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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
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.
... 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) ...
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]. ...
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.
... To date, few clinical studies on current methods have investigated the accuracy of implant positions in dynamic navigation [34][35][36][37][38][39][40][41][42]. Previously published data on the accuracy of dynamic navigation were analyzed in three systematic reviews. ...
... In a retrospective study by Wu et al., no significant differences between the dynamic and static navigations were found at the coronal or apical endpoints or in the angular deviation when evaluating a total of 95 implants [41]. Yimari et al. also reported a similar result in a randomized clinical trial [42]. In an in vitro study by Mediavilla-Guzmán et al., only significantly different values in favor of static template-guided implantation for angular deviation were reported. ...
... In contrast to static navigation, there are still few published clinical studies on dynamic navigation [34][35][36][37][38][39][40]42]. The comparability of these studies is difficult because of heterogeneous co-factors, such as the use of different dynamic navigation systems, different implant planning programs, and different implants. ...
Background:
This prospective clinical study aimed to investigate a possible deviation between the digitally planned implant position and the position achieved using dynamic navigation. The aim of the study was to establish clinical effectiveness and precision of implantation using dynamic navigation.
Methods:
Twenty consecutive patients received an implant (iSy-Implantat, Camlog, Wimsheim, Germany). One screw implant was placed in one jaw with remaining dentition of at least six teeth. The workflow was fully digital. Digital implant planning was conducted using cone-beam computed tomography (CBCT) and an intraoral scan of the actual condition. Twenty implants were subsequently placed using a dynamic computer-assisted procedure. The clinical situation of the implant position was recorded using an intraoral scan. Using these data, models were produced via 3D printing, and CBCTs of these models were made using laboratory analogs. Deviations of the achieved implant position from the planned position were determined using evaluation software.
Results:
The evaluation of 20 implants resulted in a mean angle deviation of 2.7° (95% CI 2.2-3.3°). The 3D deviation at the implant shoulder was 1.83 mm (95% CI 1.34-2.33 mm). No significant differences were found for any of the parameters between the implantation in the upper or lower jaw and an open or flapless procedure (p-value < 0.05).
Conclusion:
The clinical trial showed that sufficiently precise implantation was possible with the dynamic navigation system used here. Dynamic navigation can improve the quality of implant positioning. In particular, the procedure allows safe positioning of the implants in minimally invasive procedures, which usually cannot be performed freehand in this form. A clinical benefit and effectiveness can be determined from the results.
... Figure 2 shows the complete flowchart of the study selection process. Of the 24 articles, 10 reported on clinical studies involving humans [43][44][45][46][47][48][49][50][51][52] and 14 reported on preclinical "in vitro" studies [53][54][55][56][57][58][59][60][61][62][63][64][65][66]. The types of studies included for each system can be observed in Table 2. ...
... One randomized clinical trial (RCT) with a split-mouth design compared the accuracy of the Navident system with freehand implant placement [45], while two RCTs (2 parallel groups) assessed the Iris-100 system and compared it with a static guided system [47,52]. ...
... The main limitations detected in the nonrandomized clinical studies were limited sample sizes, which may hamper the generalization of the results [45,49,50], and that some articles did not specify whether the outcomes were assessed by an independent blinded researcher [20,[46][47][48]. Regarding the included RCT, the main limitations were associated with the allocation concealment and the blinding of the outcome assessor [47,52]. ...
Objectives
To assess the accuracy of dynamic computer–aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer–aided implant surgery (sCAIS) systems and freehand implant placement.Materials and Methods
An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: “In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model.ResultsOut of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I2 = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I2 = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I2 = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I2 = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): −0.86°; 95% CI: −1.35 to −0.36) and freehand implant placement (MD: −4.33°; 95% CI: −5.40 to −3.25).ConclusiondCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems.Clinical RelevanceThe use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.
... Thereafter, static CAIS utilizes a surgical guide 3D printing in resin to transfer the virtually planned implant position to the surgical field, while dynamic CAIS systems utilize dynamic navigation, where the actual position of the drill is projected on the patient's radiographic anatomy in real time on a screen. Both static and dynamic CAIS systems have been assessed in multiple clinical scenarios from a single implant to fully edentulous patients with comparable outcomes in terms of accuracy and precision (Jaemsuwan et al., 2022;Kaewsiri et al., 2019;Smitkarn et al., 2019;Wei et al., 2022;Yimarj et al., 2020). Although both techniques can significantly reduce deviation when compared with freehand placement (Tahmaseb et al., 2014), they too suffer from different limitations and sources of error. ...
... When the levels indicated by the K-means classification are applied as thresholds in the currently available literature on CAIS, the combination of static and navigation CAIS as applied in this study produced the smallest average deviation reported so far (Aydemir & Arısan, 2020;Block et al., 2017;Kaewsiri et al., 2019;Smitkarn et al., 2019;Sun et al., 2020;Tahmaseb et al., 2018;Wei et al., 2022;Wu et al., 2020;Yimarj et al., 2020). ...
