Abstract
Objective: to evaluate In Vitro and in vivo the accuracy and the precision of guided implant surgery, associated with three mini-implants placement used as precision pins. Materials and Methods: For In Vitro evaluation, two acrylic resin model with artificial gum were prepared to represent edentulous mandibles. For the next in vivo evaluation two patients were treated using the same method. Three mini-implants used as reference points were placed before diagnostic and therapeutic procedure. Pre-and post-implantation CBCT images were superimposed using digital processing image software to evaluate the linear and angular deviations between the virtual planning data and the surgical results. Results: In Vitro: The mean angular deviation between the virtual and actual positions of twelve placed implants was 2.4 degrees (SD 0.168). The mean depth deviation at the level of the implant shoulder (D1) was 0.23 mm (SD 0.021), the depth deviation at the implant center (D2) was 0.21 mm (SD 0.007), and the depth deviation at the level of apical point (D3) was 0.14 mm (SD 0.014). The mean shoulder mesial radial deviation (SMR) was 0.30 mm (SD 0.007), the mean shoulder distal deviation was 0.27 mm (SD 0.028), the mean implant center deviation was 0.21 mm (SD 0.17), and the mean apex radial (ARP) deviation was 0.15 mm (SD 0.021). and 0.27 mm (SD 0.19), respectively. The differences were found not statistically significant in vivo: The mean angular deviation between the virtual and actual positions of twelve placed implants was 3.0 degrees (SD 0.1167). The mean D1 deviation was 0.27 mm (SD 0.018), the mean D2 deviation was 0.29 mm (SD 0.041), and the mean D3 deviation was 0.17 mm (SD 0.019). The mean SMR deviation was 0.27 mm (SD 0.021); the mean SDR deviation was 0.34 mm (0.022) while the ARP mean deviation was 0.24 mm (SD0.248). The differences were found not statistically significant . Conclusions: Results showed that the use of three mini-implants used as precision pin allows obtaining a promising accuracy in virtual implant placement.
Highlights
IntroductionOne of the most important developments in the field of implant dentistry is the introduction of computed tomography (CT) in conjunction with Computer-aided design/computer assisted manufacturing (CAD/CAM)-generated surgical guides
Results showed that the use of three mini-implants used as precision pin allows obtaining a promising accuracy in virtual implant placement
One of the most important developments in the field of implant dentistry is the introduction of computed tomography (CT) in conjunction with Computer-aided design/computer assisted manufacturing (CAD/CAM)-generated surgical guides
Summary
One of the most important developments in the field of implant dentistry is the introduction of computed tomography (CT) in conjunction with Computer-aided design/computer assisted manufacturing (CAD/CAM)-generated surgical guides. To transfer the preoperatively planned implant position into the patient’s mouth, surgical templates based on the preoperative set-up and virtual implant planning, are either fabricated manually in a dental laboratory or stereolithographically by CAD/CAM technology. Systems, which use this kind of procedure, are called “template-based” or “static”. Different issues regarding this kind of technology are still open to debate It requires a complex consequential protocol, which involved several steps: 1) the fabrication of a radiographic template, 2) the CBCT acquisition with the template in position, 3) the computer assisted implant planning, and 4) the fabrication and use of a surgical guide for drilling and implant insertion. Factors reported influencing the accuracy of the computer-guided approach in a negative way has been identified in bone supported guides, in the use of multiple templates, and in the lack of guide fixation [13]
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