Accuracy of different types of surgical guides for dental implant placement

Abstract

BACKGROUND: The advancement of three-dimensional (3D) imaging techniques and implant planning software has contributed to a wide adoption of prosthetically guided implant placement.

AIM: This study aims to examine the virtual planning accuracy of dental implant placement using various surgical templates.

MATERIALS AND METHODS: The study included 24 partially and fully edentulous patients. Patients were divided into four groups using a parallel group design: templates for pilot osteotomy made by 3D printing (group I), full-guided templates made by 3D printing (group II), surgical templates for pilot osteotomy made by milling (group III), and full-guided templates made by milling (group IV). The accuracy of dental implant position was assessed by comparing the planned and actual position of the implants using preoperative and postoperative computed tomography. Three mean deviation parameters (angular, at the neck position, and at the apex position) were defined to evaluate the discrepancy between the planned and placed implant positions.

RESULTS: The best results were obtained in group III, where dental implant placement was performed using milled surgical templates for pilot osteotomy. The mean angular deviation, deviation at the neck, and deviation at the apex of the implant were 4.01±3.21°, 0.38±0.23 mm, and 0.56±0.51 mm, respectively (p <0.001 for all). The mean angular deviation in the group that used milled surgical templates for the full-guided osteotomy was 5.66±5.38°, with deviations at the implant neck and apex of 0.73±0.71 and 0.68±0.67 mm, respectively (p <0.001 for all), demonstrating high accuracy of implant placement within the “safety zone.”

Lower accuracy scores were found in groups I and II, when 3D printed templates were used. The mean angular deviation in the pilot osteotomy group was 7.71±5.94°, the mean deviation at the neck was 1.02±1.07 mm, and the mean deviation at the apex of the implant was 1.40±1.69 mm (p <0.001 for all). In the group for full-guided osteotomy, the mean angular deviation, deviation at the neck, and deviation at the apex of the implant were 6.4±6.21°, 0.58±0.45 mm, and 0.83±0.80 mm, respectively (p <0.001 for all).

CONCLUSION: The use of surgical templates in dental implant placement allows for a high accuracy in implant position. Milled surgical templates for dental implants are more accurate than 3D-printed templates, allowing us to introduce surgical templates into clinical practice to improve dental care quality.

Keywords

endosseous dental implantation / computer-assisted surgeries / osseointegrated dental implantation / surgical navigation

References

[1] Tsitsiashvili AM, Panin AM, Lepilin AV, Chuvilkin VI, Akhmedov GD. Implant surgery in partially edentulous patients with alveolar bone deficiency. Stomatologiya. 2019;98(1):30–33. (In Russ). doi: 10.17116/stomat20199801130

[2] Цициашвили А.М., Панин А.М., Лепилин А.В., Чувилкин В.И., Ахмедов Г.Д. Хирургическое лечение пациентов с использованием имплантатов при частичном отсутствии зубов в условиях дефицита костной ткани // Стоматология. 2019. Т. 98, № 1. С. 30–33. doi: 10.17116/stomat20199801130

[3] Dubova LV, Melnik AS, Stupnikov AA, Savelyev VV. Comparative evaluation of data kineseography and electromyography at patients without signs of TMJ disorders and with. Endodontiya Today. 2016;(2):11–15. (In Russ).

[4] Дубова Л.В., Мельник А.С., Ступников А.А., Савельев В.В. Сравнительная оценка показателей кинезиографии и электромиографии у пациентов без признаков патологии ВНЧС и с мышечно-суставной дисфункцией // Эндодонтия Today. 2016. № 2. С. 11–15.

