioning.
Article
Aim: This randomized controlled clinical trial (RCT) aimed to compare the accuracy of implant positions between static computer-assisted implant surgery (CAIS) and freehand implant surgery in a single edentulous space. Materials and methods: Sites with single edentulous spaces and neighbouring natural teeth were randomized into static CAIS or freehand implant surgery groups. In both groups, digital implant planning was performed using data from cone beam computed tomography (CBCT) and surface scans. In the static CAIS group, a surgical guide was produced and used for fully guided implant surgery, while in the freehand group, the implants were placed in a freehand manner. Postoperative CBCT was used for 9 measurements representing the deviations in angles, implant shoulders and apexes between planned and actual implant positions. Results: Fifty-two patients received 60 single implants. The median(IQR) deviations in angles, shoulders and apexes were 2.8(2.6)°, 0.9(0.8) mm and 1.2(0.9) mm, respectively, in the static CAIS group, and 7.0(7.0)°, 1.3(0.7) mm and 2.2(1.2) mm, respectively, in the freehand group. Statistically significant differences were found in 6 out of nine measured parameters using Mann Whitney U test (p < 0.05). Conclusion: Static CAIS provided more accuracy in implant positions than freehand placement in a single edentulous space. This article is protected by copyright. All rights reserved.
Article
Objectives The aim of this RCT was to compare the accuracy of implant placement between static and dynamic computer‐assisted implant surgery (CAIS) systems in single tooth space. Materials and methods A total of 60 patients in need of a single implant were randomly assigned to two CAIS groups (Static n = 30, Dynamic n = 30) and implants were placed by one surgeon. Preoperative CBCT was transferred to implant planning software to plan the optimal implant position. Implants were placed using either stereolithographic guide template (Static CAIS) or implant navigation system (Dynamic CAIS). Postoperative CBCT was imported to implant planning software, and deviation analysis with the planned position was performed. Primary outcomes were the deviation measurements at implant platform, apex, and angle of placement. Secondary outcome was the distribution of the implant deviation into each 3D direction. Results The mean deviation at implant platform and implant apex in the static CAIS group was 0.97 ± 0.44 mm and 1.28 ± 0.46 mm, while that in the dynamic CAIS group was 1.05 ± 0.44 mm and 1.29 ± 0.50 mm, respectively. The angular deviation in static and dynamic CAIS group was 2.84 ± 1.71 degrees and 3.06 ± 1.37 degrees. None of the above differences between the two groups reached statistical significance. The deviation of implants toward the mesial direction in dynamic CAIS group was significantly higher than that of the static CAIS (p = 0.032). Conclusions Implant placement accuracy in single tooth space using dynamic CAIS appear to be the same to that of static CAIS. (Thai Clinical Trials Registry TCTR20180826001).
Article
Aim: The purpose of this study was to determine if restoration emergence angle was associated with peri-implantitis. Materials and methods: A data set consisting of 96 patients with 225 implants (mean follow-up: 10.9 years) was utilized. Implants were divided into bone level and tissue level groups and radiographs were analyzed to determine the restoration emergence angles, as well as restoration profiles (convex or concave). Peri-implantitis was diagnosed based on probing depth and radiographic bone loss. Associations between peri-implantitis and emergence angles/profiles were assessed using Generalized Estimating Equations. Results: Eighty-three patients with 168 implants met inclusion criteria. The prevalence of peri-implantitis was significantly greater in the bone level group when the emergence angle was >30 degrees compared to an angle ≤30 degrees (31.3% vs 15.1%, P=0.04). In the tissue level group, no such correlation was found. For bone level implants, when a convex profile was combined with an angle of >30 degrees, the prevalence of peri-implantitis was 37.8% with a statistically significant interaction between emergence angle and profile (p = 0.003). Conclusions: Emergence angle of >30 degrees is a significant risk indicator for peri-implantitis and convex profile creates an additional risk for bone level implants, but not for tissue level implants. This article is protected by copyright. All rights reserved.
