Influence of surgeon experience on implant placement in guided surgeries: A systematic review and meta-analysis of randomized clinical trials

Accuracy of Three-Dimensional Computer-Aided Implant Surgical Guides: A Prospective In Vivo Study of the Impact of Template Design

Background: Digital planning and the use of a static surgical guide for implant placement provide predictability and safety for patients and practitioners. The aim of this study was to investigate differences in the accuracy and fit of long and short guides. Methods: In patients with at least one missing tooth, long (supported by the entire dental arch) and short templates (supported by two teeth, mesial and distal) were compared via intraoral scans and the superimposition of the STL files of the initial planning and the actual position in the patient's mouth along the X-, Y- and Z-axes. Furthermore, this study evaluated the conditions (e.g., mouth opening, the implant position) under which fully guided implantation can be realized. Results: The largest deviation was observed in the Z-axis, although this deviation was not as high for the short templates (0.2275 mm) as it was for the long templates (0.4007 mm). With respect to the 3D deviation (dXYZ), the average deviation from the mean value was 0.2953 mm for the short guides and 0.4360 mm for the long guides (p = 0.002). The effect size (Cohen's d) was 0.709, which was between the medium (0.50) and large effect sizes (0.80). The shorter templates showed a smaller deviation from the actual plan by 80%. With a mouth opening ≥50 mm, fully guided surgery can be performed in the molar region. In the premolar region, the lower limit was 32 mm. Conclusions: The 3D accuracy was significantly higher for the shorter template, which could therefore be favored.

Safety and accuracy assessment of static computer assisted localized piezoelectric alveolar decortication: an in vitro study

OBJECTIVES

To assess the safety and accuracy of static computer assisted corticotomy surgery (sCACS) in comparison with freehand piezocision.

MATERIALS AND METHODS

A randomized in vitro study was conducted. A total of 260 interradicular corticotomies were performed in 20 identical printed models. sCACS was performed in half of the models, while the rest underwent freehand localized decortication. Accuracy was measured in the three spatial axes by overlapping the digital planning with a previous cone-beam computed tomography (CBCT) scan of the patient and a postoperative CBCT of the models. Safety was determined as the number of damaged root surfaces. Descriptive and bivariate analyses were performed.

RESULTS

Freehand corticotomies increased the likelihood of iatrogenic root damage 2.21-fold (95%CI: 1.30 to 3.77; p = 0.004). Both groups showed some degree of deviation compared to digital planning. Nevertheless, the accuracy of sCACS was significantly greater in sagittal (B = -0.21 mm, 95%CI: -0.29 to -0.12; p < 0.001), axial (B = -0.32 mm, 95%CI: -0.48 to -0.18; p < 0.001) and angular deviation (B = -2.02º; 95%CI: -2.37 to -1.66; p < 0.001) compared to freehand surgery, with the exception of depth.

CONCLUSIONS

The precision and safety of sCACS are greater than the freehand technique.

CLINICAL RELEVANCE

Corticotomies are performed in crowded areas where there is usually space limitation. Clinicians should consider the systematic use of surgical guides, since minimal deviations can cause iatrogenic root damage in areas where malocclusions are present.

Clinical and radiographic outcomes around 4 mandibular implant-retained overdentures in individuals with type 2 diabetes: A long-term retrospective study

OBJECTIVES

To report the implant survival rates, clinical, and radiographic status after a period of more than 5 years in the function of 4 inter-foraminal implants retaining mandibular overdentures (OVDs) in individuals with T2DM.

METHODS

78 completely edentulous participants with type 2 diabetic mellitus (T2DM) who had worn mandibular OVDs retained by 4 inter-foraminal implants for long-term functional life were selected for this study. The participants were divided into 2 groups according to glycosylated haemoglobin A1c (HbA1c) levels before implant placement: group I with an HbA1c value > 6.5 % (inadequately controlled T2DM), and group II with an HbA1c value ≤6.5 % (well-controlled T2DM). The inadequately controlled T2DM was further subdivided into 2 groups: Group IA with an HbA1c value > 6.5 % and ≤8 % (moderately controlled), and Group IB has an HbA1c value > 8 % (poorly controlled). Implant survival rate, plaque index (PI), bleeding on probing (BOP), probing depth (PD), and radiographic crestal bone level (CBL) around implants were measured.

RESULTS

Among 312 implants, 6 failed, 4 in well-controlled diabetics, and 2 in inadequately controlled diabetics. The overall survival rate was 98.07 %. The mean PI in group Ι was 36.4 (group IA =37.76, group IB = 34.27), and in group ΙΙ it was 19. The mean BOP in group Ι was 45.5 (group IA =47.84, group IB = 41.76), and in group ΙΙ it was 22. The mean PD in group Ι was 4.1 (group IA =4.3, group IB = 3.85) and in group ΙΙ was 2.2. The mean radiographic CBL in group Ι was 3.4 (group IA =3.7, group IB = 2.9), and in group ΙΙ was 1.5. Group IA exhibited a significantly greater level of PI, BOP, PD, and CBL compared to group IB and group IΙ (P1=0.017, P2=0.001).

CONCLUSIONS

Individuals with T2DM can benefit from 4 inter-foraminal implants retained mandibular OVDs, and their inability to maintain proper glucose control may not exclude implant success.

CLINICAL SIGNIFICANCE

This study is a significant step toward improving knowledge of options available for treatment and anticipated outcomes for T2DM completely edentulous populations undergoing implant therapy.