Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance

Accuracy of the Yakebot dental implant robotic system versus fully guided static computer-assisted implant surgery template in edentulous jaw implantation: A preliminary clinical study

AIMS

To compare the accuracy of the Yakebot dental implant robotic system with that of fully guided static computer-assisted implant surgery (CAIS) template in edentulous implantation.

MATERIALS AND METHODS

Thirteen patients with edentulous were recruited and divided into two groups: the Yake robotic system group (experimental) (n = 5) and the CAIS group (control) (n = 8). Postoperative cone-beam computed tomography (CBCT) was performed immediately, and the 3-dimensional positions of implants were obtained and compared with that in the preoperative design. The comparison showed platform, apical, depth, and angular deviations. A value of p < 0.05 was considered statistically significant.

RESULTS

A total of 84 implants (36 in the robotic group and 48 in the CAIS group) were placed. The mean deviation at the implant platform, apex, depth, and angle in the CAIS group was 1.37 ± 0.72 mm, 1.28 ± 0.68 mm, 0.88 ± 0.47 mm, and 3.47 ± 2.02°, respectively. However, the mean deviation at the implant platform, apex, depth, and angle in the robotic group was 0.65 ± 0.25 mm, 0.65 ± 0.22 mm, 0.49 ± 0.24 mm, and 1.43 ± 1.18°, respectively. Significant differences in the four types of deviation (p < 0.05) between the two groups were observed.

CONCLUSION

The accuracy of robotic system in edentulous implant placement was superior to that of the CAIS template, suggesting that robotic system is more accurate, safe, and flexible, can be considered a promising treatment in clinical practice.

Influence of Kennedy class and number of implants on the accuracy of dynamic implant navigation: An in vitro study using an X-ray free evaluation methodology

OBJECTIVES

The aim of this in vitro study was to evaluate the accuracy of fully guided dynamic implant navigation surgery in Kennedy I, II, and III class dental arch defects with two different implant designs, using an X-ray free evaluation method.

METHODS

Polyurethane resin maxillary models simulated posterior edentulous defects. Four cone beam computed tomography (CBCT) scans and four intraoral (IOS) scans were obtained for each model and a digital wax-up with the correct implant positions was made. The accuracy of implant positions was evaluated using an IOS-based X-ray-free method (3Shape). Four deviation characteristics were evaluated: insertion point, depth deviation, horizontal and angle deviation.

RESULTS

The insertion point deviation measures ranged from 0.19 mm to 1.71 mm. Depth (s) and (u) deviations ranged from -1.47 mm to 0.74 mm and from 0.02 mm to 1.47 mm, respectively. Horizontal deviation ranged from 0.09 mm to 1.37 mm.

CONCLUSIONS

There is a tendency of a decreasing insertion point deviation for an increasing number and distribution area of the teeth (increasing Kennedy class number). Kennedy class II and distal implant position had the most influence for the higher deviations.

CLINICAL SIGNIFICANCE

Dynamic implant guidance provides accurate spacing, angulation, depth and position of the implants. It is important to understand how the number of missing teeth and implant design could influence the accuracy of dynamic implant navigation. Thus, it is important to evaluate factors influencing the accuracy of dynamic systems by using a X-ray-free post-operative method and to overcome the limitations of providing multiple CBCT scans.

A systematic review of the accuracy of digital surgical guides for dental implantation

PURPOSE

This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves).

METHODS

A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018-2022) were included and assessed by Newcastle-Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions.

RESULTS

Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°).

CONCLUSIONS

Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology.

Effect of three different grafting materials on immediate implant placement using vestibular socket therapy in class II extraction sockets in the maxillary esthetic zone: a randomized controlled clinical trial

BACKGROUND

This study compared the effectiveness of three bone grafting materials used for treating class II fresh extraction sockets in the esthetic zone with immediate implant placement using Vestibular Socket Therapy (VST) to evaluate the pink esthetic score (PES), peri-implant mucosal levels (PML), and facial bone thickness (FBT).

