Implant placement in the pterygoid region with dynamically navigated surgery: A clinical report

Comparison of the accuracy of dynamic navigation and the free hand approaches in the placement of pterygoid implants in the completely edentulous maxilla: An in vitro study

Background/purpose

Pterygoid implant is a promising solution for patients with a partially or fully edentulous atrophic maxilla. However, whether dynamic navigation system will improve the accuracy of pterygoid implant surgery is still unknown. This study aimed to compare the accuracy of dynamic navigation and free-hand approaches in pterygoid implant placement in completely edentulous maxilla models.

Materials and methods

Twenty three-dimensional (3D)-printed edentulous maxilla models were assigned to two groups: the dynamic navigation system group and the free-hand group. Two pterygoid implants were planned in the bilateral pterygomaxillary area and then placed in each model. The entry, exit and angle deviations of the pterygoid implants were measured after pre- and post-operative cone-beam CT (CBCT) image fusion. Student's t test and Mann-Whitney U test were used. A P value < 0.05 was considered statistically significant.

Results

A total of 40 pterygoid implants were placed in 20 models. The comparison deviation of the dynamic navigation group and the free-hand group showed a mean (±SD) entry deviation of 0.93 ± 0.46 mm vs. 2.28 ± 1.08 mm (P < 0.001), an exit deviation of 1.37 ± 0.52 mm vs. 3.14 ± 1.82 mm (P < 0.001), and an angle deviation of 2.41 ± 1.24° vs. 10.13 ± 4.68° (P < 0.001). There was no significant difference in the accuracy with regard to the side factors between the navigation group and the free-hand group.

Conclusion

The dynamic navigation system has higher accuracy for pterygoid implant placement in a complete edentulous maxilla than the free-hand approach.

Clinical achievements of implantology in the pterygoid region: A systematic review and meta-analysis of the literature

The purpose of the study is to evaluate the survival rate of pterygoid implants compared to implants placed in different maxilla area and to settle as an alternative solution for the rehabilitation of the posterior maxilla atrophy. Studies that were included for this systematic review were selected using different database of references: PubMed Medline, Lilacs and Cochrane Library. Other journal platforms were also used for the research. Five articles met the strict inclusion/exclusion criteria of the 180 articles founded. This systematic review was registered on Prospero (CRD42023409706) and followed PRISMA statement. A total of 768 implants placed presented 97.43 % with a peak of 100 % of survival rate. Follow-up period varies from a minimum of 1 year to a maximum of six years. Pterygoid implants could be a valid alternative in patients presenting a posterior maxilla atrophy, but results should be interpreted cautiously due to the difficulty of the surgical technique. Further studies in the future should be taken in consideration to confirm the success rate of pterygoid implants since there is only one prospective RCT, potentially incorporating modern technologies such as guided surgery or navigated surgery could be a solution for the success of pterygoid implants, minimizing the risk and less dependent on the operator.

Impact of digital technologies on implant surgery in fully edentulous patients: A scoping review

BACKGROUND

For over three decades, digital technologies have been used in Implant Dentistry, beginning with the introduction of planning software for Static Computer-Assisted Implant Surgery (S-CAIS). During this time, this field has witnessed the emergence of diverse methodologies and a proliferation of technological advancements. Today, S-CAIS is a widely adopted procedure for the placement of dental implants in both partially and fully edentulous patients, with Dynamic Computer-Assisted Surgery (D-CAIS) and Robotic-Assisted Implant Surgery (RAIS) rapidly gaining attention among dental professionals. The continuous advancements in this arena are not merely indicative of technological progress; they represent a steadfast dedication to refining precision, enhancing efficiency, and fostering innovation with the goal of optimizing patient outcomes in dental implantology.

AIMS

The purpose of the following review is to meticulously examine the spectrum of digital technologies available and to describe their protocols, advantages, and shortcomings as well as to evaluate their accuracy in implant surgery in patients with complete edentulism.

MATERIALS AND METHODS

A scoping review was performed following the Joanna Briggs Institute (JBI) protocols, leveraging the population, concept, and context (PCC) framework to construct the research question and determine the inclusion and exclusion criteria.

RESULTS

Two hundred and sixty-seven records were identified for screening. After applying all the screening criteria, 41 articles were included for review and qualitative data analysis.

DISCUSSION

S-CAIS, D-CAIS, and RAIS were identified as the main technologies for computer assisted implant surgery. Their applications, characteristics, protocols and levels of accuracy were compared and described.

CONCLUSION

Taking into consideration the limitations of this study, S-CAIS appears to be the most applied and validated technology in implant surgery for fully edentulous patients followed by D-CAIS and RAIS being these last two promising initiatives in the field. Despite having similar levels of accuracy, the overall comparison showed a slightly higher values in RAIS followed by D-CAIS and S-CAIS.

The impacts of registration-and-fixation device positioning on the performance of implant placement assisted by dynamic computer-aided surgery: A randomized controlled trial

OBJECTIVES

To assess the efficacy of dynamic computer-aided surgery (dCAS) in replacing a single missing posterior tooth, we compare outcomes when using registration-and-fixation devices positioned anterior or posterior to the surgical site. Registration is performed on either the anterior or opposite posterior teeth.

METHODS

Forty individuals needing posterior single-tooth implant placement were randomly assigned to anterior or posterior registration. Nine parameters were analyzed to detect the deviations between planned and actual implant placement, using Mann-Whitney and t-tests for nonnormally and normally distributed data, respectively.

