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Como otimizar a confecção da prótese total sobre implantes em casos de cirurgia guiada
... Dessa forma, a utilização de sistemas de planejamento virtual permite a importação para o computador de arquivos obtidos nas tomografias e a reconstrução tridimensional de toda a maxila ou mandíbula do paciente a ser reabilitado. Além disso, é possível também importar arquivos STL através do escaneamento intra-oral ou dos modelos de gesso com ou sem o enceramento diagnóstico, permitindo um planejamento preciso do posicionamento do implante em relação ao osso alveolar remanescente e o dente a ser reposto 15 . ...
A sobrevida das próteses sobre os implantes sofre interferência do sistema de fixação adotado e dos tipos de próteses implantossuportadas parafusadas e cimentadas, cada qual com características biomecânicas próprias, com ênfase em elementos como adaptação, oclusão, estética, retenção, reversibilidade e provisionalização. A partir disso, o objetivo do artigo consiste em analisar a sobrevida de prótese sobre os implantes com sistema cone morse e características biomecânicas de próteses implantossuportadas parafusadas e cimentadas. Como método, caracteriza-se a pesquisa como uma revisão de literatura, formada por uma amostra de 23 (vinte e três) artigos científicos nacionais e internacionais publicados entre os anos de 2010 a 2021 em base de dados como SciELO, CAPES, LILACS, PubMed e Google Acadêmico. Os resultados evidenciam que não há unanimidade sobre qual o melhor tipo de prótese para aumentar a taxa de sobrevivência, pois, ambos os tipos possuem vantagens e desvantagens. No que se refere ao sistema cone morse, os resultados indicaram que ele é satisfatório para aumento da sobrevida das próteses. Ao final, conclui-se que a escolha entre prótese implantossuportada parafusada e a restauração sobre prótese implantossuportada cimentada ocorrerá pelo profissional e levará em consideração as necessidades e reais condições clínicas de cada caso, visto que ambas as técnicas apresentam vantagens e desvantagens e/ou limitações que ocasionam ou não altas taxas de sobrevivência.
Purpose: Scientific evidence regarding the accuracy of implants placed into patients by the aid of a surgical template is limited. The objective of the present study was to verify if any variation exists between virtually planned implants' position using a computer, compared with the subsequently clinically placed implants with the aid of a surgical template in the mandible and the maxilla.
Material and Methods: A total number of 25 edentate jaws were treated with the aid of a surgical template. In total, 139 implants were inserted. Fifty implants were inserted in the mandible and 89 in the maxilla. A voxel-based registration method was used to match two separate cone-beam computed tomography scans of the patients. The implant positions were calculated and compared between the planned implants and the implants' clinical position after more than 1 year after surgery. The results included the linear differences in distance at the level of the hex, the apex, and the depth. The angular differences were presented in degrees.
Results: Statistical results indicated some factors with significant deviations. The greatest errors were found when comparing between patients moving during the computed tomography scans and those that did not move. The results showed significant divergence at the level of the hex and apex of the implants.
Conclusion: The hypothesis was rejected, as the statistical results indicated that there were significant differences between virtually planned implants' position and the final position of implants placed clinically.
Computer-aided oral implant surgery offers several advantages over the traditional approach. The purpose of this study was to evaluate the in vivo accuracy of computer-aided, template-guided oral implant surgery by comparing the three-dimensional positions of planned and placed implants.
Oral implant therapy was performed in two treatment centers on eligible patients using computerized tomography (CT)-based software planning and computer-aided design/computer-assisted manufacture stereolithographic templates. A second CT scan was obtained after surgery. Preoperative and postoperative CT images were compared (planned vs actual implant positions), and the accuracy of this type of image-guided therapy was assessed.
