Apical Deviation Research Articles

Accuracy comparison of single- and double-sleeve endodontic guides for fiber post removal

BackgroundThis study aimed to assess the accuracy of two different endodontic guides for fiber post removal.MethodsIn this in vitro study, 54 maxillary canine fiber posts were mounted on 36 maxillary stone casts; 18 teeth were mounted unilaterally, and 36 teeth were mounted bilaterally. Static endodontic guides were fabricated according to baseline cone-beam computed tomography (CBCT) and intraoral optical scans using Blue Sky software. In the single-sleeve endodontic guides group (SSG), two anterior and two posterior teeth were included in a 5-unit guide. In the double-sleeve endodontic guides group (DSG) group, the guide was passed through the midline to include both canine teeth and extended by 2 teeth posterior to the canine teeth bilaterally (a 10-unit guide). After drilling, postoperative CBCT scans were taken and superimposed on the virtually designed path, and the maximum coronal deviation (MCD) at the marginal entry point of the tooth, maximum apical deviation (MAD) at 10 mm apical to the tooth margin, and maximum angular deflection (MAnD) of the drill were calculated.ResultsThe mean MCD, MAD, and MAnD were 0.34 mm, 0.6 mm, and 2.32 degrees, respectively, in the SSG and 0.31 mm, 0.7 mm, and 2.37 degrees, respectively, in the DSG. The two groups were not significantly different from each other in terms of MCD (P = 0.573), MAD (P = 0.290), or MAnD (P = 0.896).ConclusionsThe accuracies of the two techniques, the extended double sleeve guide and the single sleeve guide, were comparable and thus DSG may be used for removal of fiber posts in adjacent or distant teeth.

Accuracy of flapless surgery using an autonomous robotic system in full-arch immediate implant restoration: A case series

ObjectivesThis observational study aimed to evaluate the accuracy of robotic computer-assisted implant surgery (r-CAIS) for full-arch immediate restoration and to analyse possible factors contributing to deviations. MethodsThree edentulous patients (five arches) underwent r-CAIS. Osteotomies were performed using an autonomous robot under the surgeon's supervision, and implant placement was performed in a freehand or robotic manner. Prefabricated provisional prostheses were delivered immediately after surgery. Postoperative cone beam computed tomography scans were performed to assess the deviations between the planned and placed implants. Statistics were compared with deviations of s-CAIS outlined in a meta-analysis. ResultsA sum of 28 implants were used. The mean global coronal and apical deviations measured 0.91 ± 0.43 mm and 1.01 ± 0.45 mm, respectively, and the mean angular deviation measured 1.21 ± 1.24 º. The r-CAIS showed significantly better precision than the s-CAIS in full-arch cases (P < 0.001). The implants inserted using the robotic arm exhibited fewer deviations than those placed in the freehand manner. Eighty percent of prefabricated provisional prostheses were successfully delivered. ConclusionsWithin the limitations of the present study, our data suggest that autonomous r-CAIS is a feasible approach for simultaneous immediate restoration in edentulous patients, showing better accuracy than s-CAIS. Further large-scale studies are necessary to verify the advantages and disadvantages of this novel technique and to explore possible factors that influence its accuracy. Clinical SignificanceAutonomous r-CAIS can provide clinically acceptable implant placement accuracy in edentulous patients, significantly surpassing s-CAIS. This level of accuracy may represent a viable therapeutic approach for simultaneous immediate full-arch restoration.

Influence of augmented reality technique on the accuracy of autotransplanted teeth in surgically created sockets

BackgroundThe objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth. Materials and methodsForty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student’s t-test and Mann–Whitney non-parametric statistical analysis were used to analyze the results.ResultsNo statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different.ConclusionThe augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry

BackgroundSpinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aimThis study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. MethodsThis study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. ResultsRelevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). ConclusionThis study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.