METHODS

Twenty-four surgical sites in the maxillary anterior region presented with type II socket defects received immediate implants and simultaneous bone grafting with either a collagen plug soaked in blood, demineralized bone matrix Grafton, or a particulate mixture of 2/3 autogenous bone chips and 1/3 deproteinized bovine bone mineral MinerOss X. The outcome measures were evaluated at 6 and 12 months. The study was registered on www.

CLINICALTRIAL

gov (12/07/2021 - ID: NCT04957654).

RESULTS

Twenty-two cases (91.6%) showed a total PES score of > 10, without a significant difference between all groups. The vertical height soft tissue changes showed significant improvement in the Collagen plug and Grafton groups at 6 and 12 months, while MinerOss X showed no significant difference at 6 and 12 months compared to baseline. Radiographically, FBT was 0.72 ± 0.20, 0.44 ± 0.12, and 0.95 ± 0.37 at baseline, which significantly increased to 1.61 ± 0.88, 1.48 ± 1.20 and 2.31 ± 0.86 at 12 months for all three groups, respectively.

CONCLUSION

The use of a particulate bone graft mixture significantly increases the FBT compared to collagen plugs and DBM-Grafton when performing VST during immediate implant placement in compromised Class II extraction sockets.

Digital workflow of labial guides for alveolar ridge reduction during implant-supported full-arch rehabilitation

This article presents a technique for fabricating two-piece labial guides using resin and cobalt-chromium for guided alveoloplasty, implant placement, and immediate full-arch implant-supported fixed complete denture placement. This technique reduces tissue damage and overcomes the negative effect of the anatomical position of the palatal neuropore and mobility of the tissue flap on the positioning and stability of the guide. The use of labial retention metal guides with improved mechanical properties of cobalt-chromium and fixation plugs allows the unilateral placement of the guide. Thus, minimally invasive implant surgery can be performed owing to the absence of large palatal flap elevation and obstruction. Such a design provides better stability of the guides and clear visual access during surgery.

Long-Term Effect of Guided Implant Surgery on Clinical Outcomes and Peri-Implantitis of Maxillary Implants-An Observational Cohort Study

(1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8-73.8). The mean follow-up time was 9.1 years (range 7.3-11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery.

Accuracy of an autonomous dental implant robotic system versus static guide-assisted implant surgery: A retrospective clinical study

STATEMENT OF PROBLEM

The accuracy of implant placement is a prerequisite for prosthetically driven implant surgery and is necessary to ensure the long-term stability of dental implants. Imprecise implant position may bring difficulties for restoration, damage anatomic structures, affect peri-implant tissues, and lead to ultimate implant failure.

PURPOSE

The purpose of this retrospective clinical study was to compare the accuracy of implants placed with an autonomous dental implant robotic (ADIR) system with those placed with static computer assisted implant surgery (sCAIS).

MATERIAL AND METHODS

Thirty-nine participants were enrolled in this retrospective study: 20 participants had received implant surgery with the ADIR system and 19 participants had implants placed with sCAIS. The preoperative plans and postoperative cone beam computed tomography (CBCT) scans after implant placement were matched during the study. The coronal, apical, and angular deviations were measured and analyzed. A linear regression model was established to analyze the source of deviation. MANOVA was used to compare differences in the major outcome variables (α=.05).

RESULTS

A total of 60 implants were placed in 39 participants (30 in each of the 2 groups). The mean ±standard deviation coronal, apical, and angular deviation of the ADIR system group and sCAIS group were 0.43 ±0.18 mm versus 1.31 ±0.62 mm (P<.001), 0.56 ±0.18 mm versus 1.47 ±0.65 mm (P<.001), and 1.48 ±0.59 degrees versus 2.42 ±1.55 degrees (P=.003), respectively. In addition, there was no significant difference in accuracy in the different implant regions (anterior, premolar, molar, maxilla, mandible) (P>.05). No complications were observed.