Twenty-five adult patients were included in this retrospective study; 17 (11 partially and eight fully edentulous arches) were treated in center 1, and eight (six partially and two fully edentulous arches) in center 2. Of the 104 implants inserted with the computer-aided method, 100 integrated, giving a cumulative survival rate of 96% (mean follow-up, 36 months). There were no major surgical complications. With regard to accuracy, 89 implants were available for comparison; mean lateral deviations at the coronal and apical ends of the implants were 1.4 mm and 1.6 mm, respectively. Mean depth deviation was 1.1 mm and mean angular deviation was 7.9 degrees. There was a statistically significant correlation in the accuracy of any implants placed with the same guide. There was no difference in accuracy data from the two private centers; nor could a learning curve be demonstrated.
Based upon this clinical study of 25 patients, the following observations were made: (1) computer-aided oral implant surgery used in two treatment centers provided a high likelihood (96%) of implant survival, and (2) deviations from planned implant positions existed in the coronal and apical portions of the implants as well as with implant angulation. Mean deviations were less than 2 mm in any direction and less than 8 degrees.
Background:
Sinus elevation is a reliable and often used technique. The success of implants placed in such situations, even with bone substitutes alone, led us to strive for bone loss close to zero and to seek out variables that cause higher or lower rates of resorption. The objective of this study was twofold: to evaluate the survival rates and marginal bone loss (MBL) around implants installed in maxillary sinus augmentation using anorganic bovine bone, and to identify surgical and prosthetic prognostic variables.
Methods:
A total of 55 implants were placed in 30 grafted maxillary sinuses in 24 patients. Periapical radiographs were evaluated immediately after implant placement (at baseline), at 6 months, and at the most recent follow-up. MBL was calculated, taking into account the distortion rate for each radiograph as compared to the original implant measurements, from the difference between the initial and final measurements.
Results:
The survival rate was 98.2%, with only one implant lost (100% survival rate after loading) over a mean follow-up time of 2 ± 0.9 years. The MBL ranged from 0 to 2.85 mm: 75.9% of mesial sites and 83.4% of distal sites showed <1mm of MBL, while 35.2% of mesial sites and 37% of distal sites exhibited no bone loss. The MBL was significantly (p<0.05) greater in open flap as compared to flapless surgery.
Conclusion:
Within the limitations of this study, we concluded that maxillary sinus elevation with 100% anorganic bovine bone presents predictable results, and that flapless surgery results in less MBL as compared to traditional open flap surgery.
This systematic review evaluated the implant survival rate, changes in marginal bone level, and complications associated with guided surgery for the treatment of fully edentulous patients followed up for longer than 1 year. A comprehensive literature search was conducted in MEDLINE/PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) to retrieve studies published up until July 2014 that met predefined eligibility criteria. Thirteen studies were included. In studies on the guided surgery technique, a survival rate of 97.2% and a mean marginal bone loss of 1.45mm were found during 1-4 years of follow-up. However, associated complications, such as implant loss, prosthesis or surgical guide fractures, and low primary stability, were often found, and there is a learning curve to achieve treatment success. Further longitudinal comparative studies should improve the technique and its success rate.
Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Objectives
This prospective study analyzed the accuracy of implant placement with mucosa-supported stereolithographic guides, executed by inexperienced surgeons supervised by an experienced colleague.Material and methodsFor the accuracy analysis, 75 OsseoSpeed implants™, placed in 17 fully edentulous jaws (16 patients) using a mucosa-supported stereolithographic guide (IMPLANT SAFE Guide, DENTSPLY Implants) and the Facilitate™ protocol, were included. DICOM images of the pre-surgical planning and the post-surgical CBCT were matched using the Mimics® software (Materialise Dental). These data were compared with the data (12 jaws, 52 implants) of an experienced surgeon (Vercruyssen et al. Journal of Clinical Periodontology 2014; doi:10.1111/jcpe.12231).ResultsThe global deviation at the coronal and apical point was 0.9 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively. Depth deviations were 0.5 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively, and the angular deviation was 2.8° (SD 1.5°). These deviations were statistically not inferior to the deviations of the experienced surgeon and also within the range of deviations reported by several systematic reviews.Conclusion
Within the limitations of this study and for the above-mentioned surgical protocol, inexperience of the surgeon had no influence on the accuracy of implant placement in fully edentulous jaws, when all steps needed for the procedure are supervised by experienced dentists.