A hybrid robotic system for zygomatic implant placement based on mixed reality navigation

BackgroundsZygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. MethodsThis study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. ResultsPhantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. ConclusionOur proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.

Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms “surgery”, “computer-assisted”, “dynamic computer-assisted”, “robotic surgical procedures”, and “dental implants”. The outcome variables were discrepancies including the implant’s 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02–1.19), and 1.40 mm (95% CI: 1.31–1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27–3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

Proof of Concept of a New 3D-Guided System for a Single Implant Overdenture in the Mandible: An In Vitro Study.

To evaluate the precision and efficiency of a novel guide system for single implant placement in the mandibular symphyses and to evaluate whether the outcome is affected by the level of operator experience. A total of 90 implants were placed in three different mandibular cast types (Cawood and Howell class III, IV, and V). For each model, a complete denture was 3D printed. A polyether ether ketone rail with a guide sleeve was embedded in the middle of the denture. To determine the ideal implant position, the sleeve could be moved in a buccolingual direction. Adjustment of implant angulation was possible, and an angle correction of 0, 12, or 24 degrees was available. A total of 30 clinicians were divided into three groups: group 1 (experienced, n = 10), group 2 (beginner, n = 10), and group 3 (inexperienced, n = 10). Each clinician was asked to plan and perform a guided flapless implant placement in the mandibular symphysis. Two preoperative CBCT scans were taken; the first was to verify the planning, and the second was to adjust the planning if needed. Finally, a postoperative CBCT scan was taken to compare the planning to the final implant position. Based on the first CBCT, the clinicians adjusted their planning by an average of 1.66 ± 1.65 mm coronally, 2.41 ± 2.44 mm apically, and by a mean angular correction of 6.08 ± 0.77 degrees. After implant placement, the mean deviation from the planned implant position was 0.87 ± 0.58 mm at the coronal aspect and 0.98 ± 0.64 mm at the apical aspect. The mean angular deviation was 6.05 ± 0.71 degrees. Overall, there were no significant differences in coronal and apical deviation (P > .05) based on the level of experience. In terms of angulation, a significant difference was found in both planning (P = .049) and placement (P = .038) between beginners and experienced clinicians. Guided implant placement of a single implant in the mandibular symphysis using a removable denture with guide sleeve had an acceptable level of accuracy. Clinicians with limited experience spent more time on the procedure, resulting in less angular deviation during implant planning and placement compared to experienced clinicians.

Augmented Reality Head-Mounted Device and Dynamic Navigation System for Postremoval in Maxillary Molars

IntroductionThis study evaluates the feasibility of an augmented reality (AR) head-mounted device (HMD) displaying a dynamic navigation system (DNS) in the surgical site for fiber postremoval in maxillary molars and compares it to the DNS technique. MethodsFifty maxillary first molars were divided into 2 groups: AR HMD + DNS (n = 25) and DNS (n = 25). The palatal canal was restored with RelyX fiber post (3M ESPE) luted with RelyX Unicem (3M ESPE). A core buildup was performed using Paracore (Coltene/Whaledent). Cone beam computed tomography (CBCT) scans were taken before and after postremoval. The drilling trajectory and depth were planned under X-guide software (X-Nav Technologies, Lansdale, PA). For the AR HMD + DNS group, the AR HMD (Microsoft HoloLens 2) displayed the DNS in the surgical site. The three dimensional (3D) deviations (Global coronal deviation [GCD] and global apical deviation [GAD]) and angular deflection (AD) were calculated. The number of mishaps and operating time were recorded. ResultsFiber post was removed from all samples (50/50). The AR HMD + DNS was more accurate than DNS, showing significantly lower GCD and GAD deviations and AD (P < .05). No mishap was detected. The AR HMD + DNS was as efficient in time as DNS (P > .05). ConclusionsWithin the limitations of this in vitro study, the AR HMD can safely display DNS in the surgical site for fiber post-removal in maxillary molars. AR HMD improved the DNS accuracy. Both AR HMD + DNS and DNS were time-efficient for fiber postremoval in maxillary molars.