Article
Objective: The aim of this systematic review was to assess the role of excess cement as risk indicator for peri-implant diseases. Material and methods: A systematic literature search with the keywords peri-implant disease, peri-implant mucositis, peri-implantitis, excess cement, cemented, and screw-retained restorations was performed for articles published by June 2016 using MEDLINE and EMBASE electronic databases, complemented by hand searching. Results: The included 26 publications referring to 21 study groups were published between 1999 and 2016 and comprised 945 subjects with 1010 cemented implant restorations in 10 prospective and eight retrospective studies and eight case reports/series with pronounced heterogeneity of the study designs. Prevalence of peri-implant diseases varied between 1.9% and 75% of the implants with cemented restorations, with proportions of 33-100% associated with excess cement. In publications including early follow-ups and regular recall intervals, peri-implant disease was mostly detected at an early stage. Cofactors, such as type of abutment (standardized or individualized) and cementum medium used, did not have a significant influence, while higher prevalence of peri-implant diseases was found with immediate loading or cementation subsequent to reentry, and with cemented vs. screw-retained restorations. Conclusions: Excess cement was identified as a possible risk indicator for peri-implant diseases and was more frequently observed with soft tissue healing periods shorter than 4 weeks. To reduce the risk of peri-implant disease associated with excess cement, a crown margin at the level of the mucosal margin providing sufficient access is recommendable, and soft tissue maturation and early follow-ups after restoration placement should be assured.
Book
Dental implants have become one of the most popular and rapidly growing techniques for replacing missing teeth. While their predictability, functionality, and durability make them an attractive option for patients and clinicians alike, complications can arise at any stage from patient assessment to maintenance therapy. Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, updates and expands the hallmark first edition, which was the first comprehensive reference designed to provide clinicians of all skill levels with practical instruction grounded in evidence-based research. Featuring cases from a variety of dental specialties, the book covers the most commonly occurring implant complications as well as the unique. Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, is organized sequentially, guiding the reader through complications associated with the diagnosis, treatment planning, placement, restoration, and maintenance of implants at any stage. Complications associated with various bone augmentation and sinus lift procedures are also discussed in detail with emphasis on their etiology and prevention. Each chapter utilizes a highly illustrated and user-friendly format to showcase key pedagogical features, including a list of "take home tips" summarizing the fundamental points of each chapter. New chapters include discussions of complications from drug prescribing, implant naturalization, cemented restorations, loose implant restoration syndrome, and craniofacial growth. Readers will also find more case presentations to see how complications have been managed in real-world situations. Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, brings together contributions from leading experts in the field under the superior editorship of Dr. Stuart Froum. With its pragmatic approach to preventing and managing implant complications, this expertly crafted text continues to serve as an indispensable clinical reference and guide for all dentists placing or restoring implants. © 2016 by John Wiley & Sons, Inc.
Chapter
Successful implant prostheses is dependent upon the biomechanical and biological realities that define the clinical scenario. The responses of implants and implant components is related to the forces acting on the implants in a frequency, magnitude and duration dependent manner. The placement of dental implants in relationship to the prosthesis can influence the magnitude of imposed forces by altering the bending moments acting at the various biologic and biomechanical interfaces. Malposed implants increase these bending moments and may contribute to early prosthetic failure or increased prosthetic complications. More pragmatically, the malposition of implants create difficulty in producing acceptable, and sometimes lead to, substandard restorations for individual patients. Implant angulation in buccolingual and mesiodistal orientations and the depth of implant placement that diverges from ideal planned positioning creates challenge both esthetic and functional restoration success. There exist few good solutions to malposed implant position. Careful planning that begins with prosthesis design and continues to implant localization and surgical guide fabrication is, therefore, the key to preventing complications due to implant malposition. This chapter briefly reviews the spectrum of possible implant positioning errors and illustrates some of the related complications. Clinicians are advised to begin all implant treatment scenarios with a comprehensive diagnostic protocol that includes the design and assessment of the proposed prosthesis prior to implant location decision making.
Article
Purpose: To assess the literature on the accuracy and clinical performance of static computer-assisted implant surgery in implant dentistry. Materials and methods: Electronic and manual literature searches were applied to collect information about (1) the accuracy and (2) clinical performance of static computer-assisted implant systems. Meta-regression analysis was performed to summarize the accuracy studies. Failure/complication rates were investigated using a generalized linear mixed model for binary outcomes and a logit link to model implant failure rate. Results: From 2,359 articles, 14 survival and 24 accuracy studies were included in this systematic review. Nine different static image guidance systems were involved. The meta-analysis of the accuracy (24 clinical and preclinical studies) revealed a total mean error of 1.12 mm (maximum of 4.5 mm) at the entry point measured in 1,530 implants and 1.39 mm at the apex (maximum of 7.1 mm) measured in 1,465 implants. For the 14 included survival studies (total of 1,941 implants) using static computer-assisted implant dentistry, the mean failure rate was 2.7% (0% to 10%) after an observation period of at least 12 months. In 36.4% of the treated cases, intraoperative or prosthetic complications were reported, which included: template fractures during the surgery, change of plan because of factors such as limited primary implant stability, need for additional grafting procedures, prosthetic screw loosening, prosthetic misfit, and prosthesis fracture. Conclusion: Different levels of quantity and quality of evidence were available for static computer-assisted implant placement, with tight-fitting high implant survival rates after only 12 months of observation in different indications achieving a variable level of accuracy. Future long-term clinical data are necessary to identify clinical indications; detect accuracy; assess risk; and justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.
