Effect of a dynamic navigation device on the accuracy of implant placement in the completely edentulous mandible: An in vitro study

Freehand vs. computer-aided implant surgery: a systematic review and meta-analysis-part 1: accuracy of planned and placed implant position

OBJECTIVES

This systematic review aimed to investigate and compare the accuracy of free-hand and computer-aided implant surgery (CAIS) approaches in dental implant placement.

MATERIAL AND METHODS

The PICO question as follows: In patients receiving dental implants, does computer-aided implant surgery superior in accuracy compared to non-computer-aided implant surgery? The primary outcome was angular deviation between the planned and placed position of the implant. An electronic search was made to identify all relevant studies reporting the accuracy of CAIS approaches and freehand for dental implant placement. The data were extracted in the descriptive description, and a meta-analysis of single means was performed to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 1609 initial articles, 55 were selected for data extraction. The mean value of angular, entry, and apex deviations were 7.46°, 1.56 mm, and 2.22 mm for freehand, 5.94°, 1.13 mm, and 1.43 mm for pilot drill-sCAIS, 2.57°, 0.72 mm, 0.88 mm for fully guided-sCAIS (fg-sCAIS), and 3.67°, 1.01 mm, and 1.36 for dynamic CAIS (dCAIS), respectively. Significant differences were found between the freehand and CAIS approaches (p < 0.04). Fg-sCAIS was significantly more accurate than dCAIS systems at the entry (p < 0.001).

CONCLUSIONS

Compared to the freehand approach, both sCAIS and dCAIS improve implant placement accuracy, with angular deviations ranging from 2° to 6°. Detailed planning is crucial for CAIS, particularly for fg-sCAIS, which demonstrated the highest accuracy than others. As apex deviations of 1 to 2 mm have been observed in CAIS approaches, a 2-mm safety margin should be implemented to minimize surgical risks.

Evaluation of the Accuracy, Surgical Time, and Learning Curve of Freehand, Static, and Dynamic Computer-Assisted Implant Surgery in an In Vitro Study

OBJECTIVES

This experimental study compared the accuracy of implant insertion using the free-hand (FH) technique, static computer-aided surgery (S-CAIS), or dynamic computer-assisted surgery (D-CAIS) and to evaluate the correlation of learning curves between surgeons' experience and surgical time.

MATERIALS AND METHODS

Thirty-six models were randomly assigned to three groups (FH, n = 12; S-CAIS, n = 12; D-CAIS, n = 12). Each model was planned to receive four implants in the maxillary anterior and posterior regions. Twelve participants, six experienced surgeons, and six dental students were included in this study. The primary outcome was the deviation between the planned and final implant placement from each group. Secondary outcomes were each technique's learning curve regarding surgical time.

RESULTS

The average deviation at implant platform, apex and gradual deviation with FH technique were 1.31 ± 0.88 mm, 1.75 ± 0.9 mm and 6.67° ± 3.70°, respectively. The average deviation of implant platform, apex and angular in S-CAIS were 0.67 ± 0.32 mm, 1.00 ± 0.39 and 2.66° ± 1.77°, respectively. The average deviation of implant platform, apex and angular in D-CAIS were 1.14 ± 0.70 mm, 1.23 ± 0.58 and 3.20° ± 2.16°, respectively. Significant discrepancies at the implant platform, implant apex, and angular deviation were found between all surgical methods (p < 0.016). Learning curves were evident after multiple implant insertions using both freehand and S-CAIS.

CONCLUSION

The findings indicate that computer-assisted implant insertion leads to a more precise implant alignment than implants inserted freehand in an experimental set-up.

Accuracy of bi-coordinate and multi-coordinate handpiece calibration methods for robot-assisted implant placement

STATEMENT OF PROBLEM

To ensure accurate robot-assisted surgery, it is essential to identify the handpiece position at the end effector of the robotic arm. Clinically, the relationship between the optical tracking device and the handpiece has been typically confirmed by using a calibration plate at the end effector of the robotic arm. However, the accuracy of the handpiece calibration methods for robot-assisted implant placement remains unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of bi-coordinate and multi-coordinate handpiece calibration methods, as well as the multi-coordinate handpiece plate under partial obstruction, in the context of robot-assisted implant placement.

MATERIAL AND METHODS

In total, 120 implants were divided into 6 groups based on the calibration plate used in the study: bi-coordinate handpiece calibration plate for the maxilla (Bmx), bi-coordinate handpiece calibration plate for the mandible (Bmn), multi-coordinate handpiece calibration plate for the maxilla (Mmx), multi-coordinate handpiece calibration plate for the mandible (Mmn), partially obscured multi-coordinate handpiece calibration plate for the mandible with the primary coordinate unblocked and the auxiliary coordinate covered (MmnPrim), and partially obscured multi-coordinate handpiece calibration plate for the mandible with the auxiliary coordinate unblocked and the primary coordinate covered (MmnAux). Calibration of the robotic arm was conducted separately for each group. Then the robot autonomously performed osteotomies and implant placements at the first and second premolars according to the preoperative plan. Following surgery, the robotic software program calculated the deviation values between the planned and actual implant positions. Differences between the test groups were analyzed using 1-way analysis of variance (ANOVA) and the Bonferroni post hoc test (α=.05).