CONCLUSIONS

The accuracy of the implant position using the ADIR system was significantly higher than with sCAIS, suggesting that the ADIR system can achieve minimally invasive and excellent accuracy. In addition, implant regions had no significant influence on the accuracy of implant placement. (Keywords: Robotic system, Implant surgery, Static guide, Autonomous, Accuracy).

Digital implant placement accuracy: a clinical study on a fully-guided flapless single-unit immediate-loading protocol

AIMS

The primary aim of the present study was to measure the discrepancy between the virtual and the actual position of the single-unit implants placed via a digitally-designed fully-guided surgical template using a flapless surgical technique. Prefabricated provisional restorations and periodontal factors were evaluated after the immediate loading of implants and 3 months after the surgery, respectively.

MATERIALS AND METHODS

Fourteen implants in nine patients were virtually planned after importing intraoral scans and cone-beam computed tomography (CBCT) records into 3D planning software. Accordingly, fully-guided surgical templates, customized abutments, and provisional restorations were designed and fabricated. The implant position after the surgery was compared with its virtual counterpart in terms of angular and apical linear deviations. Implants were immediately loaded after the surgery, and the occlusal level of the delivered provisional restorations was compared with their designed positions. Early implant failure, bleeding on probing, and peri-implant pockets were documented on the 3-month follow-up.

RESULTS

A mean angular deviation of 5.07 ± 2.06° and a mean apical linear deviation of 1.74 ± 0.63 mm resulted. Two out of 14 implants failed within the first 3 months of the surgery, and the occlusal level difference was calculated for nine prefabricated provisional restorations.

CONCLUSIONS

DIONAVI protocol has been evaluated regarding its accuracy, and an estimation of the expected deviation is presented to the clinicians using this protocol. However, before widespread use, immediate-loading protocols and provisional restorations must be studied further.

TRIAL REGISTRATION

IRCT, IRCT20211208053334N1. Registered 6 August 2022.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report

OBJECTIVE

complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis.

METHODS

A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered.

RESULTS

Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort.

CONCLUSIONS

Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.

How to Avoid Errors When Using Navigation to Place Implants - A Narrative Review

PURPOSE

Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation.

METHODS

Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer-reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic.

RESULTS

The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°.

CONCLUSION

The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.

Minimal invasiveness at dental implant placement: A systematic review with meta-analyses on flapless fully guided surgery

Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: "In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer-aided fully guided (either dynamic or static computer-aided implant placement (sCAIP)) (I) superior to flapped conventional (free-handed implant placement (FHIP) or cast-based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long-term prognosis, and costs (O)?" Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full-text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta-analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast-based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer-aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta-analyses indicated less depth deviation (difference in means (MD) = -0.28 mm; 95% confidence interval (CI): -0.59 to 0.03; moderate certainty), angular deviation (MD = -3.88 degrees; 95% CI: -7.00 to -0.77; high certainty), coronal (MD = -0.6 mm; 95% CI: -1.21 to 0.01; low certainty) and apical (MD = -0.75 mm; 95% CI: -1.43 to -0.07; moderate certainty) three-dimensional bodily deviations, postoperative pain (MD = -17.09 mm on the visual analogue scale (VAS); 95% CI: -33.38 to -0.80; low certainty), postoperative swelling (MD = -6.59 mm on the VAS; 95% CI: -19.03 to 5.85; very low certainty), intraoperative discomfort (MD = -9.36 mm on the VAS; 95% CI: -17.10 to -1.61) and surgery duration (MD = -24.28 minutes; 95% CI: -28.62 to -19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta-analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three-dimensional bodily position). Moreover, flapless sCAIP presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long-term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested.