Objective:
To compare implant accuracy of combined static and dynamic (SD) computer assisted implant surgery (CAIS) with static (S), dynamic (D) CAIS and freehand surgery (FH) for single implant placement.
Materials and methods:
120 patients were randomized into four groups. Implants were placed using both stereolithographic surgical guide and dynamic navigation in SD group, stereolithographic surgical guide in S group, dynamic navigation in D group and conventional freehand in FH group. Analysis of deviation between planned and final implant position, as well as K means analysis were conducted for implant deviation at platform, apex, and angle (primary outcomes) and directional distribution at platform and apex (secondary outcome).
Results:
Significant differences were found among the four groups (P < 0.001): The 3D deviation (mm) at platform of SD, S, D and FH groups was 0.62 ± 0.50, 1.06 ± 0.67, 1.02 ± 0.45, and 1.48 ± 0.68, respectively, at apex was 0.75 ± 0.57, 1.40 ± 0.71, 1.28 ± 0.50, and 2.18 ± 0.95 and angle was 1.24 ± 1.41, 3.18 ± 2.04, 3.28 ± 1.57, and 7.50 ± 4.06 (degrees) respectively. Deviation at the platform of FH group was significantly more towards mesial (p = 0.026) and coronal (p = 0.014) direction, while at the apex, towards distal (p = 0.004) and lingual (p= 0.002) than SD group.
Conclusion:
The use of combined static and dynamic CAIS provided significantly higher accuracy than the two alone and freehand surgery for single implant placement.
... Gargallo-Albiol et al. (18) classified implant navigation surgery as dynamic and static. The ideal plan is transferred to the actual surgical site through a custom-made template in the case of static CAIS (sCAIS) or through real-time tracking and guidance of the surgical drill in dynamic CAIS systems (dCAIS) (19). ...
... Our group created a workflow based on open software, avoiding extra costs, and included laboratory practice with biomodels to reduce the learning curve. dCAIS in healthy non-oncological case results are excellent, and similar to the sCAIS, Yimarj et al. (19) reported a 1.24-mm crestal insertion error, 1.58-mm apical mismatch, and 3.78°angular deviation. In another systematic review and meta-analysis, Wei et al. (17) reported that the average global platform deviation, global apical deviation, and angular deviation were 1.02 mm, 1.33 mm, and 3.59°, respectively. ...
Image-guided surgery, prosthetic-based virtual planning, 3D printing, and CAD/CAM technology are changing head and neck ablative and reconstructive surgical oncology. Due to quality-of-life improvement, dental implant rehabilitation could be considered in every patient treated with curative intent. Accurate implant placement is mandatory for prosthesis long-term stability and success in oncologic patients. We present a prospective study, with a novel workflow, comprising 11 patients reconstructed with free flaps and 56 osseointegrated implants placed in bone flaps or remnant jaws (iliac crest, fibula, radial forearm, anterolateral thigh). Starting from CT data and jaw plaster model scanning, virtual dental prosthesis was designed. Then prosthetically driven dental implacement was also virtually planned and transferred to the patient by means of intraoperative infrared optical navigation (first four patients), and a combination of conventional static teeth supported 3D-printed acrylic guide stent, intraoperative dynamic navigation, and augmented reality for final intraoperative verification (last 7 patients). Coronal, apical, and angular deviation between virtual surgical planning and final guided intraoperative position was measured on each implant. There is a clear learning curve for surgeons when applying guided methods. Initial only-navigated cases achieved low accuracy but were comparable to non-guided freehand positioning due to jig registration instability. Subsequent dynamic navigation cases combining highly stable acrylic static guides as reference and registration markers result in the highest accuracy with a 1–1.5-mm deviation at the insertion point. Smartphone-based augmented reality visualization is a valuable tool for intraoperative visualization and final verification, although it is still a difficult technique for guiding surgery. A fixed screw-retained ideal dental prosthesis was achieved in every case as virtually planned. Implant placement, the final step in free flap oncological reconstruction, could be accurately planned and placed with image-guided surgery, 3D printing, and CAD/CAM technology. The learning curve could be overcome with preclinical laboratory training, but virtually designed and 3D-printed tracer registration stability is crucial for accurate and predictable results. Applying these concepts to our difficult oncologic patient subgroup with deep anatomic alterations ended in comparable results as those reported in non-oncologic patients.
... 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. ...
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. ...
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. ...
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. ...
(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 . ...
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.
... Several studies have compared the accuracy of sCAIS and dCAIS in dental implant surgery, and most have demonstrated that sCAIS and dCAIS have met the clinical requirements. No statistically significant difference was found between the approaches regarding the entry, exit and angle deviations [2,[33][34][35][36], and this result was also strongly supported by recent systematic reviews [9,37,38]. However, both sCAIS and dCAIS still have disadvantages [39]. ...
Objectives
To compare the accuracy of dental implant placement using dynamic navigation system and robotic systems.
