An Open System Approach for Surgical Guide Production

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods

OBJECTIVES

This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy.

DATA

In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots.

SOURCES

A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search.

RESULTS

A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors.

CONCLUSIONS

Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives.

CLINICAL SIGNIFICANCE

To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.

Four narrow dental implants and conventionally cast bar-supported removable hybrid acrylic complete denture as a therapeutic modality for terminal dentition

The report portrays four narrow implants and cast bar-supported removable hybrid acrylic complete dentures and other terminal dentition treatment options in the maxilla. The therapeutic module could be efficient and satisfactory to patients.

Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review

In the field of modern dentistry, ideal three-dimensional positioning of dental implant with optimal prosthetic fit offers successful long-term outcomes. To achieve such accurate implant placement, presurgical evaluation of hard and soft tissue matters the most. Their efforts can be attained using various application programs such as digital imaging, implant planning software, laboratory- or computer-assisted surgical guides, and dynamic navigation approach. To overcome different opinions and choices regarding guided surgery, this article explains an evidence-based literature review to assess its various outcomes and allowing informed choices before using various guided surgical techniques based on its expectation and reality outcomes. This highlights a clinician's choice to guide his successful implant surgery without causing distress in the midway of treatment. An online search was done on PubMed/Medline database to bring in accuracy to the expertise. This review includes reference of publications from 2000 to 2019, which is related to promising outcomes using computer-assisted static or dynamic navigation system for the placement of implant. Out of these, 809 were related to the computer-guided implant placement. Relevant papers were chosen in accordance with the inclusion and exclusion criteria. This review article contemplates to reflect the fact that computer-guided approach is considered to offer more predictable, safer, and faster implant placement with the predetermined final prosthetic outfit. Thus, digital planning and placing of dental implants in the correct position keep escalating to a higher achievement levels than a classical freehand approach. Nevertheless, this guided surgical approach also holds some errors and risks, which must be identified and rectified.

Accuracy of the match between cone beam computed tomography and model scan data in template-guided implant planning: A prospective controlled clinical study

BACKGROUND

Template-guided implant placement is a method for optimal implant positioning from a prosthetic and surgical viewpoint. The treatment planning is based on three-dimensional X-ray data and model scan data, as well as on prosthetic planning (set-up). These data are matched (superimposed) with the aid of an X-ray template or by manual matching without special referencing.

PURPOSE

The objective of this prospective controlled clinical study was to determine and compare the accuracy of the match with and without an additional X-ray template.

MATERIALS AND METHODS

The DICOM data of the cone beam computed tomography (CBCT) were converted into surface data sets and then superimposed on model scan data using three different methods (manually, based on an X-ray template, or semi-automatically with computer assistance). The mean deviations between these results of these matching methods were investigated.

RESULTS

The procedures achieved a matching accuracy of 0.2 mm on average. This corresponds to the resolution of the CBCT (0.2 voxels). Further studies are necessary to verify the procedure even for patients with few (0-4) residual teeth.

CONCLUSION

In the presence of a sufficient number of residual teeth, the manual matching of model scan data with CBCT data is sufficiently accurate for implant planning and template-guided implementation. The results of the present study suggest that X-ray templates can be dispensed with saving the patient a substantial amount of time and money.

Effects of minute misregistrations of prefabricated markers for image-guided dental implant surgery: an analytical evaluation

OBJECTIVES

The goal of the present study was to develop a theoretical analysis of errors in implant position, which can occur owing to minute registration errors of a reference marker in a cone beam computed tomography volume when inserting an implant with a surgical stent.

MATERIAL AND METHODS

A virtual dental-arch model was created using anatomic data derived from the literature. Basic trigonometry was used to compute effects of defined minute registration errors of only voxel size. The errors occurring at the implant's neck and apex both in horizontal as in vertical direction were computed for mean ±95%-confidence intervals of jaw width and length and typical implant lengths (8, 10 and 12 mm).

RESULTS

Largest errors occur in vertical direction for larger voxel sizes and for greater arch dimensions. For a 10 mm implant in the frontal region, these can amount to a mean of 0.716 mm (range: 0.201-1.533 mm). Horizontal errors at the neck are negligible, with a mean overall deviation of 0.009 mm (range: 0.001-0.034 mm). Errors increase with distance to the registration marker and voxel size and are affected by implant length.

CONCLUSION

Our study shows that minute and realistic errors occurring in the automated registration of a reference object have an impact on the implant's position and angulation. These errors occur in the fundamental initial step in the long planning chain; thus, they are critical and should be made aware to users of these systems.