Abstract
The accuracy of implant placement with a fully guided digital template can be influenced by many factors, such as arch difference, alveolar bone density, timing of implant placement and open flap. The purpose of this article was to evaluate the factors presumptively affecting the accuracy of implant placement assisted by the fully guided template in the anterior zone. In 40 patients with missing anterior teeth, a total of 52 implants were placed with tooth-borne, fully guided templates after CBCT evaluation, in West China Hospital of Stomatology, Sichuan University. After overlapping the pre-and post-operative DICOM data, measurements were taken in the dental implant planning software (Nobel Clinician®) to calculate linear and angular deviations between virtual placement plan and actual implant placement. Grouping was categorized according to three factors that possibly have an influence on accuracy: arch type (maxilla/mandible), timing of implant placement (immediate/delayed), surgical technique (open flap/flapless). The data was analyzed with independent sample t-test (p < 0.05). The results showed that the apical, coronal, depth and angular mean deviations of implant positions in anterior zone were 1.13 ± 0.39 mm, 0.86 ± 0.33 mm, 0.41 ± 0.66 mm, 3.32 ± 1.65° with the fully guided templates. The accuracy at apex level, coronal level and the angulation were similar between the maxilla and mandible, and the magnitude of all four deviations between immediate and delayed implantation, open flap and flapless technique were small. No statistically significant difference was observed (p > 0.05). Whereas there was significant difference in depth deviation between maxilla and mandible (p < 0.05). Conclusively, the implant site, alveolar bone density, timing of implant placement and surgical techniques merely compromise the implant placement accuracy under the assistance of a fully guided template.
Highlights
Implant restorations in the anterior zone are usually accompanied with patients’higher aesthetic expectations and sufficient available bone volume
Different from the traditional free-hand implant placement that overly relies on the clinician’s skill set and experience, computer-assisted, template-guided implantology is driven by final optimal restoration, according to which clinicians address considerations for the most optimal implant position prior to the surgery [5,6,7]
Forty patients were enrolled in this study (The data has been attached in Supplementary Materials)
Summary
Implant restorations in the anterior zone are usually accompanied with patients’higher aesthetic expectations and sufficient available bone volume. One possible technique that facilitates a more accurate implant positioning is computer-assisted, template-guided implantology [3,4]. The template has been postulated to provide higher precision [8,9,10,11], which can help to achieve better implant placement with the potential for reduced operative complications [12,13,14]. Through digital designing software such as Simplant® and Nobel Clinician®, the patient’s cone-beam computed tomography (CBCT) data was overlapping with the intraoral or model threedimensional data obtained by an optical scanner [15], so that the clinicians can virtually plan the optimal three-dimensional implant position before the operation. Using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate the surgical template, and with the assistance of which we can transfer the preoperative virtual plan into the actual surgery
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