Fixation Pins Increase the Accuracy of Implant Surgery in Free-End Models: An In Vitro Study

PURPOSE

Implant surgical guides, in combination with implant planning software, have been designed for accurate surgery, especially in partial edentulism. The purpose of this study was to examine the effect of fixation pins of surgical guides on the accuracy of static computer-assisted implant surgeries in a maxillary free-end situation.

MATERIALS AND METHODS

This in vitro study was conducted to compare surgical guides using various fixation pin protocols in implant surgery. A patient dental model with missing teeth from maxillary right first premolar to third molar was used as the study model… Implant placement was planned at maxillary right first premolar, right first molar, and right second molar; Straumann full guide templates were designed and fabricated using the coDiagnostiX software. The experiment involved surgical guides with no fixation pins (NF), buccal unilateral fixation pin (BF), palatal unilateral fixation pin (PF), and bilateral fixation pins on the buccal and palatal sides (BPF), based on the position and number of fixation pins. The deviation between the actual and planned positions was used to evaluate implant accuracy. The fixation pin protocols were the primary predictive variables. Angular, 3D platform, and 3D apex deviations were the primary outcome variables. Statistical analysis was performed using the one-way analysis of variance and Tukey's test (α = 0.05).

RESULTS

NF generated the maximum angular deviation (3.65 ± 1.39°), 3D platform deviation (1.58 ± 0.55 mm), and 3D apex deviation (2.18 ± 0.79 mm), whereas BPF produced the minimum angular deviation (1.88 ± 0.86°), 3D platform deviation (1.09 ± 0.51 mm), and 3D apex deviation (1.53 ± 0.45 mm). A statistically significant difference between NF and BPF in the angular deviation, 3D platform, and apex deviation (P < .0001, P = .009, and P = .002, respectively) was identified. The unilateral fixation pin exerted a significant effect only on the angular accuracy (BF, P = .0018; PF, P = .0001).

CONCLUSION

In a maxillary free-end situation, templates with a fixation pin generate better implant accuracy than those without it. A bilateral fixation pin protocol may produce less deviation than those without fixation pins. The implant accuracy does not appear to be affected by the position of the unilateral fixation pin.

An Experimental Anodized Titanium Surface for Transgingival Dental Implant Elements-Preliminary Report

The characteristics such as microtopography, physical and chemical properties influence the behavior of an implant in a soft tissue. Anodization-as a potent method of titanium alloy surface modification-of the transgingival abutment or healing screw, has achieved some improvement. One of the possible surface treatment method is low-pressure radiofrequency oxygen plasma treatment. The aim of the study was to evaluate the chemical properties and cytocompatibility of the experimental surface. Titanium discs made of grade-23 titanium alloy (Ti-6Al-4V) anodized (A sample) with different voltage parameters (28, 67, 78, and 98 V) were included in the study. Half of the samples regarded as the "S" group were additionally treated with low-pressure radiofrequency oxygen plasma treatment. The surfaces were characterized using scanning electron microscopy, X-ray spectroscopy and Raman spectroscopy, and electrochemically investigated via a corrosion test. Furthermore, two cell lines were used, including the CHO-compatible reference line and a primary human fibroblast line for the MTT assay; direct (contact) cytotoxicity of the materials was tested with the cells, and the growth of fibroblasts on the surfaces of the different materials was tested. The morphology of the "S"-treated samples did not differ from the morphology of only-anodized samples. However, the oxygen concentration on the surface in that group slightly increased by about 1% as a result of post-trial treatment. The highest corrosion resistance was observed for both A-78 V and S-78 V samples. The cytotoxicity assay revealed no changes in cell morphology or vitality. The MTT test proved comparable culture viability among all groups; however, the "S" samples showed statistically significantly higher fibroblast proliferation and adhesion scores compared to the "A" samples. Through the in vitro study, the low-pressure radiofrequency oxygen plasma treatment of the anodized Ti-6Al-4V alloy presented itself as an auspicious option in the field of transgingival element surface modification of implants.

