Three-dimensional guidance system for implant insertion: Part I

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.

Novel CBCT and optical scanner-based implant treatment planning using a stereolithographic surgical guide: a multipronged diagnostic approach

This report describes the use of the combination of 2 technologies (Cone-beam computed tomography and Optical 3-dimensional scan) to maximize accuracy of implant placement in an area where previous implants failed and had to be removed. This report also stresses the increased efficiency of combining technologies to fabricate stereolithographic surgical guide which, when used intraoperatively, can improve precision of placement.

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

An adjustable, cast based, fully restrictive surgical guide

The 3D Click Guide is a fully restrictive cast-based surgical guide for the placement of dental implants. This in-office system consists of prefabricated parts that are assembled onto a carrier. The 3-dimensional data are derived from a dental cast in combination with a periapical radiograph or cone-beam computed tomography data.

In-vitro study on the accuracy of a simple-design CT-guided stent for dental implants

Purpose

An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement.

Materials and Methods

A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated.

Results

The deviation of the entry point and angulation of the central axis in the reference plane were 0.47±0.27 mm, 0.57±0.23 mm, and 0.64±0.16°, 0.57±0.15°, respectively. However, for the two different angulations in each group, the 20° angulation showed a greater error in the deviation of the entry point than did the 10° angulation.

Conclusion

The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

Cast-based guided implant placement: a novel technique

One of the most challenging aspects of implant placement is the correct spatial positioning of the dental implant in the bone. Surgical guides of various configurations have been proposed to aid implant placement. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes a combination of analog techniques, including bone sounding and periapical radiographs used to study the available bone volume. A simplified casting protocol is proposed, and the implant platform position of the implant analog is transferred to a surgical guide composed of a stiff vinyl polysiloxane material. This surgical guide is used in a conventional flapless guided implant surgery protocol. This combination of techniques allows precise placement of a dental implant, abutment, and provisional restoration in a minimally invasive manner.

Accuracy of miniscrew implant placement with a 3-dimensional surgical guide

PURPOSE

Deviation in the trajectory during drilling or tapping of miniscrew implants increases the risks of root injury. The purposes of this study were to assess the accuracy of miniscrew placement into the dentoalveolar bone, aided by a 3-dimensional (3D) surgical guide, and to compare the results with those from conventional procedures.

MATERIALS AND METHODS

A total of 220 miniscrews implanted, aided by a 3D surgical guide (n = 180), a conventional wire guide (n = 20), or no surgical guide (n = 20), were retrospectively examined in relation to the accuracy of placement. Coordinates, distances, and angles of the superimposed images of the planned and the correspondent implants were assessed and analyzed by 1-way analysis of variance.

RESULTS

The results demonstrate that using the 3D surgical guide produced a significantly smaller variation between the planned and actual implant positions at the miniscrew head and tail (0.6 +/- 0.5 mm [mean +/- standard deviation] and 2.0 +/- 0.4 mm) compared with the wire guide (1.0 +/- 0.4 mm and 5.3 +/- 1.1 mm) and no guide (3.6 +/- 1.7 mm and 10.5 +/- 3.5 mm). The accuracy of placement was significantly improved with the 3D surgical guide (1.8 +/- 0.9 degrees) compared with the wire guide (16.9 +/- 2.6 degrees) and no guide (21.2 +/- 2.9 degrees).

CONCLUSIONS

The 3D surgical guide provides a precise method for miniscrew placement into the dentoalveolar bone. The accurate insertion of miniscrews using the 3D surgical guide allows orthodontists to precisely transfer the radiographic information from preoperative planning to the surgical site, thus minimizing the risks of root injury.

Presurgical Planning With CT-Derived Fabrication of Surgical Guides

As implant dentistry is evolving toward accelerated treatment protocols, with immediate or delayed functional and nonfunctional loading, the importance of presurgical planning becomes paramount. The paradigm for restorative-driven implant placement works best when templates are used to transfer information from the desired plan to the surgical reality. The advent of computed tomography (CT) imaging, and CT-derived surgical templates allow for clinically significant improvements in accuracy, time efficiency, and reduction in surgical error, benefiting the patient, surgeon, restorative dentist, and the laboratory. Continued advances in the state-of-the-art software applications that enable enhanced planning give clinicians the vision necessary to deliver the desired results, while serving as an excellent communication tool between all members of the implant team. This article illustrates the advantages of using CT scan-based templates through various clinical presentations. Procedures were illustrated for single and multiple tooth applications in both mandibular and maxillary arches.

Precision surgical template for implant placement: a new systematic approach

The importance of a precise surgical template for implant placement cannot be overstated. The radiographic template carries both clinical and radiographic information for the planning of fixture angulation and location. This article describes a systematic approach to the fabrication of a dual-purpose radiographic surgical template. The simple steps result in the accurate transfer of radiographic information to the surgical template with no need for complex equipment or maneuvers. key words: dental implants, implant placement, radiographic template, surgical template

Evaluation of the effect of the residual bone angulation on implant-supported fixed prostheses in mandibular posterior edentulism. Part I: Spiral computed tomography study

Dental implants are usually angulated buccolingually because of the anatomy of the residual bone in mandibular posterior edentulous cases. Although angulated dental implants compromise the construction of implant-supported prostheses, the effect of buccolingual angulation of the residual bone has not been clearly stated. This study is performed to determine the biomechanical effect of buccolingual angulation. The goal was to reveal the actual buccolingual angulation values of the residual bone in which implants were to be placed. Thirty mandibular Kennedy I and II cases comprised of forty edentulous posterior regions with missing second premolars and first, second, and third molars were included. Buccolingual angulation values along the 28 mm of residual bone were measured on 1-mm spacing cross-sectional images of spiral computed tomography. Paired sample t test was used for the statistical analysis. The minimum angulation values at the second premolar, first molar, and second molar region were 0 degrees, 3 degrees, and 9 degrees, respectively. The average angulation values were 4 degrees, 10 degrees, and 15 degrees, respectively, and the maximum angulation values were 11 degrees, 18 degrees, and 22 degrees, respectively. The ability to measure the buccolingual angulation of mandibular posterior residual bone before dental implantation may help the clinician at the implant treatment-planning phase.