Apex Deviation Research Articles

Examining the Influence of Freehand, Pilot-Guided, and Fully Guided Surgical Protocols on the Accuracy of Immediately Placed Implants—An In Vitro Study

This study aimed to evaluate the influence of the guidance level on the accuracy of immediately placed implants. Methods: Eighteen identical maxillary models (randomly split into three groups (n = 6): fully guided (FG), pilot-guided (PG), and freehand (FH)) were used to place 72 implants (n = 24). After placement, the mean global, angular, mesial–distal, buccal–palatal, and vertical deviation at the platform and apex of the placed implants, relative to the preoperatively planned positions, was calculated. Results: Significant differences in global and mesial–distal deviation were found between implants in the FG group and implants in the PG and FH groups. Significant differences were also found between the implants in the FG and FH groups as well as the implants in the PG and FH groups in terms of angular and mesial–distal apex deviation. Finally, significant differences were found between the implants in the FG and PG groups in terms of buccal–palatal platform deviation. Conclusions: The results of this in vitro study show that immediate implants placed using fully guided surgical guides have significantly less deviation, and are therefore more accurate, than implants placed freehand or using pilot guides, but this should be further validated in a clinical trial.

The Accuracy of Dental Implant Placement With Different Methods of Computer-Assisted Implant Surgery: A Network Meta-Analysis of Clinical Studies.

Computer-assisted implant surgery (CAIS) has been introduced as a tool to aid in reaching a more accurate implant position. The aim of this network meta-analysis was to compare all the available CAIS techniques and obtain collective evidence on the method that offers the highest accuracy compared to freehand implant placement. Database search was done in PubMed, Scopus, and Cochrane library in addition to extensive search in the gray literature and related systematic reviews, aiming to find clinical studies that compared any CAIS technique with another, or with freehand implant placement. The outcomes evaluated were angle, platform, and apex deviation. The search process ended on March 18, 2024. Thirty-three studies were included. All CAIS techniques (static with partial or full guidance, dynamic with partial or full guidance, the combination of static and dynamic CAIS) showed significantly less deviation than freehand implant placement, except for the static CAIS with guidance for the pilot drill only. The combination of static and dynamic CAIS ranked best among all other methods. Based on the GRADE system, the certainty of evidence in the outcomes of the meta-analysis was judged as low or moderate. The current study demonstrates that computer-assisted implant surgery provides significantly higher accuracy in implant placement, with the combination of static and dynamic CAIS being the most precise. Nevertheless, future studies are needed, considering the different types, locations, and extents of edentulism in the analyzed investigations, as well as the necessity of obtaining stronger evidence. PROSPERIO number: CRD42023482030.

Comparative analysis of dental implant placement accuracy: Semi-active robotic versus free-hand techniques: A randomized controlled clinical trial.

Robot-assisted implant surgery has emerged as a novel digital technology, and the accuracy need further assessment. This study aimed to compare the accuracy of single dental implant placement between a novel semi-active robot-assisted implant surgery (RAIS) method and the conventional free-hand implant surgery (FHIS) method through a multicenter, randomized controlled clinical trial. Patients requiring single dental implant placement were recruited and randomized into RAIS and FHIS group. Deviations at the platform, apex, and angle between the planned and final implant positions were assessed in both groups. Additionally, the evaluation of instrument and surgical complications was examined. A total of 140 patients (median age: 35.35 ± 12.55 years; 43 males, 97 females) with 140 implants from four different research centers were included, with 70 patients (70 implants) in the RAIS group and 70 patients (70 implants) in the FHIS group. In the RAIS and FHIS groups, the median platform deviations were 0.76 ± 0.36 mm and 1.48 ± 0.93 mm, respectively (p < 0.001); median apex deviations were 0.85 ± 0.48 mm and 2.14 ± 1.25 mm, respectively (p < 0.001); and median angular deviations were 2.05 ± 1.33° and 7.36 ± 4.67°, respectively (p < 0.001). Similar significant difference also presented between RAIS and FHIS group in platform vertical/horizontal deviation, apex vertical/horizontal deviation. Additionally, implants with self-tapping characteristics exhibited significantly larger deviations compared with those without self-tapping characteristics in the RAIS group. Both RAIS and FHIS methods demonstrated comparable morbidity and safety pre- and post-operation. The results indicated that the RAIS method demonstrated superior accuracy in single dental implant placement compared with the FHIS method. Specifically, RAIS exhibited significantly smaller deviations in platform, apex, and angular positions, as well as platform and apex vertical/horizontal deviations. This clinical trial was not registered prior to participant recruitment and randomization. https://www.chictr.org.cn/showproj.html?proj=195045.