Article
Advent of osseointegration has rapidly led to use of dental implants over recent years. Implant complications are often inadvertent sequelae of improper diagnosis, treatment planning, surgical method, and placement. This can be overcome by using surgical guides for implant positioning. Although conventionally made surgical guide are used, the clinical outcome is often unpredictable, and even if the implants are well placed, the location and deviation of the implants may not meet the optimal prosthodontic requirements. High accuracy in planning and execution of surgical procedures is important in securing a high success rate without causing iatrogenic damage. This can be achieved by computed tomography, 3D implant planning software, image-guided template production techniques, and computer-aided surgery. This article evaluates about the various systems of conventionally made surgical guide using radiograph and also the newer computer generated surgical guide in detail.
Article
Purpose: Recent clinical studies have shown that implant placement is highly predictable with computer-generated surgical guides; however, the reliability of these guides has not been compared to that of conventional guides clinically. This study aimed to compare the accuracy of reproducing planned implant positions with computer-generated and conventional surgical guides using a split-mouth design. Materials and methods: Ten patients received two implants each in symmetric locations. All implants were planned virtually using a software program and information from cone beam computed tomographic scans taken with scan appliances in place. Patients were randomly selected for computer-aided design/computer-assisted manufacture (CAD/CAM)-guided implant placement on their right or left side. Conventional guides were used on the contralateral side. Patients underwent operative cone beam computed tomography postoperatively. Planned and actual implant positions were compared using three-dimensional analyses capable of measuring volume overlap as well as differences in angles and coronal and apical positions. Results were compared using a mixed-model repeated-measures analysis of variance and were further analyzed using a Bartlett test for unequal variance (α = .05). Results: Implants placed with CAD/CAM guides were closer to the planned positions in all eight categories examined. However, statistically significant differences were shown only for coronal horizontal distances. It was also shown that CAD/CAM guides had less variability than conventional guides, which was statistically significant for apical distance. Conclusion: Implants placed using CAD/CAM surgical guides provided greater accuracy in a lateral direction than conventional guides. In addition, CAD/CAM guides were more consistent in their deviation from the planned locations than conventional guides.
Article
To assess the accuracy of static computer-guided implant placement. Electronic and manual literature searches were conducted to collect information on the accuracy of static computer-guided implant placement and meta-regression analyses were performed to summarize and analyse the overall accuracy. The latter included a search for correlations between factors such as: support (teeth/mucosa/bone), number of templates, use of fixation pins, jaw, template production, guiding system, guided implant placement. Nineteen accuracy studies met the inclusion criteria. Meta analysis revealed a mean error of 0.99 mm (ranging from 0 to 6.5 mm) at the entry point and of 1.24 mm (ranging from 0 to 6.9 mm) at the apex. The mean angular deviation was 3.81° (ranging from 0 to 24.9°). Significant differences for all deviation parameters was found for implant-guided placement compared to placement without guidance. Number of templates used was significant, influencing the apical and angular deviation in favour for the single template. Study design and jaw location had no significant effect. Less deviation was found when more fixation pins were used (significant for entry). Computer-guided implant placement can be accurate, but significant deviations have to be taken into account. Randomized studies are needed to analyse the impact of individual parameters in order to allow optimization of this technique. Moreover, a clear overview on indications and benefits would help the clinicians to find the right candidates.