Immediate flapless full-arch rehabilitation of edentulous jaws on 4 or 6 implants according to the prosthetic-driven planning and guided implant surgery: A retrospective study on clinical and radiographic outcomes up to 10 years of follow-up

OBJECTIVES

to retrospectively evaluate clinical and radiographic outcomes of immediate, flapless full-arch prostheses, supported by 4/6 implants according to prosthetic-driven planning and guided surgery.

MATERIALS AND METHODS

The study involved 28 edentulous patients (20 female/8 males; average age 67.75 ± 8.627 years), 32 prostheses (17 all-on-4/15 all-on-6) and 164 implants. The Implants survival, prostheses success/survival, peri-implant marginal bone loss, incidence of biological and prosthetic complications were evaluated. Multiple linear regression analysis was performed to analyze the influence of implant and patient characteristics on marginal bone loss.

RESULTS

Cumulative implant survival rate was 89.7% for all-on-four (seven failures) and 99.0% for all-on-six (one failure) after a mean follow-up of 6.46 ± 2.236 years (range 1-10 years). Cumulative prosthesis success rate was 51.5% (58.8% for all-on-four/ 43.8% for all-on-six). Prosthesis survival rate was 88.2% for all-on-four. No failure was registered in all-on-six. Mean value of marginal bone loss was 1.38 ± 0.1.28 mm at 5-year and 2.09 ± 0.56 mm at 10-year follow-up. No difference was found in the mean value of marginal bone resorption between all-on-four (1.56 ± 1.61 mm) and all-on-six (1.20 ± 0.85 mm) (p = 0.104) and between tilted (1.22 ± 1.29 mm) and axial implants (1.44 ± 1.27 mm) (p = 0.385) after 5-year follow-up. The incidence of biological complications was 1.0% in all-on-six (one mucositis) and 10.3% in all-on-four (two peri-implantitis). Prosthetic complications affected teeth of final rehabilitations with 3 detachments, 10 chippings or fractures, and 3 severe occlusal wears.

CONCLUSIONS

Based on the results and within the limitations of the present study, the implant-supported hybrid prosthesis according to prosthetic-driven planning and guided surgery showed to be an efficient, safe, and effective approach to rehabilitate edentulous jaws.

Comparison between flapless-guided and conventional surgery for implant placement: a 12-month randomized clinical trial

OBJECTIVES

The study was aimed at comparing implants installed with guided and conventional surgery.

MATERIAL AND METHODS

Twenty-nine total edentulous patients were selected, and maxillary contralateral quadrants were randomly assigned to static computer-aided implant surgery (S-CAIS): flapless computer-guided surgery, and conventional surgery (CS): flap surgery with conventional planning. Tomography scans were performed at baseline and 10 days after the surgery for deviation measurement, and radiography was done at baseline and after 6 and 12 months, for peri-implant bone level (PIBL) analysis. Peri-implant fluid and subgingival biofilm were collected to evaluate bone markers and periodontal pathogens.

RESULTS

S-CAIS showed less linear deviation at the apical point and the midpoint and less angular deviation (p < 0.05), with greater depth discrepancy in the positioning of the platform (p < 0.05). Higher values of vertical PIBL were observed for the S-CAIS group at baseline (p < 0.05), while lower values of horizontal PIBL were observed for CS (p < 0.05). Bone markers and Tf presented higher levels in CS (p < 0.05). Flapless S-CAIS allowed smaller linear and angular deviations than the conventional technique.

CONCLUSION

However, PIBL was higher in S-CAIS; the conventional technique led to a greater angiogenic and bone remodeling activity by elevating the angiogenic levels and bone markers.

CLINICAL RELEVANCE

Evaluating the different implant insertion techniques can guide clinical and surgical regarding the accuracy, the release pattern of bone markers, and the peri-implant bone level.

TRIAL REGISTRATION

ReBEC-RBR-8556fzp.

