Computer-Aided Design and Computer-Aided Modeling (CAD/CAM) for Guiding Dental Implant Surgery: Personal Reflection Based on 10 Years of Real-Life Experience

Dynamic navigation vs. static navigation in implant placement: A meta-analysis

OBJECTIVE

The precision of implant surgery is pivotal to the success of implant outcomes. This meta-analysis was conducted to assess the comparative efficacy of static computer-aided implant surgery (sCAIS) and dynamic computer-aided implant surgery (dCAIS) on the accuracy of implant placement.

METHODS

A systematic search was performed in the Cochrane Library, PubMed, clinical trial registries, Embase, the Chinese National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases for studies comparing sCAIS and dCAIS up to April 16, 2024. The Newcastle-Ottawa Scale (NOS) was used for the quality assessment of included cohort studies (CSs), and Cochrane Risk of Bias version 2 (RoB2) were utilized to evaluate the risk of bias of included randomized controlled trials (RCTs). The meta-analysis was conducted with RevMan 5.3 software developed by the Cochrane Collaboration.

RESULTS

A total of 9 studies, comprising 4 RCTs and 5 CSs, were included in the final analysis. The meta-analysis revealed that dCAIS significantly reduced implant apical deviation (MD=-0.12, 95% CI: -0.23 to -0.02, P = 0.02) and implant depth deviation (MD=-0.20, 95% CI: -0.34 to -0.06, P = 0.004) compared to sCAIS. However, no significant differences were observed in implant platform deviation (MD=-0.01, 95% CI: -0.08 to 0.06, P = 0.74) and implant angular deviation (MD=-0.30, 95% CI: -0.78 to 0.18, P = 0.22) between the two techniques. Egger's test results indicated no evidence of publication bias across the analyzed outcomes (all P > 0.05).

CONCLUSIONS

The current evidence suggests that dCAIS offers superior implant accuracy over sCAIS.

CLINICAL SIGNIFICANCE

dCAIS may be preferred for use in implant placement. Further high-quality clinical research is necessary to comprehensively evaluate the roles of dCAIS and sCAIS in various types of edentulous conditions, particularly within the context of uniform navigation systems.

Effect of magnetic resonance imaging protocol on decision-making for positioning of dental implants in edentulous cases

PURPOSE

This study aimed to assess the influence of magnetic resonance imaging (MRI) protocol on the decision-making for the positioning of dental implants in edentulous arches in comparison to planning based on cone beam computed tomography (CBCT).

MATERIALS AND METHODS

One phantom was scanned with CBCT and two MRI protocols (T1- and T2-weighted). Two calibrated examiners performed digital implant planning (coDiagnostiX, Dental Wings), considering a digital prosthetic planning and alveolar ridge surface scan. Four implants were planned for each patient dataset, and the angular deviation between the long axis of the implants and the prosthetic planning occlusal plane was measured.

RESULTS

Each examiner planned 40 implants, 12 implants with CBCT and 28 implants with MRI (16 with T1 and 12 with T2 images). Significant differences in angle deviation were observed between CBCT, T1, and T2 in the anterior region for both examiners (p = 0.009 for examiner 1 and p = 0.042 for examiner 2). Implants planned with CBCT showed significantly lower angular deviation than those based on the T1 and T2 scans for both examiners (p = 0.028 and p = 0.046 for examiner 1 and p = 0.028 and p = 0.027 for examiner 2). No significant difference in angular deviation was found between T1 and T2 for both examiners (examiner 1: p = 0.600, examiner 2: p = 0.916).

CONCLUSION

Compared to CBCT planning, the MRI protocol influenced decision-making for anterior dental implants, with angular deviations within acceptable clinical thresholds, but further studies are needed to validate these findings.

A method for assessing guide layout and error on implant accuracy

Functional and esthetic results require accurate implant placement. We aimed to develop a predictive method for assessing guide layout and error on implant accuracy. A mathematical model for position error analysis was constructed based on triangular mesh data. This model examines the relationship between the spatial shifts of multiple surfaces and the spatial shifts of specific points. It involves encasing these surfaces in a cuboid bounding box and expressing them in a local coordinate system. The influence of positioning surface error and layout of surgical guide were researched with a simulation test. The result shows that error in the implant site position is directly related to the error in the guide locating surface under the same layout. When the guide locating surface layout varies, as the length, width, and height of the minimum cuboid envelope increase, the maximum deviation in the implant site position decreases.

Digital planning and bone regenerative technologies: A narrative review

OBJECTIVES

The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry.

MATERIAL AND METHODS

A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry.

RESULTS

Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement.

CONCLUSIONS

Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.