Time and costs related to computer-assisted versus non-computer-assisted implant planning and surgery. A systematic review

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.

The Influence of Guiding Concept on the Accuracy of Static Computer-Assisted Implant Surgery in Partially Edentulous Cases: An In Vitro Study

Background and Objectives: Static Computer-Assisted Implant Surgery (sCAIS) can be performed with different drill guiding systems. This study aimed to compare the accuracy of two guiding concepts of sCAIS in partially edentulous cases. Materials and Methods: Forty polyamide models of partially edentulous maxillae with seven implantation sites were fabricated. In total, 140 replica implants were placed with keyless (KL) and drill-key (DK) guiding systems using static, full-arch, tooth-supported surgical guides. Three-dimensional crestal and apical, angular and vertical deviations from the planned implant positions were compared using Mann-Whitney U and Kruskal-Wallis H tests. Intergroup homogeneity of variance homogeneity was examined using Levene's test to assess the precision. Results: Overall median 3D crestal and apical deviations of implants placed in the KL group were significantly higher compared to the DK group (0.86 mm [0.63-0.98] vs. 0.72 mm [0.52-0.89], p = 0.006 and 1.26 [0.98-1.52] vs. 1.13 [0.70-1.45], p = 0.012). In the subgroup analysis, implants placed with a KL system showed higher 3D crestal (p = 0.029), 3D apical (p < 0.001) and angular (p < 0.001) deviations in the extended anterior area, higher 3D crestal (p < 0.001) deviations in the proximal posterior single-tooth gap and higher vertical (p < 0.001) deviations in the distal site of free-end situation. Contrarily, the KL group showed lower 3D crestal (p = 0.007), 3D apical (p < 0.001), angular (p < 0.001) and vertical (p = 0.003) deviations in the distal posterior single-tooth gap, lower 3D apical (p = 0.007) and angular (p = 0.007) deviations in the distal site of free-end situation and lower vertical (p = 0.019) deviations in the proximal site of free-end situation. Conclusions: The deviations of both guiding concepts did not exceed the recommended safety margins. Statistically significant differences in deviations were found between two guiding concepts. Guiding concepts with superior accuracy varied across different sites of implantation.

Systematic review of peri-implant conditions and aesthetic outcomes of customized versus conventional healing abutments

PURPOSE

Customized healing abutments are utilized to enhance aesthetics and peri-implant soft and hard tissue health, and play a crucial role in the implant-prosthetic workflow. This systematic review was performed to assess and compare the clinical outcomes of customized healing abutments with conventional ones.

METHODS

The review was registered with PROSPERO (ID: CRD42024532449) and followed the PRISMA-guidelines. The PICO-question addressed was: "In patients with dental implants, do customized healing abutments result in beneficial peri-implant conditions compared with conventional healing abutments?" Clinical trials involving immediate and late implant placement that compared different healing abutments based on quantifiable outcomes were included. The "PubMed", "PubMed Central", "Cochrane Library", and "Web of Science databases" were screened for eligible studies until 4/20/2024.

RESULTS

Of 1,396 titles retrieved, 5 studies met the inclusion criteria and were analyzed. The included studies showed a low risk of bias as assessed by the RoB2 tool and Joanna Briggs Institute Critical Assessment questionnaire. Compared to conventional healing abutments, customized abutments were associated with a trend toward better clinical outcomes in peri-implant soft and hard tissue, as well as aesthetics. Several results within the cohorts using customized healing abutments showed significantly improved values in soft and hard tissue results as well as aesthetic parameters. Importantly, none of the included studies reported biological or aesthetic disadvantages associated with the use of customized healing abutments.

CONCLUSIONS

Customized healing abutments maintain stability of peri-implant hard and soft tissue. However, further studies with larger sample sizes and longer follow-up periods are needed to validate these findings.

Effect of immediate all-digital restoration of single posterior implants: The SafetyCrown concept on patient-reported outcome measures, accuracy, and treatment time-A randomized clinical trial

OBJECTIVE

The SafetyCrown workflow facilitates the immediate restoration of posterior single sites with the one-abutment/one-time concept. This randomized clinical trial aimed to assess the direct effect of immediate restoration on dental patient-reported outcomes (dPROs), feasibility, implant accuracy, and time.