RESULTS

The ranges of angular deviation and 3-dimensional deviations at the implant platform and apex across the 6 groups were 0.30 degrees to 0.48 degrees, 0.31 to 0.36 mm, and 0.31 to 0.38 mm, respectively. No statistically significant differences were found among the groups (P>.05).

CONCLUSIONS

Both the bi-coordinate and multi-coordinate handpiece calibration methods demonstrated acceptable accuracy for robot-assisted implant placement. The multi-coordinate calibration plate provides a feasible method for robot calibration in scenarios where the mandible is partially obstructed.

A modified workflow for dynamic navigation implant surgery in fully edentulous patients utilizing a customized patient tracking module

A refined navigated implant workflow for the edentulous patients is introduced utilizing a patient-customized tracking module. This technique initiates with the placement of an incisor implant to anchor the tracking module, enabling real-time tracing of the edentulous arch while eliminating the need for additional insertions. This approach optimizes surgical procedures, reduces trauma, and mitigates the risk of potential implant placement site occupation.

Exploring the Learning Curve of Dental Implant Placement Using a Task-Autonomous Robotic System Among Young Dentists From Different Specialties-A Pilot Module Study

BACKGROUND

The learning curve effect of dynamic computer-assisted implant surgery (D-CAIS) was observed among inexperienced novice surgeons. The learning curves can provide valuable information for novice surgeons and valid comparisons between new and conventional techniques. Recently, robotic computer-assisted implant surgery (R-CAIS) has shown promise as a novel dental implant surgical technique for both partially and edentulous patients. However, its learning curve remains unknown.

PURPOSE

The aim of this study was to explore the learning curve of dental implant placement surgery with a task-autonomous robotic system among young dentists with different specialties.

METHODS AND MATERIALS

Four young dentists (mean age: 25.3 ± 1.5 years at the beginning of their first attempt) with equal representation of males and females and with different specialties participated in this study. None of the participants had prior experience in R-CAIS. Each operator placed eight implants over eight attempts using a semi-active task-autonomous robotic system. Among the eight implants, four were straight lateral incisor implants, and four were 30°-tilted premolar implants. The implants were placed in each dental quadrant of the maxillary and mandibular jaw modules. The operation time was recorded. Coronal, apical, and angular deviations between the planned and actual sites of implant placement were measured by merging preoperative and postoperative cone-beam computed tomography (CBCT) scans. The data were analyzed with repeated-measures ANOVA (α = 0.05).

RESULTS

The mean time for implant placement was associated with the number of attempts (p < 0.01). The time taken for the second attempt was significantly shorter than that of the first attempt (33.26 vs. 30.47 min; p < 0.001) then it plateaued. Three-dimensional (3D) angular (p = 0.31), coronal deviation (p = 0.26), and apical deviation (p = 0.06) did not differ significantly among attempts. The mean values and standard deviations of 3D coronal deviation, 3D apical deviation, and 3D angular deviation were 0.71 ± 0.31 mm, 0.72 ± 0.30 mm, and 0.94 ± 0.58°, respectively. Neither the position of the jaw (p > 0.59) nor the tilt angle of the implant (straight or 30°-tilted, p > 0.85) was related to implant placement accuracy.

CONCLUSIONS

Dentists quickly learned the basic workflow of R-CAIS and thus facilitated the clinicians in the mastery of implant placement on edentulous jaw modules, leading to a comparable operating speed and high precision. Moreover, the accuracy of placement of straight and tilted implants in both the maxilla and mandible with R-CAIS was satisfactory.

Application of dynamic navigation technology in oral and maxillofacial surgery

OBJECTIVES

Dynamic navigation (DN) technology has ushered in a paradigm shift in dentistry, revolutionizing the precision of diverse procedures in oral and craniofacial surgery. This comprehensive review aims to review the manifold applications of DN, including implantology, endodontics, oral and dental surgeries, and other dental disciplines.

MATERIALS AND METHODS

A thorough search of the online databases PubMed and Google Scholar was conducted up to March 2024. Publications associated with DN in the field of oral and maxillofacial surgery were sourced.

RESULTS

Narrative literature review.

CONCLUSIONS

DN harnesses cone beam computerized tomography imaging, virtual design software, and motion tracking technology to construct a virtual model of the patient's oral cavity, affording real-time instrument tracking during procedures. Notably, in implantology, DN facilitates implant placement, enhances safety measures, and augments procedural efficiency. The application of DN in sinus lift procedures contributes to improved surgical outcomes and reduced complications. Within endodontics, DN guides root canal treatment (RCT), retreatment of failed RCT, and endodontic microsurgery, ensuring conservative access cavities and precise canal location. Beyond these, the versatility of DN extends to encompass maxillomandibular and orthognathic surgeries, tooth extraction, removal of foreign bodies, and facial reconstruction. However, it is crucial to acknowledge potential disadvantages and error-prone scenarios as DN technologies advance.