[5] Tereshchuk SV, Ivanov SYu. The influence of zero-gravity on the volume of the augmented in the posterior maxilla bone and the survival of the dental implants placed in this bone. Clinical Dentistry. 2021;24(4):74–79. (In Russ). doi: 10.37988/1811-153X_2021_4_74

[6] Терещук С.В., Иванов С.Ю. Влияние невесомости на выживаемость имплантатов, установленных в реконструированную костную ткань альвеолярного отростка верхней челюсти методом направленной костной регенерации и открытого синус-лифтинга // Клиническая стоматология. 2021. Т. 24, № 4. С. 74–79. doi: 10.37988/1811-153X_2021_4_74

[7] Tsitsiashvili AM, Gurevich KG, Panin AM, Akimochkina LA. Quality of life of patients with partially edentolous atrophy jaws getting dental implant treatment. Sistemnyi analiz i upravlenie v biomeditsinskikh sistemakh. 2019;18(4):138–143. (In Russ). doi: 10.25987/VSTU.2020.18.4.017

[8] Цициашвили А.М., Гуревич К.Г., Панин А.М., Акимочкина Л.А. Качество жизни пациентов с отсутствием зубов, находящихся на лечении с применением дентальных имплантатов в условиях ограниченного объёма костной ткани // Системный анализ и управление в биомедицинских системах. 2019. Т. 18, № 4. С. 138–143. doi: 10.25987/VSTU.2020.18.4.017

[9] Ivanov SYu, Muraev AA, Rukina EA, Bunev AA. Immediate dental implantation. Sovremennye problemy nauki i obrazovaniya. 2015;(5):230. (In Russ).

[10] Иванов С.Ю., Мураев А.А., Рукина Е.А., Бунев А.А. Метод непосредственной дентальной имплантации // Современные проблемы науки и образования. 2015. № 5. 230.

[11] Olesova VN, Kashchenko PV, Bronshtein DA, Magamedkhanov MIu, Khavkin VA. Advantage of computer planning of intraosseous dental implantation. Stomatologiya. 2011;90(2):43–48. (In Russ).

[12] Олесова В.Н., Кащенко П.В., Бронштейн Д.А., Магамедханов М.Ю., Хавкин В.А. Компьютерное планирование внутрикостной дентальной имплантации // Стоматология. 2011. Т. 90, № 2. С. 43–48.

[13] Ivashchenko AV, Bayrikov AI, Monakov DV, Monakov VA. Experimental substantiation of the use of the navigation system in dental implantology. Russian Journal of Dentistry. 2014;18(6):12–14. (In Russ).

[14] Иващенко А.В., Байриков А.И., Монаков Д.В., Монаков В.А. Экспериментальное обоснование использования навигационной системы в дентальной имплантологии // Российский стоматологический журнал. 2014. Т. 18, № 6. С. 12–14.

[15] Geng W, Liu C, Su Y. Accuracy of different types of computer-aided design/computer-aided manufacturing surgical guides for dental implant placement. Int J Clin Exp Med. 2015;8(6):8442–8449.

[16] Geng W., Liu C., Su Y. Accuracy of different types of computer-aided design/computer-aided manufacturing surgical guides for dental implant placement // Int J Clin Exp Med. 2015. Vol. 8, N 6. P. 8442–8449.

[17] Yafi F, Camenisch B, Al-Sabbagh M. Is digital guided implant surgery accurate and reliable? Dent Clin North Am. 2019;63(3):381–397. doi: 10.1016/j.cden.2019.02.006

[18] Yafi F., Camenisch B., Al-Sabbagh M. Is digital guided implant surgery accurate and reliable? // Dent Clin North Am. 2019. Vol. 63, N ٣. P. ٣٨١–٣٩٧. doi: 10.1016/j.cden.2019.02.006

[19] Bover-Ramos F, Viña-Almunia J, Cervera-Ballester J, Peñarrocha-Diago M, García-Mira B. Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies. Int J Oral Maxillofac Implants. 2018;33(1):101–115. doi: 10.11607/jomi.5556

