Guided Dental Implant Surgery: Systematic Review

Comparison of temperature changes in different irrigation methods used in guided piezosurgery: in vitro study

PURPOSE

The study aimed to investigate the cooling performance of three different surgical methods for bone splitting during implant dentistry procedures.

METHODS

An in vitro study was conducted on bovine ribs to test the cooling performance of three osteotomy methods: conventional osteotomy with standard cooling irrigation, template-assisted osteotomy with standard cooling irrigation, and modified template-assisted osteotomy with additional cooling fluid through internal irrigation channels in the surgical guide. A negative control group without cooling was also included. Temperature measurements were taken during the procedures using a contactless infrared thermometer.

RESULTS

The results showed that the conventional osteotomy without cooling resulted in the highest mean of the peak temperatures (114.7 °C ± 45.4), while the modified template-assisted osteotomy with additional cooling achieved the lowest mean of the peak temperatures (29.4 °C ± 7). Statistically significant differences in temperature were observed among the groups (p < 0.001).

CONCLUSION

The study rejected the null hypothesis and demonstrated that the cooling method used during bone splitting procedures significantly affected the temperature development at the surgical site. The modified template-assisted osteotomy with additional cooling provided the best cooling performance. However, caution should be exercised in interpreting the results due to the limitations of the in vitro study. Further research with stronger external validity is needed to confirm these findings and explore their applicability in clinical settings to benefit patients.

Dental implant planning using artificial intelligence: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Data on the role of artificial intelligence (AI) in dental implant planning is insufficient.

PURPOSE

The purpose of this systematic review with meta-analysis was to analyze and evaluate articles that assess the effectiveness of AI algorithms in dental implant planning, specifically in detecting edentulous areas and evaluating bone dimensions.

MATERIAL AND METHODS

A systematic review was conducted across the MEDLINE/PubMed, Web of Science, Cochrane, and Scopus databases. In addition, a manual search was performed. The inclusion criteria consisted of peer-reviewed studies that examined the accuracy of AI-based diagnostic tools on dental radiographs for dental implant planning. The most recent search was conducted in January 2024. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included articles.

RESULTS

Twelve articles met the inclusion criteria for this review and focused on the application of AI in dental implant planning using cone beam computed tomography (CBCT) images. The pooled data indicated an overall accuracy of 96% (95% CI=94% to 98%) for the mandible and 83% (95% CI=82% to 84%) for the maxilla in identifying edentulous areas for implant planning. Eight studies had a low risk of bias, 2 studies had some concern of bias, and 2 studies had a high risk of bias.

CONCLUSIONS

AI models have the potential to identify edentulous areas and provide measurements of bone as part of dental implant planning using CBCT images. However, additional well-conducted research is needed to enhance the accuracy, generalizability, and applicability of AI-based approaches.

Personalized and Complex Esthetic Oral Rehabilitation in a Case of Non-Syndromic Oligodontia

Dental agenesis is one of the most common developmental anomalies in humans and it is frequently associated with several other oral abnormalities. The present case describes non-familial agenesis of permanent teeth in a twenty-one-year-old boy with no apparent systemic abnormalities. The treatment included a personalized and interdisciplinary approach involving endodontics, orthodontics, implant-supported restorations and prosthetic treatments. The treatment plan was thoroughly elaborated using photographic analysis, study models, orthopantomogram, CBCT and cephalograms. Virtual smile design, diagnostic waxing and mock-ups previsualized the treatment objectives. The edentulous spaces were reconstructed by inserting dental implants and monolithic zirconia implant-supported restorations. The final results showed a highly esthetic and functional rehabilitation. Periodic check-ups have shown that the stability of the result is well maintained and that the implant-supported restorations are an optimal solution for patients with multiple anodontia.

Comparison of Dental Zirconium Oxide Ceramics Produced Using Additive and Removal Technology for Prosthodontics and Restorative Dentistry-Strength and Surface Tests: An In Vitro Study

BACKGROUND

The aim of this in vitro study was to determine the mechanical and functional properties of zirconium oxide ceramics made using 3D printing technology and ceramics produced using conventional dental milling machines.

METHODS

Forty zirconia samples were prepared for this study: the control group consisted of 20 samples made using milling technology, and the test group consisted of 20 samples made using 3D printing technology. Their surface parameters were measured, and then their mechanical parameters were checked and compared. Density, hardness, flexural strength and compressive strength were tested by performing appropriate in vitro tests. After the strength tests, a comparative analysis of the geometric structure of the surfaces of both materials was performed again. Student's t-test was used to evaluate the results (p < 0.01).

RESULTS

Both ceramics show comparable values of mechanical parameters, and the differences are not statistically significant. The geometric structure of the sample surfaces looks very similar. Only minor changes in the structure near the crack were observed in the AM group.