Methods
Eighty three-dimensional (3D) printed phantoms, including edentulous and partially edentulous jaws, were assigned to two groups: a dynamic navigation system (Beidou-SNS) group and a robotic system (Hybrid Robotic System for Dental Implant Surgery, HRS-DIS) group. The entry, exit and angle deviations of the implants in the three-dimensional world were measured after preoperative plans and postoperative cone-beam computed tomography (CBCT) fusion. A linear mixed model with a random intercept was applied, and a p value <.05 was considered statistically significant.
Results
A total of 480 implants were placed in 80 phantoms. The comparison deviation of the dynamic navigation system and robotic system groups showed a mean (± SD) entry deviation of 0.96 ± 0.57 mm vs. 0.83 ± 0.55 mm (p=0.04), a mean exit deviation of 1.06 ± 0.59 mm vs. 0.91 ± 0.56 mm (p=0.04), and a mean angle deviation of 2.41± 1.42° vs. 1 ± 0.48° (p<0.00).
Conclusions
The implant positioning accuracy of the robotic system was superior to that of the dynamic navigation system, suggesting that this prototype robotic system (HRS-DIS) could be a promising tool in dental implant surgery.
Clinical significance
This in vitro study is of clinical interest because it preliminarily shows that the robotic system exhibits lower deviations of dental implants than the dynamic navigation system in dental implant surgery placement in both edentulous and partially edentulous jaws. Further clinical studies are suggested to evaluate the current results.
... Currently, using markers as dental splints is the primary registration method used in DCAIS, which provides a noninvasive and easy-to-use registration program. A certain number of clinical cases have shown that this method is feasible in patients with dentition defects [9,10]. Nevertheless, when patients have severe periodontitis or are edentulous, the image cannot truly reflect the real position of the dental splint because of tooth movement, and it may not even be available for installation on the patients [11][12][13][14]. ...
Dynamic computer-aided implant surgery (DCAIS) can improve dental implantation accuracy and reduce surgical risks. In the registration procedure of DCAIS, the type and the number of registration markers significantly impact the accuracy of DCAIS. One problem of DCAIS in clinical application is that only invasive screw markers can be used for implantation in edentulous patients. It could cause additional trauma, scar formation and usually increase patient discomfort. In this experiment, a personalized 3D-printed edentulous maxillary model was used for simulating clinical situations, and a 3D-printed noninvasive adhesive marker (3D-PNAM) was designed to figure out the above problem. In this research, six target screws were implanted into the model's maxillary alveolar ridge as targets for accuracy analysis. This study used target registration error (TRE) as an index to evaluate the accuracy of invasive screw makers and noninvasive adhesive markers. Results showed that 3D-PNAMs had the same accuracy as screw markers, and placing at least six registration markers in the maxilla was needed for good registration accuracy. The registration markers should be further improved and designed according to application areas' clinical needs and anatomical characteristics in future clinical studies.
... Navigation surgery has two main advantages: visualization and instant modifiable solutions. In the past 20 years, navigation has been proven to gain high accuracy, similar to static surgical guides in conventional dental implant placement (Kaewsiri et al., 2019;Guzmán et al., 2019;Ruppin et al., 2008;Yimarj et al., 2020;Zubizarreta-Macho et al., 2020). The application of navigation in ZI surgery was first proposed in 2000, which was later than conventional implant placement (Schramm et al., 2000). ...
Objectives:
To assess the accuracy of a real-time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize devices related negative events and their management.
Material and methods:
Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation-supported ZI surgery were included. The deviations of entry, exit and angle were measured after image data fusion. A linear mixed-effects model was used. Statistical significance was defined as p<.05. Devices related negative events and their management were also recorded and analyzed.
Results:
Two hundred and thirty-one zygomatic implants (ZIs) with navigation guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation guided surgery finally. The deviations in entry, exit and angle were 1.57±0.71 mm, 2.1±0.94 mm and 2.68±1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p=.03 and .00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p=.01). A total of 28 devices related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow-up time was 24.11 months (SD 12.62).
Conclusions:
The navigation-supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention.
... al. wurden weder am koronalen oder apikalen Endpunkt noch in der Winkelabweichung signifikante Unterschiede zwischen dynamischer und statischer Navigation bei der Auswertung von insgesamt 95 Implantaten gefunden 33 . Auch Yimari et al. stellten in einer randomisierten klinischen Studie keine signifikanten Unterschiede zwischen statischer und dynamischer Navigation fest 34 . In einer In-vitro-Untersuchung von Mediavilla-Guzmán et al. gab es ausschließlich bei der Winkelabweichung signifikant verschiedene Werte zugunsten der statischen, schablonengeführten Implantation. ...