[20] Bover-Ramos F., Viña-Almunia J., Cervera-Ballester J., Peñarrocha-Diago M., García-Mira B. Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies // Int J Oral Maxillofac Implants. 2018. Vol. 33, N 1. P. 101–115. doi: 10.11607/jomi.5556

[21] Vokulova JA, Zhulev EN. A method for evaluation of dental implant placement accuracy using digital technologies. Siberian Medical Review. 2022;(1):59–65. (In Russ). doi: 10.20333/25000136-2022-1-59-65

[22] Вокулова Ю.А., Жулев Е.Н. Методика оценки точности установки зубных имплантатов с применением цифровых технологий // Сибирское медицинское обозрение. 2022. № 1. С. 59–65. doi: 10.20333/25000136-2022-1-59-65

[23] Cristache СM, Gurbanescu S. Accuracy evaluation of a stereolithographic surgical template for dental implant insertion using 3D superimposition protocol. Int J Dent. 2017;2017:4292081. doi: 10.1155/2017/4292081

[24] Cristache С.M., Gurbanescu S. Accuracy evaluation of a stereolithographic surgical template for dental implant insertion using 3D superimposition protocol // Int J Dent. 2017. Vol. 2017. 4292081. doi: 10.1155/2017/4292081

[25] Tallarico M, Martinolli M, Kim Y, et al. Accuracy of computer-assisted template-based implant placement using two different surgical templates designed with or without metallic sleeves: a randomized controlled trial. Dent J. 2019;7(2):41. doi: 10.3390/dj7020041

[26] Tallarico M., Martinolli M., Kim Y., et al. Accuracy of computer-assisted template-based implant placement using two different surgical templates designed with or without metallic sleeves: a randomized controlled trial // Dent J. 2019. Vol. 7, N 2. 41. doi: 10.3390/dj7020041

[27] Schulz MC, Hofmann F, Range U. Pilot-drill guided vs. full-guided implant insertion in artificial mandibles — a prospective laboratory study in fifth-year dental students. Int J Implant Dent. 2019;5(1):23. doi: 10.1186/s40729-019-0176-4

[28] Schulz M.C., Hofmann F., Range U. Pilot-drill guided vs. full-guided implant insertion in artificial mandibles — a prospective laboratory study in fifth-year dental students // Int J Implant Dent. 2019. Vol. 5, N 1. 23. doi: 10.1186/s40729-019-0176-4

[29] Pascual D, Vaysse J. Chirurgie implantaire et prothèse guidées et assistées par ordinateur : le flux numérique continu. Rev Stomatol Chir Maxillofac Chir Orale. 2016;117(1):28–35. (In French). doi: 10.1016/j.revsto.2015.11.011

[30] Pascual D., Vaysse J. Chirurgie implantaire et prothèse guidées et assistées par ordinateur : le flux numérique continu // Rev Stomatol Chir Maxillofac Chir Orale. 2016. Vol. 117, N 1. P. 28–35. doi: 10.1016/j.revsto.2015.11.011

[31] Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2018;29 Suppl. 16:416–435. doi: 10.1111/clr.13346

[32] Tahmaseb A., Wu V., Wismeijer D., Coucke W., Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis // Clin Oral Implants Res. 2018. Vol. 29, Suppl. 16. P. 416–435. doi: 10.1111/clr.13346

[33] Unsal GS, Turkyilmaz I, Lakhia S. Advantages and limitations of implant surgery with CAD/CAM surgical guides: A literature review. J Clin Exp Dent. 2020;12(4):e409–e417. doi: 10.4317/jced.55871

[34] Unsal G.S., Turkyilmaz I., Lakhia S. Advantages and limitations of implant surgery with CAD/CAM surgical guides: A literature review // J Clin Exp Dent. 2020. Vol. 12, N 4. P. e409–e417. doi: 10.4317/jced.55871

[35] Bencharit S, Staffen A, Yeung M, et al. In vivo tooth-supported implant surgical guides fabricated with desktop stereolithographic printers: fully guided surgery is more accurate than partially guided surgery. J Oral Maxillofac Surg. 2018;76(7):1431–1439. doi: 10.1016/j.joms.2018.02.010