CONCLUSION

Ceramics made using additive technology have similar mechanical and surface parameters to milled zirconium oxide, which is one of the arguments for the introduction of this material into clinical practice. This in vitro study has shown that this ceramic can compete with zirconium made using CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) methods.

Radiographic marginal bone level evaluation around two different tissue-level implant systems: a one-year prospective study

BACKGROUND

Marginal bone loss, is a frequently reported variable in the evaluation of dental implants. The primary objective of this study was to evaluate radiographic marginal bone level changes around the two different tissue-level implant systems placed adjacently in the posterior maxilla or mandible. The influence of implant macro-geometry and vertical soft tissue thickness on marginal bone loss were also evaluated.

METHODS

Seven patients were included in the study and a total of 18 implants were analyzed. Each patient received two different implants placed adjacently in the maxilla or the mandible. The implants used in our study were either Straumann® SP cylindrical implants or JD Octa® tapered implants. During the surgery, vertical soft-tissue thickness was measured with a periodontal probe placed on the top of the bony crest and in the center of the future implant site. Healing abutments were then seated. Three months following implant placement, impressions were taken, and screw-retained metal ceramic prostheses were delivered. Standardized intraoral radiographs were taken immediately after implant placement and one year following implant loading in order to assess marginal bone level changes.

RESULTS

Results showed a mean marginal bone loss of 0.55±0.5 mm for Straumann® SP implants and 0.39±0.49 mm for JD Octa® implants after one year of loading and the difference was not statistically significant between the two systems. A statistically significant correlation was found between soft tissue thickness and marginal bone loss; in sites with thin mucosal tissues (≤2 mm), there was significantly greater bone loss compared to sites with thick, soft tissues (> 2 mm) in both implants.

CONCLUSIONS

Radiographic marginal bone loss was not statistically different between the two implant systems at the one-year examination period. Moreover, vertical soft tissue thickness influenced marginal bone loss regardless of the implant system used.

Survival Rate of Dental Implants in the Cleft Area: A Cross-Sectional Retrospective Study

This study aimed to evaluate the survival rate of osseointegrated implants installed in the cleft area. An extensive data survey was conducted using the medical records of individuals who had implants installed in the cleft area between 1999 and 2020. The variables assessed were age, sex, implant follow-up time, implantation procedures, and rehabilitation with implant-supported prostheses. Data were analyzed in terms of implant survival time, correlating with the factors: age, sex, execution, or no-execution of bone regrafting, the time interval between secondary alveolar bone grafting and regrafting, the time interval between regrafting and implant installation, and the time interval between implant installation and provisional and definitive prosthesis. Data were analyzed with respect to implant survival. χ 2 and Student t tests were used with a 5% significance level. A total of 1295 medical records were analyzed, of which 688 reported implants in cleft areas (56.1% in females, 43.9% in males) with a success rate of 92.73% and a mean follow-up time of 53.2 (±45.0) months. There were no statistically significant differences in the correlation between the survival rate and sex ( P = 0.895, χ 2 test), between the implant survival rate and regrafted area ( P = 0.904, χ 2 test), or between the survival rate and patient age ( P = 0.246, Student t test). The survival rate of implants in the cleft area was 92.73%. Age, sex, and the need for regrafting did not influence the survival rate of implants installed in the cleft area. Clinical studies that evaluate the survival rate of implants installed in patients with cleft maxilla are of great relevance to the dental field.

CBCT Evaluation of Quality and Quantity of Bones for Immediate Implant Treatment Planning in Central Incisor Area in relation to Arch Form

Understanding the quality of the ridge and facial cortical bone in the aesthetic zone is important for treatment with an immediate dental implant. This study aimed to analyze bone density and widths of the facial cortical bone and alveolar ridge at the central incisors in relation to arch form. A total of 400 teeth from 100 cone-beam CT images were divided equally between the upper and lower central incisors. The central incisor area was assessed for the width of the facial cortical and alveolar bones at three different points (3 mm, 6 mm, and 9 mm from the cementoenamel junction). Arch forms and densities of cortical and cancellous bones in the interradicular regions were evaluated. The difference in facial cortical bone thickness at 3 points was smaller for the upper teeth than for the lower teeth on both sides. The alveolar bone width was higher in the maxilla than the mandible with highly significant differences (P < 0.001). The highest bone density was at the buccal aspect of the mandible (897.36 ± 136.72 HU), while the lowest density was at the cancellous bone of the maxilla (600.37 ± 126.63 HU). The dominant arch form was ovoid 71%, followed by square 20% and the tapering arch form 10%. The tapering arch form has the highest alveolar bone width in the upper jaw without statistical significance. The facial cortical bone thickness needs to be evaluated before implantation in the anterior region because it is less than two millimeters in both jaws. CBCT is important for the immediate implant. The ovoid shape was the dominant arch form.