Fully Digital Workflow for Planning Static Guided Implant Surgery: A Prospective Accuracy Study.

Chia-Cheng Lin,Chiung-Fang Huang,Ching-Zong Wu,Hsin-Chung Cheng,Dayen Peter Wang,Mao-Suan Huang

doi:10.3390/jcm9040980

Abstract

The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has been extensively examined; however, more information is required to justify the application of fully digital planning protocol. The purpose of this study was to investigate the clinical accuracy of sGIS with a fully digital planning workflow. Twenty-one partially edentulous patients were enrolled in this prospective study. Cone-beam computed tomography (CBCT) and intraoral scans were taken and superimposed by matching the dental surface images directly (surface registration protocol) or by matching fiducial markers on a stereolithographic (SLA) radiographic template fabricated from the digital data of the intraoral scan (fiducial marker registration protocol). Virtual implant treatment plans were then determined, and tooth-supported SLA surgical guides were fabricated according to the plans. Twenty-six implant surgeries were performed via the surgical guide by one surgeon. Pre- and post-operative CBCT images were superimposed, and the positional and angular deviations between placed and planned implants were measured with metrology software. A total of 43 fully guided implants were placed, in which 25 implants were planned with the surface registration protocol. Implants planned based on the surface registration protocol had a larger mean angular deviation than the fiducial marker registration protocol. No significant differences were found for any deviations of the examined variables. Within the limits of this study, we concluded that the clinical accuracy of the sGIS planned with a fully digital workflow was consistent with the conventional workflow for partially edentulous patients.

Highlights

Implant dentistry has shifted from a “surgically driven approach” to a “prosthetically driven approach”, because appropriate implant positioning is crucial to achieving long-term functional and esthetic success [1]
The digital treatment plans of 15 patients were based on the surface registration protocol, whereas six patients were based on the fiducial marker protocol
Seven implants in five surgeries had to be inserted free-handed in the molar sites due to the limited mouth opening of the patient; only 43 implants were inserted fully guided by the surgical guide

Summary

Introduction

Implant dentistry has shifted from a “surgically driven approach” to a “prosthetically driven approach”, because appropriate implant positioning is crucial to achieving long-term functional and esthetic success [1]. Computer-guided implant surgery has been developed for over two decades. This digital technology is commonly recommended because it can reduce inaccuracy in terms of implant positioning [2]. Two types of guided implant surgery systems have been developed: static (template-based) and dynamic navigation. The surgical guide can confine (guide) the direction and depth of the implant bed preparation and implant placement so that a virtually planned implant position can be transferred to the implant site. To achieve the appropriate implant position and angulation, a precise blueprint of the future restoration on the implant, that is, the digital planning itself, is an essential determinant of the correct implant positioning for computer-guided implant surgery

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Conclusion