Article
The aim of the present investigation was the analysis of the factors presumptively affecting the accuracy outcome of cone-beam computed tomography (CBCT)-derived laboratory-based surgical guides for implant placement in partially edentulous patients. In 52 partially edentulous patients a total of 132 implants were placed following CBCT diagnostics with the aid of laboratory-fabricated, tooth-borne templates. Based on the image fusion technique measurements were done to calculate linear and angular deviations between virtually planned and placed implants. The implant sites were stratified according to four factors that presumably may influence the transfer accuracy: (i) type of arch (maxilla/mandible), (ii) kind of template (single-tooth gap/interrupted dental arch/shortened dental arch/reduced residual dentition), (iii) surgical technique (flapless/open flap), (iv) number of sleeve-guided site preparation steps (fully guided placement/freehand placement/freehand final drilling). The data were analyzed using analysis of variance and the Bonferroni test. The transfer accuracy of shoulder level, apex level, and angulation was similar for maxilla and mandible as well as for flapless and open flap approach. The differences were small in magnitude and reached no or only a borderline statistical significance. At implant sites in the reduced residual dentition group, the discrepancies were more pronounced than in the single-tooth gap group, whereas no significant differences could be determined between free ending templates in the shortened dental arch and bilateral anchored templates in the interrupted dental arch. Implant placement through the guide allowed a more accurate implementation of the virtual plan to the surgical site than freehand insertion or freehand final drilling. CBCT-derived laboratory-based surgical templates enabled an implant placement in the cancellous maxilla as well as flapless procedures without compromising the transfer accuracy. The number and distribution of the remaining teeth as well as the number of sleeve-guided implant site preparation steps influenced the extent of deviation that can be achieved in partial edentulism.
Article
To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement. On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration. The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 mum even at the apical end. Mean angle deviations of 1.18 degrees were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations. Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning.
Article
The aim of this systematic review was to analyze the dental literature regarding accuracy and clinical application in computer-guided template-based implant dentistry. An electronic literature search complemented by manual searching was performed to gather data on accuracy and surgical, biological and prosthetic complications in connection with computer-guided implant treatment. For the assessment of accuracy meta-regression analysis was performed. Complication rates are descriptively summarized. From 3120 titles after the literature search, eight articles met the inclusion criteria regarding accuracy and 10 regarding the clinical performance. Meta-regression analysis revealed a mean deviation at the entry point of 1.07 mm (95% CI: 0.76-1.22 mm) and at the apex of 1.63 mm (95% CI: 1.26-2 mm). No significant differences between the studies were found regarding method of template production or template support and stabilization. Early surgical complications occurred in 9.1%, early prosthetic complications in 18.8% and late prosthetic complications in 12% of the cases. Implant survival rates of 91-100% after an observation time of 12-60 months are reported in six clinical studies with 537 implants mainly restored immediately after flapless implantation procedures. Computer-guided template-based implant placement showed high implant survival rates ranging from 91% to 100%. However, a considerable number of technique-related perioperative complications were observed. Preclinical and clinical studies indicated a reasonable mean accuracy with relatively high maximum deviations. Future research should be directed to increase the number of clinical studies with longer observation periods and to improve the systems in terms of perioperative handling, accuracy and prosthetic complications.
Article
To demonstrate the predictability of flapless surgery using navigation surgery. Computer-generated preoperative implant planning was compared to actual placement by CT (computerized tomography) scanning of patients before and after surgery. Once pre- and postoperative coordinates of virtual implants were obtained, linear distances and angles were calculated. Coronal and apical errors consisted of the shortest distance from the preoperative planning to the postoperative overlay. Fourteen implants were placed in 6 patients who received CT scans before and after implant placement. Preoperative implant planning using software was compared to actual placement. The average discrepancy of the head of the implant was 0.89 mm +/- 0.53 SD (range, 0.32 to 1.96). The average discrepancy of the apex of the implant was 0.96 mm +/- 0.50 SD (range, 0.25 to 1.99). The average angle discrepancy and standard deviation were 3.78 degrees +/- 2.76 SD (range, 0.60 to 9.87). Optical computerized navigation is vulnerable to technological and technical errors. Yet, the present case series suggests that less than 1 mm of mean linear deviation and less than 4 degrees of angular deviation might be attainable.