Comparison of the Biological Behavior and Topographical Surface Assessment of a Minimally Invasive Dental Implant and a Standard Implant: An In Vitro Study

The current study aimed to assess the topographical and physical properties of a minimally invasive implant (MagiCore®: MC®, InnosBioSurg, IBS) and to evaluate its biological behavior compared to a gold standard implant (NobelParallel™: NB™, Nobel Biocare™). After surface characterization, the biological behavior assessment was conducted regarding human gingival fibroblasts (hGF) and osteoblast-like cells (MG63). Roughness values for NBTM were Ra = 1.28 µm and for MC® they were Ra = 2.02 µm. Alamar BlueTM assay LIVE/DEADTM staining results indicated equivalent biological development regarding both cell types for the two implants. Significant enhancement was found for hGF ALP activity in the presence of the two tested implants in a time-dependent manner from day 7 to day 14 (** p < 0.01). Alizarin red staining demonstrated significant calcium deposition enhancement when cells were interfaced with the NB™ compared to the MC® implant (** p < 0.05). Moreover, SEM and confocal imaging revealed good cell adhesion with a denser cellular layer on the MC® than the NB™ surface. The MC® cytocompatibility was ranked as equivalent to the gold standard implant despite the surface properties differences. These findings provide new insights about the minimally invasive implant’s biological behavior and its potential clinical implication in different implantology situations.

Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial

OBJECTIVE

The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year.

MATERIALS AND METHODS

Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n = 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n = 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap.

RESULTS

All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p < 0.001). Similarly, changes in mesial papilla (test = -0.64 ± 0.95 mm, control = -1.20 ± 0.81 mm), distal papilla (test = -0.56 ± 1.17 mm, control = -1.26 ± 0.63 mm), horizontal soft-tissue (test = -0.82 ± 0.95 mm, control = -1.84 ± 0.88 mm; p < 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes.

CONCLUSION

The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

Accuracy of a guided implant system with milled surgical templates

PURPOSE

This in vitro study analyzed the accuracy of a computer-assisted design (CAD)/computer-assisted manufacturing (CAM) guided implant surgery system by comparing linear, angular, and coronal deviations between the planned and final implant placement.

METHODS

By using a fully guided surgery workflow, 32 dental implants were placed in 16 partially edentulous models. After virtual design of the restorations, radiological and CAD files were matched and implant positions were planned by using dedicated implant planning software (Galileo Implant version 1.9.2.). Templates were designed (Cerec Omnicam) and milled (Cerec MC XL) by using chairside workflow. Galileo Implant version 1.9.2. was used to evaluate accuracy.

RESULTS

Mean horizontal and angular-coronal total deviation values were 0.2 mm (SD = 0.126) and 1.1º (SD = 0.834) respectively. Multivariate analysis of variance showed significant differences in horizontal and angular-coronal total deviation in the 32 implants (P = 0.0001). Multivariate analysis with one-factor interaction showed no statistical difference in implant position or implant type (P = 0.139) between eight maxilla models and eight jaw models.

CONCLUSION

Horizontal and angular-coronal deviations of implants placed with chairside digital workflow were within the recommended safety margin for fully guided surgery.

Accuracy of Computer-Assisted Flapless Implant Placement by Means of Mucosa-Supported Templates in Complete-Arch Restorations: A Systematic Review

The aim of this study was to systematically review the current scientific literature regarding the accuracy of fully guided flapless implant positioning for complete-arch rehabilitations in edentulous patients and to assess if there was any statistically significant correlation between linear deviation at shoulder point, at apex point and angular deviation. The electronic and manual literature search of clinical studies was carried out using specified indexing terms. A total of 13 studies were eligible for qualitative analysis and 277 edentulous patients were rehabilitated with 1556 implants patients by means of fully guided mucosa-supported template-assisted flapless surgery. Angular deviation was 3.42° (95% CI 2.82–4.03), linear deviation at shoulder point 1.23 mm (95% CI 0.97–1.49) and linear deviation at apex point 1.46 mm (95% CI 1.17–1.74). No statistically significant correlations were found between the linear and angular deviations. A statistically significant correlation was found between the two linear deviations (correlation coefficient 0.91) that can be summarized by the regression equation y = 0.03080 + 0.8254x. Computer-assisted flapless implant placement by means of mucosa-supported templates in complete arch restorations can be considered a reliable and predictable treatment choice despite the potential effects that flapless approach could bring to the overall treatment.