Dental implants can be virtually planned with regard to a prosthetically optimal position before the surgical intervention on the basis of 3D data of the hard and soft tissues. Dynamic navigation procedures are then used to transfer their position to the clinical situation on the patient. The advantages of dynamic navigation over template-guided navigation include compatibility with different implant systems, independence from special drilling systems, implantation under visual control, the ability to make uncomplicated intraoperative changes, and easier navigation in distal areas. The results of computer-assisted dynamic navigation are comparable to those of static navigation. Minimum distances from endangered anatomical structures must be maintained for all guided implant insertion procedures. A pronounced learning curve and the avoidance of possible sources of error in data collection and in the transfer of the implant position, such as patient movements, incorrect positioning of the reference markers, or incorrect assignment of the reference markers in the implant planning program, must be taken into account. In this paper, the theoretical aspects of dynamic navigation and the clinical application are discussed in detail on the basis of two treatment cases.
... Surgeries in all three groups were conducted under local anesthesia as per previously published protocol by Yimarj and colleagues. 10 all three surgical protocols. Duration of surgery was measured by the same observer from the first incision until completion of the last suture. ...
Objective
The purpose of this study was to compare patient-reported outcomes and experiences (PROs and PREs) among three techniques of dental implant placement, including (a) conventional freehand, (b) dynamic, and (c) static computer-aided implant surgery (CAIS).
Material and methods
Ninety patients were randomly assigned to have dental implant placed with one of the three protocols. Participants were asked to fill in a series of self-administered questionnaires assessing (1) preoperative expectations, (2) postoperative healing events during the first week after surgery, and (3) experiences and overall satisfaction with the procedures at 2 weeks. Differences within the groups were analyzed by Wilcoxson signed-rank test. Kruskal–Wallis test was used for comparisons among the three groups.
Results
Eighty-eight patients completed the study. Patients' expectations on chewing difficulty, the postoperative experience of duration of pain, speaking limitations, and impact on routine activities were significantly different among groups (p = 0.04, 0.01, 0.038, and 0.046, respectively). Overall, patients appeared to significantly underestimate the duration of postoperative pain (p = 0.035) and swelling (p = 0.001). No significant difference in magnitude of postoperative pain, swelling, and painkiller consumption was found among the groups. The short-term functional limitations after surgery were deemed acceptable by most participants and 89% were satisfied by the overall procedure.
Conclusions
Surgical placement of dental implant with conventional freehand, static, and dynamic CAIS techniques did not result in any difference in the level of postoperative pain and swelling, and appeared to lead to equal levels of satisfaction as expressed by the patients postoperatively.
... 12,13 Dynamic guided surgery or navigation allowed a real-time visualization of implant site preparation while the drills are on function, without any template hiding the surgical field or hampering the soft tissue handling. 14,15 Dynamically assisted full surgical guidance was possible, deviations from the predetermined plan can be assessed and the related adjustments of position made at any time during the surgery. 16,17 Currently, the original dynamic navigation concept was implemented to orchestrate the surgical and prosthetic aspects to achieve ideal site-specific results and meet patient expectations of anticipate a natural-appearing with an immediate temporary FDP. ...
Objective
To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete‐arch prosthesis.
Materials and Methods
This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48–75) requiring at least one complete‐arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes).
Results
Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete‐arch FDPs immediately loaded (mean follow‐up 16.2 ± 1.7 months, 14–18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65–78). The mean MBL was −0.53 ± 0.28 mm (−0.22 to −1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively.
Conclusion
Within the limitations of this proof‐of‐concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete‐arch FDP was facilitated, resulting in high implant and prosthetic success rates.
Clinical Significance
The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete‐arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health.
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.
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.
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.
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.
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).
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.
Ideal implant placement is the basis for long-term implant survival and satisfactory restoration outcomes. Static and dynamic computer-assisted guidance have been used to improve the accuracy of implant placement, but both have shortcomings that robots can overcome. This clinical report describes the use of an autonomous implant robot to complete the placement of 2 adjacent implants with immediate postoperative restoration.
Objectives:
This in-vitro study compared the accuracy of implant placement using static versus dynamic computer-assisted implant surgery (CAIS) at two implant sites.
Methods:
Partially edentulous maxillary models were 3D-printed, and two implants (Straumann TL RN4.1 × 10mm) were inserted in FDI positions 15 and 16 per model using two CAIS approaches (10 models per approach). A three-dimensional (3D) reconstruction tool was used for implant planning, surgical guide design, and measuring implant positioning accuracy. In static CAIS, the implants were placed with 3D-printed surgical guides (n=20); in dynamic CAIS, real-time navigation was performed (n=20). Primary outcomes were defined as coronal and apical global deviation as well as angular deviations and deviation comparison between implants placed at positions 15 and 16; the secondary outcome was the bi-directional deviation in mesial-distal, buccal-palatal, and apical-coronal direction.
Results:
The mean±SD 3D-deviation at implant platform and apex levels for static CAIS in position 15 was 0.81±0.31mm, 1.41±0.37mm, and in position 16 was 0.67±0.31mm, 1.07±0.32mm.