The aim of this systematic review was to evaluate the outcomes of flapless surgery for implants placed using either free-hand or guided (with or without 3D navigation) surgical methods. Literature searches were conducted to collect information on survival rate, marginal bone loss, and complications of implants placed with such surgeries. Twenty-three clinical studies with a minimum of 1year follow-up time were finally selected and reviewed. Free-hand flapless surgery demonstrated survival rates between 98.3% and 100% and mean marginal bone loss between 0.09 and 1.40mm at 1-4 years after implant insertion. Flapless guided surgery without 3D navigation showed survival rates between 91% and 100% and mean marginal bone loss of 0.89mm after an observation period of 2-10 years. The survival rates and mean marginal bone loss for implants placed with 3D guided flapless surgery were 89-100% and 0.55-2.6mm, respectively, at 1-5 years after implant insertion. In 17 studies, surgical and technical complications such as bone perforation, fracture of the surgical guide, and fracture of the provisional prosthesis were reported. However, none of the identified methods has demonstrated advantages over the others. Further studies are needed to confirm the predictability and effectiveness of 3D navigation techniques.
The purpose of this report is to present the clinical outcomes and patients' satisfaction of full-mouth rehabilitation using computer-aided flapless implant placement and immediate loading of a prefabricated prosthesis.
The study included 30 consecutive fully edentulous patients who received 312 implants. Mandible and maxilla were treated in the same surgical session with computer-guided flapless approach using the NobelGuide protocol. Prefabricated screw-retained fixed prostheses were inserted at the end of surgery. Clinical and radiographic evaluations were assessed at 6, 12, and 36 months. At baseline and 6 months after surgery, patients answered Oral Health Impact Profile in Edentulous Adults questionnaire to assess satisfaction.
The implant survival rate was 97.9%, whereas the average marginal bone loss was 1.9 ± 1.3 mm after 3 years. At 6 months, patients showed significantly greater satisfaction with their fixed rehabilitation when compared with conventional dentures.
The results of this study confirm that rehabilitation with a prefabricated fixed prosthesis supported by implants placed with NobelGuide protocol is a viable and predictable treatment and increases patients' satisfaction and improves oral health-related quality of life.
PurposeTo design a relevant method to compare the virtual planned implant position to the ultimately achieved implant position and to evaluate, in case of discrepancy, the cause for this. Materials and Methods
Five consecutive edentulous patients with retention problems of the upper denture received four implants in the maxilla. Preoperatively, first a cone-beam CT (CBCT) scan was acquired, followed by virtual implant planning. Then, a surgical template was designed and endosseous implants were flapless installed using the template as a guide. To inventory any differences in position, the postoperative CBCT scan was matched to the preoperative scan. The accuracy of implant placement was validated three-dimensionally (3D) and the Implant Position Orthogonal Projection (IPOP) validation method was applied to project the results to a bucco-lingual and mesio-distal plane. Subsequently, errors introduced by virtual planning, surgical instruments, and validation process were evaluated. ResultsThe bucco-lingual deviations were less obvious than mesio-distal deviations. A maximum linear tip deviation of 2.84mm, shoulder deviation of 2.42mm, and angular deviation of 3.41 degrees were calculated in mesio-distal direction. Deviations included errors in planning software (maximum 0.15mm), for surgical procedure (maximum 2.94 degrees), and validation process (maximum 0.10mm). Conclusions
This study provides the IPOP validation method as an accurate method to evaluate implant positions and to elucidate inaccuracies in virtual implant planning systems.