The influence of crown coverage on the accuracy of static guided implant surgery in partially edentulous models: An in vitro study

OBJECTIVE

To evaluate the influence of crown coverage of surgical guides on the accuracy of static computer-assisted implant surgeries (sCAISs) in different partially edentulous situations.

METHODS

Acrylic models with five types of partially edentulous situations were fabricated in this study. In coDiagnostiX software (Dental Wings, Montreal, Canada), surgical templates were designed and fabricated with reduced crown coverage (RCC), standard crown coverage (SCC) and extended crown coverage (ECC). Then, fully guided implant placement into the acrylic models was performed by dental surgeons with more than 10 years of experience. In total, 120 models and 120 guides were manufactured, and 168 bone-level Straumann replica implants (4.1 × 10 mm, Institut Straumann AG, Basel, Switzerland) were inserted. Postoperative implant positions were scanned (Trios 3, 3 shape, Copenhagen, Denmark) and compared with the preplanned virtual positions via coDiagnostiX (Dental Wings, Montreal, Canada). The angular, coronal and apical deviations were measured and analyzed to evaluate the accuracy of implant insertion. Statistical analysis was performed using one-way ANOVA and Tukey's test.

RESULTS

For single tooth missing situations, the RCC group was similar to the SCC group and ECC group in anterior sites. In premolar or molar sites, the SCC and ECC groups had no statistically significant difference (p > .05), while the RCC group had more coronal and apical deviation (p < .05). For multiple teeth missing situations, there was no difference among the RCC, SCC and ECC groups (p > .05). No difference was found among the five edentulous situations with different CCs (p > .05).

CONCLUSION

The CC of templates can significantly affect the accuracy of guided surgeries when implants are inserted in a single gap at posterior sites. Templates with CC extended to the undercut line may be an optimal choice for static guided surgeries.

CLINICAL SIGNIFICANCE

The accuracy of static guided implant surgery can be influenced by the CC of templates, and proper CC with the guide covering extending to the undercut line may contribute to improved accuracy. CC should be taken into consideration when designing surgical templates.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

In-house 3D printing: Why, when, and how? Overview of the national French good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery

3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Société Française de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.

Guided implant surgery workflow in edentulous patients: A precise and rapid technique

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

In vitro evaluation of bioburden, three-dimensional stability, and accuracy of surgical templates without metallic sleeves after routinely infection control activities

BACKGROUND

Surgical templates are classified as noncritical devices, and they do not need to be sterile.

AIM

Primary aim of this study was to assess the microbiological burden present on the surgical templates without metallic sleeves after disinfection. Furthermore, to evaluate trueness after disinfection and steam sterilization at 121°C/15 min, and over a 8-week storage period. Finally, to assess their accuracy after in vitro implant placement simulation.

MATERIALS AND METHODS

Forty surgical templates were printed and divided in five groups of eight templates each. Groups A to C were disinfected with 0.5% Chlorhexidine Gluconate and 70% ethyl alcohol base solution for 15 min. Templates in the group D were steam sterilized at 121°C for 15 min, while, the templates in the group E were used as control. Implant simulation was performed in the group A. Outcome measures were determination of bioburden, trueness assessment using GOM Inspect Professional software, and accuracy evaluated thought the mean angular deviation of simulated implants.