Primary outcomes:
buccal-palatal deviation is higher using static CAIS, and mesial-distal deviation is higher in dynamic CAIS. In position 15, mesial-distal deviation at the apex and the platform were lower in static approaches than in dynamic ones. In implant position 16, buccal-palatal deviation at the apex was lower in the dynamic group than with static ones.
Secondary outcomes:
for bi-directional analysis, buccal-palatal deviation at the platform (P=0.0028) and mesial-distal deviation at the apex (P=0.0056) were significantly lower in molar sites using static CAIS. Mesial-distal deviation at the apex (P=0.0246) revealed significantly lower values in position 16 following dynamic CAIS.
Conclusions:
Both static and dynamic CAIS resulted in accurate implant placement. However, dynamic CAIS exhibited higher deviation in the mesial direction in an in-vitro setting. In addition, the implant site affects the accuracy of both CAIS approaches.
Clinical significance:
Static CAIS demonstrates the highest accuracy for guided implant placement today.
Purpose:
This study proposes a method for improving the accuracy of three-dimensional (3D) models generated through cone-beam computed tomography (CBCT).
Methods:
A 3D cuboid model fitted with a ¼-scale dentition on its top surface was constructed to simulate an alveolar bone with teeth. A physical specimen of the model was printed and the distance between its opposite sides was measured using a vernier caliper. The physical model was light-scanned, and the surface data of the generated 3D model were corrected by calibrating the distance between opposite sides against the vernier caliper measurements. The physical model was also scanned using CBCT to reconstruct a second 3D model. The overall deviation between the two models and the distance deviation in each direction of the cuboid and dentition were quantified and statistically analyzed.
Results:
The overall deviation between the reconstructed CBCT model and the calibrated structured light-scanned model was 0.098 ± 0.001 mm. Following calibration, the overall deviation was 0.010 ± 0.006 mm. A one-way variance analysis suggested that the overall deviations' differences were not statistically significant (P < 0.05).
Conclusion:
This study lays a solid foundation for accurate dental implantation.
Objectives:
To assess dental implant placement accuracy with a dynamic computer-assisted implant surgery (dCAIS) system and a freehand approach. Secondarily, to compare the patients' perception and quality of life (QoL) with the 2 approaches.
Methods:
A double-arm randomized clinical trial was conducted. Consecutive partially edentulous patients were randomly allocated to the dCAIS or standard freehand approach groups. Implant placement accuracy was evaluated by overlapping the preoperative and postoperative Cone Beam Computer Tomographs (CBCT) and recording linear deviations at the implant apex and platform (in mm) and angular deviations (in degrees). Questionnaires recorded self-reported satisfaction, pain and QoL during surgery and postoperatively.
Results:
Thirty patients (22 implants) were enrolled in each group. One patient was lost to follow-up. A significant difference (P<0.001) in mean angular deviation was found between the dCAIS (4.02°; 95% CI: 2.85 to 5.19) and the FH (7.97°; 95% CI: 5.36 to 10.58) groups. Linear deviations were significantly lower in the dCAIS group, except for the apex vertical deviation, where no differences were found. Although dCAIS took 14 minutes longer (95% CI: 6.43 to 21.24; P<0.001), patients in both groups considered the surgical time acceptable. Postoperative pain and analgesic consumption during the first postoperative week were similar between groups and self-reported satisfaction was very high.
Conclusion:
dCAIS systems significantly increase the accuracy of implant placement in partially edentulous patients in comparison with the conventional freehand approach. However, they increase the surgical time significantly and do not seem to improve patient satisfaction or reduce postoperative pain.
Objectives:
To assess the relative accuracy of manual (U-shaped tube) and automatic (two-in-one) dynamic navigation registration techniques for implant surgery performed in posterior sites missing one tooth.
Materials and methods:
This study included 58 partially edentulous patients with 58 implants, including 31 and 27 in the manual and automatic groups. Deviations between the planned and actual implant placement were assessed.
Results:
The angular deviation in the overall study cohort was 2.54 ± 1.21°, while the 3D deviations at the implant platform and apex were 0.90 ± 0.46 mm and 1.04 ± 0.47 mm, respectively. The respective angular deviations in the manual and automatic groups were 2.82 ± 1.17° and 2.21 ± 1.19° (P > 0.05), while platform deviations were 0.89 ± 0.48 mm and 0.91 ± 0.45 mm (P > 0.05), and apex deviations were 0.99 ± 0.48 mm and 1.11 ± 0.46 mm (P > 0.05). No significant differences in absolute buccolingual, mesiodistal, or apicocoronal deviations were detected between these groups at either level (P > 0.05), nor were did deviation distributions differ in the buccolingual, mesiodistal, or apicocoronal directions at the platform or apex levels (P > 0.05).
Conclusions:
Manual and automated dynamic navigation registration techniques can achieve excellent accuracy when placing implants in posterior sites missing a single tooth. The two-in-one automated registration technique can reduce the amount of time and intraoperative steps necessary to complete the registration process relative to the manual U-shaped tube registration technique. Further follow-up studies are necessary to expand on these results.