Accuracy of dynamic computer-assisted implant surgery in fully edentulous patients: An in vitro study

ObjectivesTo compare miniscrew versus bone tracing registration methods on dental implant placement accuracy and time efficiency in edentulous jaws using a dynamic computer-assisted implant surgery (d-CAIS) system. MethodsTwelve fully edentulous maxillary models were allocated into two groups: miniscrew tracing (MST) group, where registration was performed by tracing four miniscrews; and bone tracing (BT) group, where registration was conducted by tracing maxillary bone fiducial landmarks. Six implants were placed on each model using the X-Guide® d-CAIS system. Pre- and postoperative cone-beam computed tomography (CBCT) scans were superimposed to evaluate implant placement accuracy. The time required for registration and the overall surgery time were also recorded. ResultsThirty-six implants were placed in each group. The MST group showed significantly lower mean angulation deviations (mean difference (MD): -3.33°; 95 % confidence interval (CI): -6.56 to -0.09); p = 0.044), 3D platform deviations (MD: -1.01 mm; 95 % CI: -1.74 to -0.29; p = 0.006), 2D platform deviations (MD: -0.97 mm; 95 % CI: -1.71 to -0.23; p = 0.010), and 3D apex deviations (MD: -1.18 mm; 95 % CI: -1.92 to -0.44; p = 0.002) versus the BT group. The overall surgery time was similar for both groups (MD: 6.10 min.; 95 % CI: -0.31 to 12.51; p = 0.06), though bone tracing required significantly more time compared with miniscrew registration (MD: 4.79 min.; 95 % CI: 2.96 to 6.62; p < 0.05). ConclusionsRegistration with MST increases the accuracy of implant placement with a d-CAIS system in edentulous jaws compared with the BT method, and slightly reduces the overall surgery time. Clinical significanceMiniscrew tracing registration improves implant placement accuracy in comparison with bone tracing registration.

Implant placement using mixed reality-based dynamic navigation: A proof of concept

Objectives: To present the first clinical application of a novel mixed reality-based dynamic navigation (MR-DN) system in the rehabilitation of a single tooth gap.Methods: The protocol consisted of the following: (1) three-dimensional patient data acquisition using intraoral scanning (IOS) and cone-beam computed tomography (CBCT), (2) implant planning using guided surgery software, (3) holography-guided implant placement using the novel MR-DN system (ANNA®, MARS Dental, Haifa, Israel) and (4) placement accuracy verification.Results: The novel MR-DN system was safe and time-efficient, as the surgery took 30 min from anaesthesia to suturing. The accuracy of implant placement was high with minimal deviations recorded in the three planes of space compared to the presurgical planning: the error at the entry point planar distance (XY) was 0.381 mm, and the entry point planar distance (Z) was 0.173 mm, for a 3D entry point distance (En) of 0.417 mm. A 3D apex deviation (An) of 0.193 mm was registered, with an angle difference of 1.852°Conclusions: This proof-of-concept study demonstrated the clinical feasibility of MR-DN for guided implant placement in single tooth gaps. Further clinical studies on a large sample of patients are needed to confirm these positive preliminary results.Statement of clinical relevance: The use of MR-DN can change the perspectives of guided dental implant surgery as a possible alternative to the classic static and dynamic guided surgical techniques for the rehabilitation of single tooth gaps.

Accuracy of immediately placed implants using surgical guides from different 3-dimensional printers: An in vitro study.

The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-printed surgical guides for fully guided immediate implants from different manufacturers. Eighteen 3D printed fully guided surgical guides (split into 3 groups [n = 6] according to their manufacturer: Company, Desktop, or Lab), were used to place 72 implants (n = 24) in identical maxillary models. After placement, the mean global, angular, mesiodistal, buccopalatal, and vertical deviation at the platform and apex of the placed implants, relative to their preoperatively planned positions, was calculated. Significant differences in global apex deviation, angular deviation, mesiodistal apex deviation, and vertical platform and apex deviation were found between the Lab and Desktop groups (p ≤ 0.007). Significant differences in mesiodistal platform and apex deviation and buccopalatal apex deviation were also found between the Company and Desktop groups (p ≤ 0.005). Finally, significant differences in buccopalatal apex deviation, and vertical platform and apex deviation were found between the Company and Lab groups (p ≤ 0.003). Mean differences between guide groups across all parameters never exceeded 0.5 mm or 1°. The choice of 3D printer has a significant effect on the accuracy of fully guided immediate implants. However, the clinical relevance of these differences may be considered limited.