RESULTS

Total microbic charge measured as colony forming units (CFU) for sample, was 24.40 in the control group (group E; n = 8), and <4.40 in the test group (group C; n = 8), with a reduction of 84%. Colored representation from GOM inspection showed no differences after disinfection and implant simulation, disinfection alone, and steam sterilization, compared to the control group. A very small difference in the surface and volume dimensions was reported 1 month after templates fabrication. The mean roundness tolerances of the tested templates improved of 0.96 ± 0.56° (95% CI 0.57-1.35).

CONCLUSION

Surgical templates without metallic sleeves can be safely used after disinfection, demonstrating high level of accuracy, even when the surgical procedures should be postponed within a couple of weeks. Further in vivo study are needed to confirm these preliminary results.

Using a Preoperative Scan Digital Impression and a Digital Index to Build Immediate Interim Full-Arch Implant-Supported Prosthesis. A Case Report and Proof of Concept

The transfer of information such esthetics and occlusion from the preoperative to the postoperative digital impression could reduce the time needed to build an immediately loaded full-arch not-guided rehabilitation and improve the quality of the immediate interim restoration. Based on the digital technology advances of the last years, the purpose of the present clinical report is to describe a novel digital workflow based on computer-aided design and computer-aided manufacturing aimed at fabricating an interim fixed full-arch restoration. The protocol entails recording preoperative information such as esthetics, the occlusal plane and the intermaxillary relationship in implant-supported complete rehabilitations before the surgical insertion of the fixtures. Then, the information is transferred to the postoperative impression using a digital index in the lower jaw and the palatal rugae in the upper jaw. Within the inherent limitations of a case report, the workflow was accurate, predictable, without errors from conventional protocols and was apparently characterized by low biological costs.

Accuracy of Guided Implant Surgery in the Edentulous Jaw Using Desktop 3D-Printed Mucosal Supported Guides

Purpose: The aim of this in vitro study is to evaluate the accuracy of implant position using mucosal supported surgical guides, produced by a desktop 3D printer. Methods: Ninety implants (Bone Level Roxolid, 4.1 mm × 10 mm, Straumann, Villerat, Switzerland) were placed in fifteen mandibular casts (Bonemodels, Castellón de la Plana, Spain). A mucosa-supported guide was designed and printed for each of the fifteen casts. After placement of the implants, the location was assessed by scanning the cast and scan bodies with an intra-oral scanner (Primescan^®, Dentsply Sirona, York, PA, USA). Two comparisons were performed: one with the mucosa as a reference, and one where only the implants were aligned. Angular, coronal and apical deviations were measured. Results: The mean implant angular deviation for tissue and implant alignment were 3.25° (SD 1.69°) and 2.39° (SD 1.42°) respectively, the coronal deviation 0.82 mm (SD 0.43 mm) and 0.45 mm (SD 0.31 mm) and the apical deviation 0.99 mm (SD 0.45 mm) and 0.71 mm (SD 0.43 mm). All three variables were significantly different between the tissue and implant alignment (p < 0.001). Conclusion: Based on the results of this study, we conclude that guided implant surgery using desktop 3D printed mucosa-supported guides has a clinically acceptable level of accuracy. The resilience of the mucosa has a negative effect on the guide stability and increases the deviation in implant position.

Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance

Background

The advent of computer‐guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols.

Purpose

(a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval.

Materials and methods

A PUBMED search was performed in July 2018. A first search was based on a general search string limited to “Dental Implants” and “flapless surgery.” A second search focused on accuracy of computer‐guided surgery using search string “Surgery, Computer‐Assisted” or “guided surgery,” and “Dental implants.” The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta‐analysis. Reviews not mentioning accuracy were excluded in search 2.

Results

Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth‐supported guides show more accuracy than bone or mucosa‐supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty‐four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki.

Conclusions

Guided flapless surgery is comparable to free‐hand surgery in terms of implant survival, marginal bone remodeling, and peri‐implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding compliance with research ethics, we should question whether scientific reports of clinical trials performed without an ethical umbrella are trustworthy. Compliance of ethics standards is imperative for submitted research papers.