Comparison of accuracy of immediate implant placement between planned and actual position in pre-extractive versus conventional method - A prospective study

This study aims to evaluate the accuracy of immediate implants in mandibular molars between the conventional method and the pre-extractive inter-radicular method. Materials and methodsA total of 20 patients were equally divided into two groups. Implants were placed using the conventional method (Group A) and pre-extractive inte-rradicular method (Group B). Coronal, apical and angular deviation between planned and placed implants were evaluated by superimposing preoperative and postoperative three-dimensional (3D) STL models in Geomagic Freeform software. The data were subjected to an unpaired Student t-test. ResultsResults revealed that the coronal, apical and angular deviation were lower in the pre-extractive inter-radicular drilling method than in the conventional method, which was statistically significant. Apical deviation was greater than coronal deviation in both the sagittal and coronal planes. It was also found that the mean deviation was greater in the sagittal plane (mesio-distal axis) than in the coronal plane (bucco-lingual axis). ConclusionComparison of the two methods revealed significant changes between the planned and actual positions of implant. When stringent steps were followed, the degree of deviation was found to be less in the pre-extractive inter-radicular approach, proving it to be more accurate than the conventional method. However, large-scale research studies are required to extrapolate our findings.

Comparing the accuracies of freehand, static computer-assisted and robot-assisted dental implant placements: an in vitro study.

To compare the accuracies among three oral implant surgical techniques: freehand (FH), static computer-assisted implant surgery (sCAIS), and robotic computer-assisted implant surgery (rCAIS). The polyurethane and bovine femur implant models were fabricated, and 126 and 96 implant sites were designed on them. The implant sites were divided into three groups: FH, sCAIS, and rCAIS, according to the implantation method. The deviation between the actual implant position and the planned position was analyzed and compared by cone beam computed tomography. In the polyurethane model test, the entry deviation, entry-level deviation, apical deviation, apical level deviation, and angle deviation in sCAIS and rCAIS groups were significantly reduced compared with those in the FH group (P<0.05). No significant differences were observed in all kinds of deviations between the sCAIS and rCAIS groups (P>0.05). In the bovine femur model test, the entry deviation, entry-level deviation, apical deviation, apical level deviation, and angle deviation in both sCAIS and rCAIS groups were significantly reduced compared with those in the FH group (P<0.05). No significant differences were observed in all kinds of deviations between the sCAIS and rCAIS groups (P>0.05). This in vitro study shows that the rCAIS technique is superior to the freehand, but has the same accuracy as the sCAIS.

Ab. No. 36 Integrated Effect of 3d Schroth Method and Cellular Rhythm Therapy on 4-D Postural Analysis in an Individual With Idiopathic Structural Scoliosis- Single Case Study

Introduction: The study attempts to widen the horizons of physiotherapy profession by promoting insights towards the advanced non-invasive treatment approaches for the management of Idiopathic Structural Scoliosis and aims to investigate the combined effect of 3D Schroth Method (spinal corrective exercise program) and Cellular Rhythm Therapy on 4D Postural Analysis in an individual with Idiopathic Structural Scoliosis Methods: An 18-year-old male diagnosed with idiopathic scoliosis for 4 years. He had thoracic levoscoliosis and lumbar dextroscoliosis with a baseline Cobb’s angle of 35º. Physical findings were uneven shoulder heights, slight right scapular winging, prominent left hip, and increased space between left elbow and trunk due to trunk deviation towards the right side. The patient intervened with Cellular Rhythm Therapy for 20 minutes followed by 3D Schroth Method exercises for 20 minutes. The treatment was given for a total of 30 days (5 sessions per week). Pre and Post interventional objective assessment was done using 4D postural analysis and subjective assessment was done using the Italian Spine-Related Quality of Life (ISYQOL) questionnaire at day 0 and day 30. Result: Significant change was found in lumbar lordosis angle (46º -31º), sagittal imbalance (6º - 2º), pelvic torsion (4º- 2º), vertebral rotation (17º -13º), apical deviation (49º - 21º), lumbar lordosis depth (32º- 30º) and in Cobb’s angle from 35º to 29º, along with difference in Italian Spine-Related Quality of Life (ISYQOL) questionnaire from 37% to 39%. Conclusion: According to the study’s findings, 3D Schroth Method and Cellular Rhythm Therapy can be an effective treatment for patients with Scoliosis. Implications: This combinational approach anticipates a useful reference guide for future management of Idiopathic Structural scoliosis.