[36] Bencharit S., Staffen A., Yeung M., et al. In vivo tooth-supported implant surgical guides fabricated with desktop stereolithographic printers: fully guided surgery is more accurate than partially guided surgery // J Oral Maxillofac Surg. 2018. Vol. 76, N 7. P. 1431–1439. doi: 10.1016/j.joms.2018.02.010

[37] Flügge T, Derksen W, Te Poel J, et al. Registration of cone beam computed tomography data and intraoral surface scans — A prerequisite for guided implant surgery with CAD/CAM drilling guides. Clin Oral Implants Res. 2017;28(9):1113–1118. doi: 10.1111/clr.12925

[38] Flügge T., Derksen W., Te Poel J., et al. Registration of cone beam computed tomography data and intraoral surface scans — A prerequisite for guided implant surgery with CAD/CAM drilling guides // Clin Oral Implants Res. 2017. Vol. 28, N 9. P. 1113–1118. doi: 10.1111/clr.12925

[39] Tatakis DN, Chien HH, Parashis AO. Guided implant surgery risks and their prevention. Periodontol 2000. 2019;81(1):194–208. doi: 10.1111/prd.12292

[40] Tatakis D.N., Chien H.H., Parashis A.O. Guided implant surgery risks and their prevention // Periodontol ٢٠٠٠. 2019. Vol. 81, N 1. P. 194–208. doi: 10.1111/prd.12292

[41] Drobyshev AYu, Vaulina DS, Red’ko NA. Otsenka tochnosti pozicionirovaniya dental’nykh implantatov s ispol’zovaniem stereolitographicheskikh khirurgicheskikh shablonov, izgotovlennykh po razlichnym opticheskim modelyam. In: Aktual’nuye voprosy stomatologii: Proceedings of the All-Russian V scientific-practical conference with international participation; 2021 May 13–14; Kirov. Kirov; 2021. P:48–50. (In Russ).

[42] Дробышев А.Ю., Ваулина Д.С, Редько Н.А. Оценка точности позиционирования дентальных имплантатов с использованием стереолитографических хирургических шаблонов, изготовленных по различным оптическим моделям // Актуальные вопросы стоматологии: сборник трудов Всероссийской V научно-практической конференции с международным участием; май 13–14, 2021; Киров. Киров, 2021. С. 48–50.

[43] Vaulina DS, Skakunov YaI, Red’ko NA, Drobyshev AYu. Predoperatsionnaya podgotovka patsientov pri planirovanii dental’noi implantatsii s ispol’zovaniem khirurgicheskogo shablona. Rossiiskaya stomatologiya. 2021;14(3):32–33. (In Russ).

[44] Ваулина Д.С., Скакунов Я.И., Редько Н.А., Дробышев А.Ю. Предоперационная подготовка пациентов при планировании дентальной имплантации с использованием хирургического шаблона // Российская стоматология. 2021. Т. 14, № 3. С. 32–33.

[45] Cristache CM, Gurbanescu S. Accuracy evaluation of a stereolithographic surgical template for dental implant insertion using 3D superimposition protocol. Int J Dent. 2017;2017:4292081. doi: 10.1155/2017/4292081

[46] Cristache C.M., Gurbanescu S. Accuracy evaluation of a stereolithographic surgical template for dental implant insertion using 3D superimposition protocol // Int J Dent. 2017. Vol. 2017. 4292081. doi: 10.1155/2017/4292081

[47] Ku JK, Lee J, Lee HJ, Yun PY, Kim YK. Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study. BMC Oral Health. 2022;22(1):8. doi: 10.1186/s12903-022-02046-z

[48] Ku J.K., Lee J., Lee H.J., Yun P.Y., Kim Y.K. Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study // BMC Oral Health. 2022. Vol. 22, N ١. 8. doi: 10.1186/s12903-022-02046-z