Theoretical and experimental study of rigid rapier weft insertion vibration

In this study, vibration equations and models were established utilizing D’Alembert’s principle to address the resonance challenge of a rigid rapier loom operating in high-speed reciprocating motion, and the equations were subsequently solved using Galyokin’s methodology. A laboratory apparatus was constructed to evaluate the findings of the first-order vibration frequency under various rapier extension lengths to validate the precision of the theoretical model, which necessitated recalibration. The accuracy of the theoretical model is confirmed by comparing its predicted results with those of the experiments. In this report, the rigid rapier is further examined in order to correct the trapezoidal acceleration within the perspective of the vibration of the rigid rapier influenced by varied rapier head masses. The results demonstrate that as the mass of the rapier head increases, the maximum apex deviation of the rigid rapier during the weft-induced process also escalates. To enhance the stability of the rigid rapier gravitating process and to provide theoretical guidance and design implications in engineering, the theoretical model of this research can also examine the influence of gravity, rapier material, rapier dimension, and other variables on the oscillation of the rigid rapier gravitation process.

The safety of maxillary sinus floor elevation and the accuracy of implant placement using dynamic navigation.

To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series

ObjectivesThis study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement. MethodsPatients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial–distal, labial–palatal, and apico-coronal directions were recorded. ResultsFifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively. ConclusionsHigh accuracy of immediate implant placement was achieved with the robotic system. Clinical significanceOur study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

Accuracy of robotic surgery for dental implant placement: A systematic review and meta-analysis.

To systematically analyze the accuracy of robotic surgery for dental implant placement. PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were included. Risks of bias in clinical studies were assessed. Meta-analyses were undertaken. Data from 8 clinical studies reporting on 109 patients and 242 implants and 13 preclinical studies were included. Positional accuracy was measured by comparing the implant plan in presurgery CBCT and the actual implant position in postsurgery CBCT. For clinical studies, the pooled (95% confidence interval) platform deviation, apex deviation, and angular deviation were 0.68 (0.57, 0.79) mm, 0.67 (0.58, 0.75) mm, and 1.69 (1.25, 2.12)°, respectively. There was no statistically significant difference between the accuracy of implants placed in partially or fully edentulous patients. For model studies, the pooled platform deviation, apex deviation, and angular deviation were 0.72 (0.58, 0.86) mm, 0.90 (0.74, 1.06) mm, and 1.46 (1.22, 1.70)°, respectively. No adverse event was reported. Within the limitation of the present systematic review, robotic surgery for dental implant placement showed suitable implant positional accuracy and had no reported obvious harm. Both robotic systems and clinical studies on robotic surgery for dental implant placement should be further developed.

Clinical evaluation of autonomous robotic-assisted full-arch implant surgery: A 1-year prospective clinical study.

This prospective clinical study aimed to evaluate the accuracy and 1-year clinical follow-up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full-arch implant surgery. Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP-FC) were recorded. Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance (p > .05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations (p > .05). The periodontal parameters, the BBT, and IP-FC remained stable during 1-year follow-up. The ADIR system showed excellent positional accuracy. The 1-year follow-up after full-arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full-arch implant surgery.

Effects of a modified surgical protocol on the positional accuracy of dental implants placed using fully guided implant surgery in the partially edentulous posterior ridge with distal extension: a dentiform model study.

The present experiment aimed to evaluate the placement accuracy of fully guided implant surgery using a mucosa-supported surgical guide when the protocol of osteotomy and installation was modified (MP) compared to when the protocol was sequentially and conventionally carried out (CP). For 24 mandibular dentiform models, 12 dentists (6 experts and 6 beginners) performed fully guided implant placements two times at the right first and second molar sites using a mucosa-supported surgical guide, once by the CP (CP group) and at the other time by the MP (MP group). The presurgical and postsurgical stereolithographic images were superimposed, and the deviations between the virtually planned and actually placed implant positions and the procedure time were compared statistically (P < .05). The accuracies were similar in the CP and MP groups. In the CP group, the mean platform and apex deviations at the second molar site for the beginners were +0.75 mm and +1.14 mm, respectively, which were significantly larger than those for the experts (P < .05). In the MP group, only the mean vertical deviation at the second molar site for the beginners (+0.53 mm) was significantly larger than that for the experts (P < .05). The procedure time was significantly longer for the MP group (+94.0 sec) than for the CP group (P < .05). In fully guided implant surgery using a mucosa-supported guide, the MP may improve the placement accuracy when compared to the CP, especially at sites farther from the most-posterior natural tooth.