RESULTS

The overall average angular deviation for this study was 2.08 ± 1.12°, with the respective average 3D platform and apex deviations of 0.77 ± 0.32 mm and 0.88 ± 0.32 mm. Angular deviation values for individuals in the anterior and posterior registration groups were 1.58°(IQR: 0.98°-2.38°) and 2.25°(IQR: 1.46°-3.43°), respectively (p = .165), with 3D platform deviations of 0.81 ± 0.29 mm and 0.74 ± 0.36 mm (p = .464), as well as 3D apex deviations of 0.89 ± 0.32 mm and 0.88 ± 0.33 mm (p = .986). No significant variations in absolute buccolingual (platform, p = .659; apex, p = .063), apicocoronal (platform, p = .671; apex, p = .649), or mesiodistal (platform, p = .134; apex, p = .355) deviations were observed at either analyzed levels.

CONCLUSIONS

Both anterior and posterior registration approaches facilitate accurate dCAS-mediated implant placement for single missing posterior teeth. The device's placement (posterior-to or anterior-to the surgical site) did not affect the clinician's ability to achieve the planned implant location.

Accuracy and efficiency of a calibration approach in dynamic navigation for implant placement: An in vitro study

Background/purpose

Computer-assisted dynamic navigation surgery could provide accurate implant placement. However, its low efficiency was always criticized by dental surgeons. The purpose of this study was to evaluate the accuracy and efficiency of a calibration approach with reflective wafers in dynamic navigation for implant placement.

Materials and methods

Eighty implants were placed in the standardized polyurethane mandibular models under dynamic navigation and divided into 2 groups according to the calibration methods (n = 40). The U-shaped tube (UT) group used a prefabricated U-shaped tube embedded with radiopaque markers. The reflective wafers (RW) group used a fixation with 3 round reflective wafers as markers. Postoperative cone beam computed tomography images were obtained for implants deviation analyses. The calibration time was used to evaluate the efficiency of the 2 methods.

Results

Significant differences were found in the trueness and efficiency between the 2 groups (P < 0.05). The 3D deviations at the implant platform and apex were smaller in UT group (0.89 ± 0.28 and 0.79 ± 0.30 mm, respectively) than in the RW group (0.99 ± 0.28 and 0.98 ± 0.30 mm, respectively). The angular deviation was larger in the UT group (2.16 ± 1.12°) than in the RW group (1.53 ± 0.88°). The calibration approach of RW group was more efficient than the UT group (2.05 ± 0.55 and 7.50 ± 0.71 min, respectively).

Conclusion

The calibration method of RW improved the efficiency significantly and achieved equivalent trueness with UT for dynamic navigation during implant placement.

Analysis of the accuracy of a dynamic navigation system when performing dental implant surgery with transcrestal sinus floor elevation: A pilot study

Background/purpose

The success of transcrestal sinus floor elevation (TSFE) is primarily reliant upon the experience of the surgeon owing to the limited operative visibility. To evaluate the accuracy associated with the use of a dynamic navigation system when conducting posterior maxilla implant surgery with TSFE.

Materials and methods

Twenty-eight implants were placed in 28 patients requiring implantation in the posterior maxilla via a TSFE approach. The drills were used to access the planned position (within 1 mm of the bottom of the maxillary sinus floor) under dynamic navigation system. TSFE was then accomplished using osteotomes and a piezoelectric device. Lastly, the implant was inserted under the dynamic navigation. Three effective deviations between planned and actual implant placement were then measured including angular deviation (AD, degrees), entry point horizontal deviation (EPHD, mm), and apical point horizontal deviation (APHD, mm).

Results

The AD, EPHD, and APHD between the planned and actual implant placement were 3.656 ± 1.665°, 1.073 ± 0.686 mm, and 1.086 ± 0.667 mm, respectively. Premolar site AD values were less than those for molar sites (P = 0.004). No significant differences in these outcomes were observed in different surgeons. Obvious sinus perforation was not detected by immediate postoperative cone beam computed tomography imaging.

Conclusion

The accuracy associated with using a dynamic navigation system when conducting posterior maxilla implant surgery via a TSFE approach using piezoelectric devices was comparable. This technique thus achieved appropriate interventional precision and safety while decreasing the morbidity associated with the TSFE approach.

Accuracy of automatic and manual dynamic navigation registration techniques for dental implant surgery in posterior sites missing a single tooth: A retrospective clinical analysis

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 > .05), while platform deviations were 0.89 ± 0.48 mm and 0.91 ± 0.45 mm (p > .05), and apex deviations were 0.99 ± 0.48 mm and 1.11 ± 0.46 mm (p > .05). No significant differences in absolute buccolingual, mesiodistal, or apicocoronal deviations were detected between these groups at either level (p > .05) nor were did deviation distributions differ in the buccolingual, mesiodistal, or apicocoronal directions at the platform or apex levels (p > .05).

CONCLUSIONS

Manual and automatic dynamic navigation registration techniques can achieve excellent accuracy when placing implants in posterior sites missing a single tooth. The two-in-one automatic 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.

A registration-and-fixation approach with handpiece adjustment for dynamic navigation in dental implant surgery

The deviations between the preoperative (planned) and postoperative (actual) positions of dental implants have always been of a major concern in dental implant surgery. Dynamic computer-aided implant surgery (dCAIS) systems have been used to achieve optimal implant positioning. The method of registration is indeed an important factor that affects the implanting accuracy. Here, we propose a fast and concise registration method using a registration-and-fixation device as well as an adjustable handpiece for dynamic navigation in dental implant surgery. To the best of our knowledge, our work is the first study of such a registration method for dynamic navigation in a dental implant system.