Statement of problem
Both the placement accuracy and primary stability of implants are important to implant therapy in the esthetic zone. The effect of dynamic and static computer-assisted navigation on the primary stability of implants in the esthetic zone remains uncertain.
Purpose
The purpose of this case-control study was to investigate the effect of dynamic and static computer-assisted navigation on the placement accuracy and primary stability of implants in the esthetic zone.
Material and methods
Partially edentulous participants who received at least 1 implant in the anterior maxilla using either fully guided static or dynamic computer-assisted implant surgery (s-CAIS, d-CAIS) from January 2020 to February 2022 were screened. Participant demographic information, timing of implant placement, primary stability represented by the insertion torque value (ITV) in Ncm, and implant survival were collected from the treatment record. Bone quality at the implant sites was determined according to the Lekholm and Zarb classification. The accuracy of implant placement represented by the linear (platform: Dpl, mm; apex: Dap, mm) and angular deviations (axis: Dan, degree) between the planned and placed implants was evaluated based on the preoperative surgical plan and postoperative cone beam computed tomography (CBCT) data. A statistical analysis of the data was completed by using the chi-square, Fisher exact, Student t, and Mann-Whitney U tests (α=.05).
Results
A total of 32 study participants (38 implants) were included. The groups of s-CAIS (16 participants, 18 implants) and d-CAIS (16 participants, 20 implants) were statistically comparable in sex (P=.072), age (P=.548), bone quality (P=.671), and timing of implant placement (P=.719). All implants survived during an average follow-up period of 13 months. The d-CAIS group showed close linear deviations (Dpl 1.07 ±0.57 mm, Dap 1.26 ±0.53 mm) but lower angular deviation (Dan 2.14 ±1.20 degrees) and primary stability (ITV 25.25 ±7.52 Ncm) than the s-CAIS group (Dpl 0.92 ±0.46 mm, Dap 1.31 ±0.43 mm, Dan 3.31 ±1.61 degrees, ITV 30.56 ±11.23 Ncm, PDpl=.613, PDap=.743, PDan=.016, PITV=.028).
Conclusions
Comparable linear positioning accuracy and higher angular deviation were found for implants placed in the esthetic zone by using s-CAIS than when using d-CAIS. Higher primary stability of implants may be achieved by using s-CAIS, as s-CAIS seemed to have higher osteotomy accuracy than d-CAIS.
Purpose
Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation.
Methods
Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer–reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic.
Results
The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°.
Conclusion
The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.
The optimal implant position is a critical factor for long-term success in fully edentulous patients. Implants can be placed through conventional freehand, static computer-assisted implant surgery (CAIS), or dynamic CAIS protocols, but at present there is very limited clinical evidence on their accuracy in fully edentulous patients. This study was performed to evaluate the accuracy of implant placement using three protocols in fully edentulous patients. Thirteen patients received 60 implants with the freehand (n = 20), static CAIS (n = 20), or dynamic CAIS (n = 20) protocol. Postoperative cone beam computed tomography was utilized to evaluate the accuracy of implant placement in relation to the planned optimal position. The data were analysed by ANCOVA followed by Bonferroni analysis. The mean angular deviation (standard deviation) in the freehand, static CAIS, and dynamic CAIS groups was 10.09° (4.64°), 4.98° (2.16°), and 5.75° (2.09°), respectively. The mean three-dimensional deviation (standard deviation) at the implant platform in the freehand, static CAIS, and dynamic CAIS groups was 3.48 (2.00) mm, 1.40 (0.72) mm, and 1.73 (0.43) mm, while at the implant apex it was 3.60 (2.11) mm, 1.66 (0.61) mm, and 1.86 (0.82) mm, respectively. No difference in terms of accuracy was found between static and dynamic CAIS; both demonstrated significantly higher accuracy when compared to the freehand protocol in fully edentulous patients.
Background:
Dynamic navigation approaches are widely employed in the context of implant placement surgery, with registration being integral to the accuracy of such navigation. Relatively few studies to date, however, have compared different registration approaches, and such a comparison has the potential to guide the development of more accurate and reliable clinical registration methodology.
Purpose:
This study was developed to compare the accuracy of dynamic navigation-based dental implant placement conducted using either U-tube or cusp registration methods.
Materials and methods:
Medical records from all patients that had undergone implant surgery between August 2019 and October 2020 in the First Clinical Division of the Peking University Hospital of Stomatology were retrospectively reviewed, with 64 patients and 99 implants ultimately meeting with study inclusion criteria. Implant placement accuracy was gauged via the superimposition of the planned implant position in preoperative cone-beam computed tomography (CBCT) images with the true postoperative implant position in postoperative CBCT images. Accuracy was measured based upon the angular deviation, entry deviation (3-dimensional [3D] deviation in the coronal aspect of the alveolar ridge), and apex deviation (3D deviation in the apical area of the implant) when comparing these two positions.