This article reviews the literature on the outcome of flapless surgery for dental implants in the posterior maxilla. The literature search was carried out in using the keywords: flapless, dental implants and maxilla. A hand search and Medline search were carried out on studies published between 1971 and 2011. The authors included research involving a minimum of 15 dental implants with a follow-up period of 1 year, an outcome measurement of implant survival, but excluded studies involving multiple simultaneous interventions, and studies with missing data. The Cochrane approach for cohort studies and Oxford Centre for Evidence-Based Medicine were applied. Of the 56 published papers selected, 14 papers on the flapless technique showed high overall implant survival rates. The prospective studies yielded 97.01% (95% CI: 90.72-99.0) while retrospective studies or case series illustrated 95.08% (95% CI: 91.0-97.93) survival. The average of intraoperative complications was 6.55% using the flapless procedure. The limited data obtained showed that flapless surgery in posterior maxilla areas could be a viable and predictable treatment method for implant placement. Flapless surgery tends to be more applicable in this area of the mouth. Further long-term clinical controlled studies are needed.
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.
The concept of "prosthetic-driven implantology" may be considered a turning point in the history of modern dental implantology. On the basis of this sophisticated approach, the available bone and the optimal prosthetic position of the future restoration are checked before surgical intervention. However, the major drawback of today's prosthodontic discipline is that it is inherently 2-dimensional in nature, which may prevent the appropriate treatment; this problem can be overcome by the 3-dimensional capability of a computer-assisted approach when performed judiciously. It was proposed that this technique has the potential to provide a high level of safety and accuracy in comparison to traditional surgical procedures.
Using a novel approach, we performed modified flapless implant surgery accompanied by a simultaneous sinus-lifting procedure. The technique used a 3-dimensional life-sized computer-aided design/computer-aided manufacturing (CAD/CAM) model prepared from the computed tomography images for prosthetic/surgical diagnosis and treatment planning.
The procedure of implant planning, model surgery, and sinus floor augmentation in this sophisticated flapless surgical approach has the potential to provide substantial benefits for both patients and practitioners.
The versatility of the described technique not only allows more accurate implementation of the treatment plan to the patient's mouth but also may offer many additional significant benefits, including the use of custom surgical guides, life-sized bone model manipulation, and surgical rehearsal, all of which are very difficult to achieve with current traditional procedures.
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.
The accuracy of surgical drilling guides was assessed for placement of zygoma implants. Six zygoma fixtures of length 45 mm (Nobel Biocare, Göteborg, Sweden) were placed in three formalin-fixed human cadavers using surgical drilling guides. The fabrication of these custom-made drilling guides was based on three-dimensional computerized tomography (3D-CT) data for the maxillary-zygomatic complex. The installation of the implants was simulated preoperatively using an adopted 3D-CT planning system. In addition, anatomical measurements of the zygomatic bone were performed on the 3D images. The preoperative CT images were then matched with postoperative ones in order to assess the deviation between the planned and installed implants. The angle between the planned and actually placed implants was < 3 degrees in four out of six cases. The largest deviation found at the exit point of one of the six implants was 2.7 mm. The present study showed that the use of surgical drilling guides should be encouraged for zygoma implant placement because of the lengths of the implants involved and the anatomical intricacies of the region.
There is a need for clinical evidence for the of use of computer tomography and CAD-CAM technology for surgical planning and fabrication of a custom surgical template in the rehabilitation of complete edentulous jaws with a prosthesis supported by 4 implants placed in immediate function.
The purpose of this study was to report on the preliminary clinical outcomes of survival and bone loss for prosthodontic rehabilitation using computer-guided flapless implant surgery and 4 implants placed in immediate function to support a fixed denture.
This clinical study included 23 consecutively treated patients (18 maxillae and 5 mandibles). Ninety-two implants were placed supporting fixed complete dentures followed between 6 and 21 months (mean of 13 months). Recall examinations included clinical evaluation of implant mobility, patient-reported discomfort, suppuration, and infection. The radiographic assessment included the determining of the marginal bone level at 6 and 12 months. A cumulative implant survival rate was calculated, and data were analyzed with descriptive statistics.
The overall cumulative implant survival rate at 1 year was 97.8%, with 97.2% and 100% in the maxilla and the mandible, respectively. The average marginal bone loss was 1.9 mm at the 1-year follow-up.
The results of this study indicate that, within the limitations of this preliminary study, this treatment modality for completely edentulous jaws is predictable with a high survival rate.
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