MATERIALS AND METHODS

Participants with a single posterior edentulous site for late implant placement underwent optical impressions, shade selection, and cone beam computed tomography. After virtual treatment planning, they were randomized into the test group and the control group. For the test group, individual definitive hybrid abutments were prefabricated. The next step was a fully guided surgery with printed guides. After the implant was placed using guided surgery, the abutment was inserted. A chairside CAD/CAM workflow was used to provide the patient with a provisional restoration. Implants in the control group were left submerged to heal. Oral health-related quality of life (OHRQoL) was assessed using the OHIP-G14, and dPRO was measured using a 10-item visual analog scale (VAS) questionnaire. Additional measurements of implant accuracy and time were performed. Follow-up was performed 7 to 10 days after implant placement.

RESULTS

Thirty-nine participants with 45 restorations were included (test group: 23, control: 22). Immediate restoration was successful in 21 out of 23 implants (91.3%) in the test group. Both groups exhibited decreased OHRQoL without significant intergroup differences, while patient satisfaction was high overall. Test group participants perceived higher benefits and satisfaction with immediate loading than participants in the control group. Implant accuracy averaged 0.60 mm at the shoulder and 0.95 mm at the apex. Operative time was longer in the immediate loading group (61.9 min) than in the control group (32.1 min) (p < 0.001).

CONCLUSIONS

Considering the limitations, the immediate restoration of late placed posterior implants using the described workflow proved feasible in 21 out of 23 cases. Both groups achieved high patient satisfaction with no differences in OHRQoL during the first week. Patients who received immediate loading rated the benefits very highly and were satisfied with the provisional restoration during the healing period.

COMPARISONS BETWEEN DIGITAL-GUIDED AND NONDIGITAL PROTOCOL IN IMPLANT PLANNING, PLACEMENT, AND RESTORATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

OBJECTIVES

The present study aimed to systematically review the current randomized clinical trials (RCTs) with respect to computer-aided design/computer-aided manufactured (CAD/CAM) techniques in the process of implant planning, placement, and rehabilitation.

MATERIALS AND METHODS

Four independent reviewers conducted an electronic and manual literature search using several databases, including the National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE. Articles were included if they were RCTs involving the interventions regarding the computer-guided impression, placement, and manufacturing process. The outcomes of interest include clinical and patient-reported outcomes and time efficiency. A meta-analysis was conducted to evaluate the time efficiency, pain severity, accuracy of implant placement, and postsurgery marginal bone level.

RESULTS

A total of 39 and 25 articles were included in the qualitative and quantitative analysis, respectively. The results of the meta-analysis showed that significantly less time was spent performing the digital impression procedure than the conventional impression (P = .002). In addition, the average adjustment time of the final prosthesis was significantly less than the nondigital fabricated prosthesis (P = .0005). Computer-guided groups reported significantly lower painkiller consumption compared to control groups (P = .03).

CONCLUSIONS

Digital impressions and CAD/CAM procedures are time-saving and provide stable and predictable outcomes. Moreover, computer-guided surgery can effectuate an accurate implant placement and less postsurgery discomfort.

Reliability of a chairside CAD-CAM surgical guide for dental implant surgery on the anterior maxilla: An in vitro study

PURPOSE

This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience.

MATERIALS AND METHODS

Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05).

RESULTS

There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists' groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05).

CONCLUSION

CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.

The clinical effect of the digital guide in the early implant restoration of second molars

BACKGROUND

In the absence of contraindications to implants, implant repair is the preferred method to treat mandibular second molar loss.

OBJECTIVE

To compare the clinical effects of a traditional implant guide and digital implant guide in the early implant restoration of second molars.

METHODS

The study included 35 patients with second molar loss randomly divided into two groups. Eighteen patients in the experimental group had an implant procedure using a computer-aided design/computer-assisted manufacturing (CAD/CAM) digital implant guide, and 17 patients in the control group had the procedure using a traditional film pressing implantation guide. Then, the surgical procedure was completed using the two different implant guides. At 3 months after surgery, four parameters including screw hole exit position, coronal deviation of the implant site, disease improvement rate, and clinical effects, which included marginal adaptation, anatomic form, marginal discoloration, postoperative sensitivity, surface roughness, and secondary caries of the upper prosthesis were compared between the two groups.

RESULTS

The screw hole exit position in the experimental group was directed to the functional cusp of the opposite jaw, and there was a statistically significant difference between the two groups. There was no statistically significant difference in the rate of disease improvement and the clinical effect of the upper prosthesis between the two groups. There was no statistically significant difference in the bilateral coronal deviation and deviation direction of implants in the two groups. The bilateral coronal deviation of the experimental group was smaller than that of the control group.

CONCLUSION

The digital implant guide can effectively reduce the deviation of the screw hole and the upper prosthesis in the restoration of the second molar. The prosthesis used in the experimental group had a good clinical outcome, which provides a theoretical basis for the restoration of the posterior molar.

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 2021 dental 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 coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; 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 daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.