Results:
The angular deviation, entry deviation, and apex deviation of all analyzed implants were 3.29 ± 0.17°, 1.29 ± 0.07 mm, and 1.43 ± 0.08 mm, respectively, while in the cusp registration group these respective values were 3.25 ± 1.58°, 1.28 ± 0.60 mm, and 1.34 ± 0.63 mm as compared to 3.35 ± 1.78°, 1.30 ± 0.78 mm, 1.55 ± 0.9 mm in the U-tube group, respectively. No significant differences in accuracy were observed when comparing these two registration techniques.
Conclusion:
Dynamic computer-assisted surgical systems can facilitate accurate implantation, and both the U-tube and cusp registration methods exhibit similar levels of accuracy. As the cusp registration technique can overcome some of the limitations of the U-tube strategy without the need for an additional registration device, it may be more convenient for clinical use and warrants further research.
Statement of problem
Dynamic navigation for implant placement has been reported to be more accurate than freehand surgery. However, the accuracy of the calibration methods used for navigation in partially edentulous individuals with distal extensions remains unknown.
Purpose
The purpose of this in vitro study on dental models was to evaluate the accuracy of 3 calibration methods of dynamic navigation for implant placement in the distal extension of partially edentulous arches.
Material and methods
Eleven standardized polyurethane mandibular models with distal extensions were prepared. The left first molar, second molar, and second premolar from each model (33 tooth sites) were randomly assigned to 1 of the 3 calibration methods: U-shaped tube embedded with radiopaque markers, anatomic tooth cusps, and bone markers with the random number table method. Preoperative and postoperative cone beam computed tomography images were obtained for deviation analyses. The primary outcomes were 3-dimensional (3D) deviation at the implant platform and apex and angular deviation. Differences among the test groups were analyzed by using a 1-way analysis of variance (ANOVA) and the least significant difference (LSD) post hoc test (α=.05).
Results
The mean ±standard deviation 3D deviations were 0.78 ±0.34, 1.86 ±0.91, and 1.44 ±0.57 mm at the implant platform and 0.79 ±0.35, 2.19 ±1.01, and 1.49 ±0.50 mm at the apex in the U-shaped tube, tooth cusp, and bone marker groups, respectively. The 3D deviations at the implant platform and apex were significantly different among the groups (P<.01). The angular deviation was 1.36 ±0.54, 2.95 ±2.07, and 2.92 ±2.45 degrees, with no significant differences among the groups (P=.092).
Conclusions
In the dynamic navigation of implant placement in the distal extension of partially edentulous arches, the U-shaped tube calibration with radiopaque markers was more accurate than the anatomic tooth cusp or bone marker calibration.
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.
Purpose: This systematic review and meta-analysis aims to investigate the influence of dynamic navigation systems on accuracy (platform, apical and angular deviations) in clinical studies.
Methods: The research question was “Do dynamic navigation systems enhance the accuracy of implant placement?” The PubMed, Scopus and Embase databases were used to search the relevant studies up to January 2021. The role of dynamic navigation systems in enhancing the accuracy (platform, apical and angular deviations) of implant placement was then analyzed to conduct a systematic review and meta-analysis.
Results: Eight articles were analysed in the systematic review and meta-analysis. The systematic review showed that the deviations in implant placement were significantly lower for dynamic navigation than for the freehand method, and there were no significant differences between the dynamic navigation and static guide methods. This meta-analysis showed that the dynamic navigation group exhibited less platform deviation, apical deviation and angular deviation than the control group. The results of subgroup analyses showed that the dynamic navigation group exhibited fewer deviations than the freehand group, and no significant differences were found between the dynamic navigation and static guide groups.
Conclusions: Dynamic navigation resulted in higher accuracy than the freehand method, and similar accuracies were found between dynamic navigation and static guidance for platform deviation, apical deviation or angular deviations.
Introduction:
Computer-assisted surgery (CAS) is a broad surgical methodology that utilizes computer technology to both plan and execute surgical intervention. CAS is widespread in both medicine and dentistry as it allows for minimally invasive and precise surgical procedures. Key innovations in volumetric imaging, virtual surgical planning software, instrument tracking and robotics have all assisted in facilitating the transfer of surgical plans to precise execution of surgical procedures. CAS has long been used in certain medical specialties including neurosurgery, cardiology, orthopedic surgery, otolaryngology, and interventional radiology, and has since expanded to oral and maxillofacial application, particularly for computer-assisted implant surgery.
Areas covered:
This review provides an updated overview of the most current research for CAS in medicine and dentistry, with a focus on neurosurgery and dental implant surgery. The MEDLINE electronic database was searched and relevant original and review articles from 2005 to 2020 were included.
Expert opinion:
Recent literature suggests that CAS performs favorably in both neurosurgical and dental implant applications. Computer-guided surgical navigation is well entrenched as standard of care in neurosurgery. Whereas static computer-assisted implant surgery has become established as routine in dentistry, dynamic computer-assisted navigation is newly poised to achieve an upward trend in dental implant surgery.