Morphogeometric characterization in keratoconus according to the RETICS grading system

Aims/Purpose: Keratoconus progression characterizes by corneal thinning resulting in irregular astigmatism and visual impairment. In the present work a computerized 3D modelling method is used to describe different morphogeometric variables in healthy corneas and keratoconus. RETICS grading system was used to characterize keratoconus with best corrected visual acuity (BCVA) as the major grading parameter. Analyzing morphogeometric variables and its correlation with visual acuity (VA) may help understand structural changes associated with visual decline in keratoconus.Methods: 124 healthy corneas and 257 eyes with keratoconus were included and classified according to the RETICS grading system as grade 1 (n = 94) when VA &gt; 0.9; grade 2 (n = 65) when 0.6 &lt; VA ≤ 0.9; grade 3 (n = 50) when 0.4 &lt; VA ≤ 0.6; grade 4 (n = 31) when 0.2 &lt; VA ≤ 0.4 and grade 5 (n = 17) when VA ≤ 0.2. Computerized 3D modelling was done and morphogeometric variables analysed: anterior surface area (ASA), posterior surface area (PSA), total area (TA), total volume (TV), anterior apex deviation (AAD), posterior apex deviation (PAD), anterior minimum thickness point deviation (AMTPD) and posterior minimum thickness point deviation (PMTPD).Results: All morphogeometric variables showed differences between normal and keratconic eyes (p &lt; 0.001). ASA and PSA present higher values in keratoconus (p &lt; 0.001), while TV shows lower values in the same subjects (p &lt; 0.001). Correlation between BCVA and all variables was calculated showing a positive correlation for the ASA (p = 0.0036) and PSA (p = 0.0172), and a negative correlation for TV (p = 0.1612) and PAD (p = 0.0821).Conclusions: As keratoconus progresses and VA worsens, corneal structural changes include an increase in the PAD, in addition to an increase of both anterior and posterior corneal areas while TV tends to decrease. Morphogeometric variables represent a new parameter to characterize keratoconus and some demonstrate a statistically significant correlation with visual loss.

Accuracy of Static Computer- Assisted Implant Placement in Posterior Edentulous Areas with Different Levels of Tooth- Support by Novice Clinicians.

Correct implant placement is necessary for satisfactory implant restoration. Therefore, the use of surgical guide is recommended. This study evaluated the accuracy of implant placement in posterior edentulous areas with different levels of tooth-support by novice clinicians according to fully-guided (FG), pilot-guided (PG), and freehand (FH) placement protocols. A mandibular model with missing first molars was designed. On one side, the model had a bound edentulous area (BEA), and on the other side, a free end edentulous area (FEA). Fourteen clinicians new to implant dentistry participated in the study, and each clinician inserted an implant in the BEA and FEA sites for every placement protocol. Angle, vertical and maximum horizontal platform and apex deviations were measured. The FG placement was more accurate than the PG and FH placements. This was significant for BEA angle deviation, BEA and FEA maximum horizontal platform deviations, and BEA maximum horizontal apex deviation. The PG placement was significantly more accurate than the FH placement for BEA and FEA maximum horizontal platform deviations. FG shows significantly greater angle, maximum horizontal platform and maximum horizontal apex deviations at FEA than BEA. This can be attributed to reduced guide support and the possibility of guide displacement during surgery.