Efficacy of digital guide-assisted implant restoration in anterior teeth aesthetics and its impact on labial bone mass.

To analyze the efficacy of digital guide-assisted implant restoration technique in enhancing the anterior teeth aesthetics and its impact on labial bone mass. We retrospectively analyzed clinical data from 90 patients who underwent maxillary anterior teeth implant restoration at The First People's Hospital of Fuyang, Hangzhou, from January 2021 to September 2023. The patients were divided into two groups: a conventional group (n=45, 45 implants, standard implant restoration) and a digital group (n=45, 45 implants, digital guide-assisted implant). We compared implant positional deviations, changes in dental plaque index (PLI), aesthetic effect scores, labial bone mass differences, and the occurrence of adverse reactions post-treatment between the two groups. The digital group exhibited significantly less deviation in root position in the buccolingual and vertical directions, less neck deviation in the buccolingual and vertical directions, and less apical deviation than the conventional group (P=0.021, P=0.005, P=0.016, P=0.008, P=0.026, respectively). Three months postoperatively, the digital group demonstrated a significantly lower mean PLI (P<0.001), higher white and pink aesthetic scores (P=0.021, P=0.005), and increased alveolar ridge height and coronal and middle labial bone mass (P=0.006, P=0.015, P=0.008). Additionally, this group experienced lower incidence of adverse reactions (4.44% vs. 17.78%) compared with the conventional group (P=0.044). The digital guide-assisted implant restoration significantly enhances implant accuracy, reduces bone resorption, improves aesthetic outcomes, and ensures higher safety.

Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies.

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.

ACCURACY OF A ROBOTIC DENTAL IMPLANT NAVIGATION SYSTEM IN DENTAL IMPLANT PRACTICE

Objective: To evaluate the implant positioning accuracy using a robotic implant navigation system in dental implant practice. Methods: The analysis of the treatment of 16 patients using a robotic implant navigation system in stages implant surgery and dental implant prosthetic rehabilitation performed for the period 2022-2023.All patients underwent a complex clinical, laboratory study, computed tomography (CT). A total of 46 implants were installed using the Navident (ClaroNav) navigation system a flapless or minimal flap approach. 25 implants were completely edentulous and 21 implants were installed in a partially edentulous area. To assess the accuracy of dental implant placement using preoperative plan cone beam computed tomography (CBCT),deviations between the planned and installed implant positions were analyzed. The coronal deviation was measured as the distance between the centers of the implant coronal platform. Apical deviation was measured as the distance between the centers of the implant apical. Angular deviation was measured as the angle of the axis of the implant center. Success of implantation and success of prosthetics of implant- supported reconstructions were evaluated. Data were statistically analyzed with. Results: No intra-operative or immediate post-operative complications were noted after procedure. The postoperative of the patients was favorable. For all implants, the mean deviations were: 0.21 mm at the entry point (lateral) and 0.27 mm at the apex. The average angle deviation from the actual and planned implant position was 1.32 degrees. Patients were satisfied with the functional and aesthetic results of implantation. Conclusion: Robotic implant navigation system allows for precise implant placement, the level of experience of the surgeon and the location of the implant do not affect the accuracy of placement and the timing of the procedure.