[49] Gargallo-Albiol J, Barootchi S, Salomó-Coll O, Wang HL. Advantages and disadvantages of implant navigation surgery. A systematic review. Ann Anat. 2019;225:1–10. doi: 10.1016/j.aanat.2019.04.005

[50] Gargallo-Albiol J., Barootchi S., Salomó-Coll O., Wang H.L. Advantages and disadvantages of implant navigation surgery. A systematic review // Ann Anat. 2019. Vol. 225. P. 1–10. doi: 10.1016/j.aanat.2019.04.005

[51] Shen P, Zhao J, Fan L, et al. Accuracy evaluation of computer-designed surgical guide template in oral implantology. J Craniomaxillofac Surg. 2015;43(10):2189–2194. doi: 10.1016/j.jcms.2015.10.022

[52] Shen P., Zhao J., Fan L., et al. Accuracy evaluation of computer-designed surgical guide template in oral implantology // J Craniomaxillofac Surg. 2015. Vol. 43, N 10. P. 2189–2194. doi: 10.1016/j.jcms.2015.10.022

[53] Vercruyssen M, Cox C, Coucke W, et al. A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template. J Clin Periodontol. 2014;41(7):717–723. doi: 10.1111/jcpe.12231

[54] Vercruyssen M., Cox C., Coucke W., et al. A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template // J Clin Periodontol. 2014. Vol. 41, N 7. P. 717–723. doi: 10.1111/jcpe.12231

[55] Olesova VN, Romanov AS, Zaslavsky RS, Grishkov MS, Zveryaev AG. Frequency and subjective reasons for rejecting repeated prosthetics on implants. AI Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2022;(1):27–30. (In Russ). doi: 10.33266/2782-6430-2022-1-27-30

[56] Олесова В.Н., Романов А.С., Заславский Р.С., Гришков М.С., Зверяев А.Г. Частота и субъективные причины отказов от повторного протезирования на имплантатах // Клинический вестник ФМБЦ им. А.И. Бурназяна. 2022. № 1. С. 27–30. doi: 10.33266/2782-6430-2022-1-27-30

[57] Suriyan N, Sarinnaphakorn L, Deeb GR, Bencharit S. Trephination-based, guided surgical implant placement: A clinical study. J Prosthet Dent. 2019;121(3):411–416. doi: 10.1016/j.prosdent.2018.06.004

[58] Suriyan N., Sarinnaphakorn L., Deeb G.R., Bencharit S. Trephination-based, guided surgical implant placement: A clinical study // J Prosthet Dent. 2019. Vol. 121, N 3. P. 411–416. doi: 10.1016/j.prosdent.2018.06.004

[59] Drobyshev AYu, Vaulina DS, Skakunov YaI, Redko NA. Fotoprotokol patsienta kak instrument obscheniya i metod obsledovaniya. Rossiiskaya stomatologiya. 2020;13(4):41–43. (In Russ).

[60] Дробышев А.Ю., Ваулина Д.С., Скакунов Я.И, Редько Н.А. Фотопротокол пациента как инструмент общения и метод обследования // Российская стоматология. 2020. Т. 13, № 4. С. 41–43.

[61] Yeung M, Abdulmajeed A, Carrico CK, Deeb GR, Bencharit S. Accuracy and precision of 3D-printed implant surgical guides with different implant systems: An in vitro study. J Prosthet Dent. 2020;123(6):821–828. doi: 10.1016/j.prosdent.2019.05.027

[62] Yeung M., Abdulmajeed A., Carrico C.K., Deeb G.R., Bencharit S. Accuracy and precision of ٣D-printed implant surgical guides with different implant systems: An in vitro study // J Prosthet Dent. 2020. Vol. 123, N 6. P. 821–828. doi: 10.1016/j.prosdent.2019.05.027

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