Accuracy of a novel semi-autonomous robotic-assisted surgery system for single implant placement: A case series

ObjectiveThis study aimed to evaluate the accuracy of dental implant placement at single-tooth sites using a novel semi-autonomous robotic-assisted surgery system (sa-RASS). MethodsPatients with single missing teeth were included. Cone-beam computed tomography (CBCT) was performed prior to surgery using a U-shaped silicone tube to develop a virtual implant placement and drilling plan. The sa-RASS was used for implant osteotomy and placement in conjunction with a surgeon. Cone-beam computed tomography data were utilized to evaluate deviations between planned and placed implants using a three-dimensional Slicer software. Data were analysed using the t-test and analysis of variance. Statistical significance was considered at P<0.05. ResultsNineteen implants were placed using the sa-RASS. No adverse events or complications were observed during the surgery. Mean ± standard deviations between planned and postoperative implant positions were 0.90 ± 0.41 mm at the platform, 1.04 ± 0.47 mm at the apex, and 3.37 ± 1.51° for angulation. In a lateral direction, deviations were 0.72 ± 0.38 mm and 0.88 ± 0.47 mm at the platform and apex, respectively. Deviations in depth were all < 1 mm at both the platform (0.46 ± 0.33 mm) and apex (0.45 ± 0.32 mm). The apex deviation was greater than that at the platform (p = 0.036 < 0.05), mainly in the lateral distance (p = 0.037 < 0.05). ConclusionsThe current study illustrates that this robotic implant system is sufficiently accurate for single-tooth implant placement. Clinical significanceThis study provides significant evidence to support the use of sa-RASS as a potential alternative to static guided surgery and dynamic navigation in dental implant surgery.

A retrospective study of dynamic navigation system-assisted implant placement

BackgroundTo evaluate the accuracy of implant placement assisted by a dynamic navigation system, as well as its influencing factors and learning curve.MethodsAt Macao We Care Dental Center, 55 cases of implant placement using dynamic navigation were retrospectively evaluated. To evaluate their accuracy, the apex, tip, and angle deviations of preoperatively planned and postoperatively placed implants were measured. The effects of the upper and lower jaws, different sites or lateral locations of dental implants, and the length and diameter of the implants on accuracy were analyzed, as well as the variation in accuracy with the increase in the number of surgical procedures performed by dentists.ResultsThe implant had an apex deviation of 1.60 ± 0.94 mm, a tip deviation of 1.83 ± 1.03 mm, and an angle deviation of 3.80 ± 2.09 mm. Statistical differences were observed in the tip deviation of implants at different positions based on three factors: jaw position, lateral location, and tooth position (P < 0.05). The tip deviation of the anterior teeth area was significantly greater than those of the premolar and molar areas. There were no statistically significant differences in apex deviation, tip deviation, or angle deviation between the implants of different diameters and lengths (P > 0.05). There were significant differences in the angle deviation between the final 27 implants and the first 28 implants. Learning curve analysis revealed that angle deviation was negatively correlated with the number of surgical procedures, whereas the regression of apex deviation and tip deviation did not differ statistically.ConclusionsThe accuracy of dynamic navigation-assisted dental implants meets the clinical needs and is higher than that of traditional implants. Different jaw positions, lateral locations, and implant diameters and lengths had no effect on the accuracy of the dental implants guided by the dynamic navigation system. The anterior teeth area had a larger tip deviation than the posterior teeth area did. As the number of dynamic implantation procedures performed by the same implant doctor increased, the angle deviation gradually decreased.

Accuracy of different registration areas using active andpassive dynamic navigation systems in dental implant surgery: An in vitro study.

To gauge the relative accuracy of the use of passive and active dynamic navigation systems when placing dental implants, and to determine how registration areas affect the performance of these systems. Eighty implants were assigned to be placed into 40 total resin mandible models missing either the left or right first molars using either passive or active dynamic navigation system approaches. U-shaped tube registration devices were fixed in the edentulous site for 20 models each on the left or right side. Planned and actual implant positions were superimposed to assess procedural accuracy, and parameters including 3D entry deviation, angular deviation, and 3D apex deviation were evaluated with Mann-Whitney U tests and Wilcoxon signed-rank tests. Respective angular, entry, and apex deviation values of 1.563 ± 0.977°, 0.725 ± 0.268 mm, and 0.808 ± 0.284 mm were calculated for all included implants, with corresponding values of 1.388 ± 1.090°, 0.789 ± 0.285 mm, and 0.846 ± 0.301 mm in the active group and 1.739 ± 0.826°, 0.661 ± 0.236 mm, and 0.769 ± 0.264 mm in the passive group. Only angular deviation differed significantly among groups, and the registration area was not associated with any significant differences among groups. Passive and active dynamic navigation approaches can achieve comparable in vitro accuracy. Registration on one side of the missing single posterior tooth area in the mandible can complete single-tooth implantation on both sides of the posterior teeth, highlighting the promise of further clinical research focused on this topic.

The accuracy of implant placement using a combination of static and dynamic computer-assisted implant surgery in fully edentulous arches: A prospective controlled clinical study.