Article
Presurgical planning is essential to achieve esthetic and functional implants. The goal of this clinical study was to determine the angular and linear deviations at the implant neck and apex between planned and placed implants using stereolithographic (SLA) surgical guides. A total of 110 implants were placed using SLA surgical guides generated from computed tomography (CT). All patients used the radiographic templates during CT scanning. After obtaining 3-dimensional CT scans, each implant insertion was simulated on the CT images. SLA surgical guides using a rapid prototyping method including a laser beam were used during implant insertion. A new CT scan was made for each patient after implant insertion. Special software was used to match images of the planned and placed implants, and their positions and axes were compared. The mean angular deviation of all placed implants was 4.1 degrees+/-2.3 degrees, whereas mean linear deviation was 1.11+/-0.7 mm at the implant neck and 1.41+/-0.9 mm at the implant apex compared with the planned implants. The angular deviations of the placed implants compared with the planned implants were 2.91 degrees+/-1.3 degrees, 4.63 degrees+/-2.6 degrees, and 4.51 degrees+/-2.1 degrees for the tooth-supported, bone-supported, and mucosa-supported SLA surgical guides, respectively. The results of this study suggested that stereolithographic surgical guides using CT data may be reliable in implant placement, and tooth-supported SLA surgical guides were more accurate than bone- or mucosa-supported SLA surgical guides.
Article
Dental implant placement requires precise planning with regard to anatomic limitations and restorative goals. The aim of this study was to evaluate the match between the positions and axes of the planned and placed implants using stereolithographic (SLA) surgical guides. Ninety-four implants were placed using SLA surgical guides generated from computed tomography (CT) between 2005 and 2006. Radiographic templates were used for all subjects during CT imaging. After obtaining three-dimensional CT images, each implant was virtually placed on the CT images. SLA surgical guides, fabricated using an SLA machine with a laser beam to polymerize the liquid photo-polymerized resin, were used during implant placement. A new CT scan was taken for each subject following implant placement. Special software was used to fuse the images of the planned and placed implants, and the locations and axes were compared. Compared to the planned implants, the placed implants showed angular deviation of 4.9 degrees+/-2.36 degrees, whereas the mean linear deviation was 1.22+/-0.85 mm at the implant neck and 1.51+/-1 mm at the implant apex. Compared to the implant planning, the angular deviation and linear deviation at the neck and apex of the placed maxillary implants were 5.31 degrees+/-0.36 degrees, 1.04+/-0.56 mm, and 1.57+/-0.97 mm, respectively, whereas corresponding figures for placed mandibular implants were 4.44 degrees+/-0.31 degrees, 1.42+/-1.05 mm, and 1.44+/-1.03 mm, respectively. SLA surgical guides using CT data may be reliable in implant placement and make flapless implant placement possible.
Article
This article presents an innovative method for the fabrication of implant drill guides for partially edentulous patients. Using a light-polymerized composite material and drill blanks placed in the prosthodontically driven implant position, surgical guides for each implant drill are constructed on the diagnostic cast. In addition to the size-customized implant surgical guides, a ridge crest preparation guide showing the proposed crown contour is used to adjust the tissue contour, if needed, during implant surgery.
Article
The accuracy of two commercially available systems for image-guided dental implant insertion based on infrared tracking cameras was compared with manual implantation. Phantoms of partially edentulous mandibles were used. In a master phantom, pilot boreholes for dental implants were placed. These boreholes were reproduced in slave phantoms using either of the two image-guided systems and manual implantation. The resulting positions were determined using a coordinate measurement machine and compared with the master model. In comparison with manual implantation, the difference of borehole positions to the master phantom was significantly lower using either of the systems for image-guided implant insertion. Image-guided insertion of dental implants is significantly more accurate than manual insertion. However, the accuracy that can be achieved with manual implantation is sufficient for most clinical situations.
Article
The ability to generate 3-dimensional volumetric images of the maxillofacial area has allowed surgeons to evaluate anatomy before surgery and plan for the placement of implants in ideal positions. However, the ability to transfer that information to surgical reality has been the most challenging part of implant dentistry. With the advent of computer-assisted surgery, the surgeon may now navigate through the entire implant procedure with extremely high accuracy. A new portable laptop navigated system for oral implantology is discussed as an adjunct for complex implant cases.
Article
The aim of this prospective randomized study was to compare the clinical accuracy of and surgical time required for mandibular dental implant placement with 2 computer-assisted navigation systems using pre- and postoperative computerized tomographic (CT) data. In 16 patients with edentulous mandibles, 4 interforaminal implants per patient were placed with computer-assisted navigation. The implant bed was prepared by transmucosal drilling without mucosal punching. Patients were randomly allocated to either the VISIT navigation system (32 implants; 8 patients) or the Medtronic StealthStation Treon navigation system (32 implants; 8 patients). Pre- and postoperative CT scans were matched using the normalized mutual information 3D regist