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.
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.
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.
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.
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.
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.
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.
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.
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%.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 registration algorithm to compare preplanned and final implant positions. Operation room time was recorded from start of preoperative preparations to end of surgery.
All implants were placed as planned; there were no intra- or postoperative complications. Average implant deviation errors of 0.7 mm and 0.9 mm were recorded for the VISIT and StealthStation Treon navigation systems, respectively. Timing revealed an average operation room time of 81.3 +/- 15.8 minutes for the VISIT navigation system and 60 +/- 10.4 minutes for the StealthStation Treon navigation system.
The accuracy of implant bed preparation and placement was similar in both systems. Both navigation systems are equally precise in a clinical environment. However, total operation room time was 25% shorter with the StealthStation Treon navigation system, probably because of the faster tracking system update rate.
The objective of this systematic review was to assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological and technical complications.
An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on SCs with a mean follow-up time of at least 5 years. Failure and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5-year proportions.
Twenty-six studies from an initial yield of 3601 titles were finally selected and data were extracted. In a meta-analysis of these studies, survival of implants supporting SCs was 96.8% [95% confidence interval (CI): 95.9-97.6%] after 5 years. The survival rate of SCs supported by implants was 94.5% (95% CI: 92.5-95.9%) after 5 years of function. The survival rate of metal-ceramic crowns, 95.4% (95% CI: 93.6-96.7%), was significantly (P=0.005) higher than the survival rate, 91.2% (95% CI: 86.8-94.2%), of all-ceramic crowns. Peri-implantitis and soft tissue complications occurred adjacent to 9.7% of the SCs and 6.3% of the implants had bone loss exceeding 2 mm over the 5-year observation period. The cumulative incidence of implant fractures after 5 years was 0.14%. After 5 years, the cumulative incidence of screw or abutment loosening was 12.7% and 0.35% for screw or abutment fracture. For supra-structure-related complications, the cumulative incidence of ceramic or veneer fractures was 4.5%.
It can be concluded that after an observation period of 5 years, high survival rates for implants and implant-supported SCs can be expected. However, biological and particularly technical complications are frequent.
Surgical navigation requires registration of the pre-operative image dataset with the patient in the operation theatre. Various marker and marker-free registration techniques are available, each bearing an individual level of precision and clinical practicability. In this study the precision of four different registration methods in a maxillofacial surgical setting is analyzed.
A synthetic full size human skull model was registered with its computer tomography-dataset using (a) a dentally mounted occlusal splint, (b) the laser surface scanning, (c) five facial bone implants and (d) a combination of dental splint and two orbital bone implants. The target registration error was computed for 170 landmarks spread over the entire viscero- and neurocranium in 10 repeats using the VectorVision2 (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical analyses were performed by anatomical region.
An average precision of 1mm was found for the periorbital region irrespective of registration method (range 0.6-1.1mm). Beyond the mid-face, precision linearly decreases with the distance from the reference markers. The combination of splint with two orbital bone markers significantly improved precision from 1.3 to 0.8mm (p<0.001) on the viscerocranium and 2.3-1.2mm (p<0.001) on the neurocranium.
An occlusal splint alone yields poor precision for navigation beyond the mid-face. The precision can be increased by combining an occlusal splint with just two bone implants inserted percutaneously on the lateral orbital rim of each side.
In dental implant surgery, computer-aided surgery (CAS) techniques can provide a high medical benefit. Two different techniques are established for transferring a CAS treatment planning to the patient: the use of surgical templates (splints) or intraoperative navigation using optical tracking. The aim of this study was to evaluate the total application accuracy of three different CAS systems (Artma virtual patient, RoboDent LapAccedo, Materialise SurgiGuide): two featuring optical tracking, one featuring stereolithographically manufactured splints.
A total of 120 implants were placed into 20 human cadaver mandibles. Preoperative computed tomography (CT) scans imported to the corresponding software were used to plan the implant positions on the computer. Implant placement was performed using either optical tracking or stereolithographic splints. Postoperative CT scans were used to obtain the achieved implant positions. A semi-automatic approach was developed to compare planned and achieved implant positions. Deviations between planned and achieved positions were measured for each implant in position (Delta xy), depth (Delta z) and axis (Delta phi).
Despite the different techniques of transfer, no statistically significant differences were found between all groups. The accuracy achieved corresponded well with the spatial resolution of the CT Scans used.
Prosthodontic complications related to non-optimal dental implant placement. Dental implant complications
- L F Cooper
Cooper LF. Prosthodontic complications related to non-optimal dental
implant placement. Dental implant complications. Etiol Prev Treat.
2016;2:539-558.
Misch's Avoiding Complications in Oral Implantology‐E‐book
- Carl E Misch
- R Resnik
Misch Carl E, Resnik R. Misch's Avoiding Complications in Oral
Implantology-E-book. London: Elsevier Health Sciences; 2017.