To compare the accuracy of implant position, using a combination of static and dynamic computer-assisted implant surgery (CAIS), with either static, dynamic, or freehand implant placement, in fully edentulous arches. Twenty-one patients with a total of 88 fixtures were included. Implants were divided equally into four groups: a combination of static and dynamic CAIS (SD group), static CAIS (S group), dynamic CAIS (D group), and freehand placement (FH group). Angular deviation, as well as the 3D platform and apex deviations, were measured for all groups. Furthermore, the direction of implant deviation was recorded and compared. The FH group showed significantly more deviation compared to all groups, considering all the aspects, and at both the implant platform and apex. A significant difference in angular deviation between the SD and S groups (p < .001), and between the SD and D groups (p < .001) was noted, favoring the SD group. When evaluating implant distribution, the FH group showed a tendency towards the buccal, apical, and distal directions at platform and apex, while in the D group, implants shifted more to the buccal. In contrast, the SD group did not show a trend toward any specific direction. The S and SD groups did not show a statistical significance considering any direction. The combination of static and dynamic CAIS increases the accuracy of implant placement in fully edentulous arches when compared with either static or dynamic CAIS alone, as well as freehand placement.

Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: Atranslational study.

Multiple generations of medical robots have revolutionized surgery. Their application to dental implants is still in its infancy. Co-operating robots (cobots) have great potential to improve the accuracy of implant placement, overcoming the limitations of static and dynamic navigation. This study reports the accuracy of robot-assisted dental implant placement in a preclinical model and further applies the robotic system in a clinical case series. In model analyses, the use of a lock-on structure at robot arm-handpiece was tested in resin arch models. In a clinical case series, patients with single missing teeth or edentulous arch were included. Robot-assisted implant placement was performed. Surgery time was recorded. Implant platform deviation, apex deviation, and angular deviation were measured. Factors influencing implant accuracy were analyzed. The in vitro results showed that with a lock-on structure, the mean (SD) of platform deviation, apex deviation, and angular deviation were 0.37 (0.14) mm, 0.44 (0.17) mm, and 0.75 (0.29)°, respectively. Twenty-one patients (28 implants) were included in the clinical case series, 2 with arches and 19 with single missing teeth. The median surgery time for single missing teeth was 23 (IQ range 20-25) min. The surgery time for the two edentulous arches was 47 and 70 min. The mean (SD) of platform deviation, apex deviation, and angular deviation was 0.54 (0.17) mm, 0.54 (0.11) mm, and 0.79 (0.22)° for single missing teeth and for 0.53 (0.17) mm, 0.58 (0.17) mm, and 0.77 (0.26)° for an edentulous arch. Implants placed in the mandible had significantly larger apex deviation than those in the maxilla. Cobot-assisted dental implant placement showed excellent positional accuracy and safety in both the in vitro study and the clinical case series. More technological development and clinical research are needed to support the introduction of robotic surgery in oral implantology. Trial registered in ChiCTR2100050885.

Effect of the number and distribution of fiducial markers on the accuracy of robot-guided implant surgery in edentulous mandibular arches: An in vitro study

ObjectivesRobot-guided implant placement based on the screw marker-assisted registration technique has been applied in dentistry. This study aimed to identify the optimal number and distribution of fiducial markers for robot-guided implant placement in edentulous mandibular phantoms. MethodsFour implants were digitally planned and placed in edentulous mandibular phantoms under robotic guidance. Different numbers of fiducial markers (3, 4, 5, or 6) and distribution patterns (dispersed or localized) were used to register the robotic system. Platform, apex, and angular deviations were measured between the planned and actual implant positions using different numbers and distributions of fiducial markers. ResultsInserting six fiducial markers resulted in optimal implant position accuracy at the platform (0.53 ± 0.19 mm) and apex (0.59 ± 0.2 mm) deviations. However, the angular deviation did not differ significantly between different numbers of fiducial markers. Furthermore, the implant position accuracy did not differ significantly between the dispersed and localized distributions of fiducial markers. ConclusionIn robot-guided implant placement for edentulous mandibular arches, the insertion of six fiducial markers significantly increases the implant placement accuracy. Clinical SignificanceThe findings of this in vitro study may serve as a reference for clinicians to determine the optimal placement of fiducial markers and to facilitate the clinical application of robot-guided systems for implant placement in edentulous patients. Further clinical studies are necessary to confirm these findings.