CLINICAL SIGNIFICANCE

DN technology empowers dentists with high accuracy, heightened safety protocols, and increased procedural efficiency, culminating in enhanced patient outcomes across various dental procedures. As DN technology further expands, its pivotal role will advance in the future of oral and maxillofacial surgery.

Accuracy of a calibration method based on cone beam computed tomography and intraoral scanner data registration for robot-assisted implant placement: An in vitro study

STATEMENT OF PROBLEM

Robotic systems have shown promise for implant placement because of their accuracy in identifying surgical positions. However, research on the accuracy of patient calibration methods based on cone beam computed tomography (CBCT) and intraoral scanner (IOS) data registration is lacking.

PURPOSE

The purpose of this in vitro study was to develop a calibration method based on the registration of CBCT and IOS data of a robot-assisted system for implant placement, evaluate the accuracy of this calibration method, and explore the accuracy of robot-assisted surgery at different implant positions.

MATERIAL AND METHODS

Twenty standardized, polyurethane, partially edentulous maxillary typodonts were divided into 2 groups: one group used a calibration method based solely on CBCT data (CBCT group), and the other used a calibration method based on the registration of CBCT and IOS data (IOS group). Four implants were planned for each typodont in the right second premolar, left central incisor, left first premolar, and left second molar positions. The robot performed the osteotomies and implant placement step by step according to the preoperative plan. The operating software program automatically measured the deviation between the planned and actual implant position. Two-way analysis of variance (ANOVA) and the least significant difference (LSD) post hoc test (α=.05) were used to analyze differences between the test groups.

RESULTS

The angular deviation and 3-dimensional deviations at implant platform and apex between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). The horizontal and depth deviations at the implant platform and apex levels between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). In the anterior region (left central incisor), the CBCT group showed higher horizontal deviation at both the implant platform and apex compared with the IOS group (P<.05). Conversely, the IOS group had greater depth deviation at both the implant platform and apex than the CBCT group (P<.05). In the posterior region, with or without distal extension (right second premolar, left first premolar, and left second molar), no statistically significant differences were found between the 2 calibration methods (P>.05).

CONCLUSIONS

The calibration method that was based on the registration of CBCT and IOS data demonstrated high accuracy. No significant differences in the accuracy of the calibration methods for robot-assisted implant placement were found between the CBCT group and IOS group.

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.

The accuracy of dynamic computer assisted implant surgery in fully edentulous jaws: A retrospective case series

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.

Accuracy and patient-centered results of static and dynamic computer-assisted implant surgery in edentulous jaws: a retrospective cohort study

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.

Guided Biopsy of a Radiopaque Lesion Simultaneous with Dental Implants’ Placement: A Multidisciplinary Approach

Background: New technologies and techniques allow us to offer better solutions for patients’ needs. Specifically, guided surgery is usually flapless, and the resulting prosthetic rehabilitation often includes immediate loading. Thus, bleeding risk is controlled, and more comfortable prosthetic procedures are performed. Guided surgery decreases surgical risks and is less invasive. The aim of this article is to present a case of guided osteotomy for bone biopsy and implant placement. Methods: CBCT was performed for the patient’s bone examination, an optical scanner was used for intra-oral images, and surgical certified software was applied for the osteotomy planning and the surgeon’s guide realization. Case report: The patient’s question is about left maxilla prosthetic rehabilitation. During the oral cavity and X-ray examination, a radiopacity with a feathered edge was found; in order to detect the finding, a CBCT was performed, and the surgery was planned. A bone biopsy was performed simultaneously with the implant’s placement through a drill guide. The specimen sent for histological exam showed osteosclerosis. Conclusions: It is the opinion of the authors that by involving and combining close collaboration and communication, several professional specializations (clinicians and radiologists) can improve the treatments for better patient care.

Learning Curve and Comparison of Dynamic Implant Placement Accuracy Using a Navigation System in Young Professionals

The aim of the current study was to evaluate the learning curve and accuracy of implant placement by young professionals using a dynamic computer-assisted surgical system for dental implant placement. Ten students tried to place eight implants with a dynamic surgical system in predefined positions on two consecutive weekends, resulting in 160 implant placements in total. Postoperatively, the positions of the implants were scanned with an intraoral scanner and compared for deviations at the entry point, the apex, as well as angular deviations to the master model. The mean values of all measurements improved; statistical significance was found for the changes in the angle as well as for the position of the implants to the apex (p < 0.001). Furthermore, the young professionals indicated subjective improvement in handling the dynamic surgery system. Navigated surgical dental implant placement can be learned quickly and can support young professionals in everyday clinical practice, especially in difficult anatomic situations.