Evaluation of the accuracy of implant placement by using implant positional guide versus freehand: a prospective clinical study

PurposeThe aim of this study is to examine and compare the accuracy of implant placement using implant positional guide and freehand.Methods48 implants were placed in patients with single tooth loss with implant positional guide and freehand, respectively. The accuracy of implant placement was assessed by comparing the actual and planned position, including four parameters: coronal deviation, apical deviation, angular deviation, and vertical deviation.ResultsComparing all the variables, it has been found that the implant positional guide is more accurate than the freehand. All parameters describing in the deviation were significantly lower in the implant positional guide group than the freehand.ConclusionsThe implant positional guide can act as a practicable tool for dental implant surgery. It is a promising technology that guarantees low cost and high precision in implant surgery. However, based on the restricted evidence from clinical studies, longer follow-up periods, larger population studies, and standardized experimental studies are required.Trial registration CHICTR, ChiCTR2300071024. Registered 28 April 2023—CHICTR, ChiCTR2300071024. Registered 28 April 2023—Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=195424.

Positional accuracy during the sequence of static computer-assisted implant surgery in three alveolar ridge morphologies: An in vitro study.

This in vitro study aimed to assess the positional accuracy during the sequence of static computer-assisted implant surgery (sCAIS) according to the anatomical characteristics of the alveolar ridge. Maxillary bone models with six single tooth gaps including clinical scenarios of healed alveolar ridge (HR), single-rooted (SRS), and three-rooted socket (TRS) morphologies were used in this study. Positional deviations during implant placement procedures were evaluated after the pilot osteotomy (PD), final osteotomy (FD), and implant placement with respect to the pre-planned implant position by using a software package. ANOVA and post hoc analyses were performed. A total of 90 implants were included in this study. Higher mean angular, crestal, and apical deviations were found after the PD and FD (3.5 ± 2.4°, 0.7 ± 0.3mm, and 1.4 ± 0.8mm versus 3.6 ±2.2°, 0.6 ± 0.3mm, and 1.2 ± 0.6mm) compared to IP (2.8 ± 1.6°, 0.7 ± 0.3mm, and 1.2 ± 0.5mm, p ≤ 0.004). Implants placed in TRS demonstrated higher mean angular, crestal, and apical deviations (4.0 ± 1.7°, 0.8 ± 0.3mm, and 1.6 ± 0.5mm) compared to implants placed in SRS (2.5 ± 1.2°, 0.7 ± 0.3mm, and 1.1 ± 0.4mm) or HR (2.0 ± 0.9°, 0.5 ± 0.3mm, and 0.8 ± 0.4mm, p < 0.001). Positional deviations during sCAIS procedures are initiated with the first implant osteotomy and persist throughout the drilling sequence. However, deviations slightly decreased after implant placement. The alveolar ridge morphology is strongly associated with positional deviations. Higher deviations were observed in three-rooted and single-rooted sockets simulating an immediate approach compared to healed sites simulating a delayed protocol.

Inter- and intraindividual variability in virtual single-tooth implant positioning.

The purpose of this prospective study was to determine the inter- and intraindividual variability in virtual single-tooth implant positioning based on the level of expertise, specialty, total time spent, and the use of a prosthetic tooth setup. Virtual implant planning was performed on matched pre- and post-extraction intraoral scans (IOS), and cone-beam computed tomography scans of 15 patients. Twelve individual examiners, involving six novices and experts from oral surgery and prosthodontics positioned the implants, first based on anatomical landmarks utilizing only the post-extraction, and second with the use of the pre-extraction IOS as a setup. The time for implant positioning was recorded. After 1 month, all virtual plannings were performed again. The individual implant positions were superimposed to obtain 3D deviations using a software algorithm. An interindividual variability with mean angular, crestal, and apical positional deviations of 3.8 ± 1.94°, 1.11 ± 0.55, and 1.54 ± 0.66 mm, respectively, was found. When assessing intraindividual variability, deviations of 3.28 ± 1.99°, 0.78 ± 0.46, and 1.12 ± 0.61 mm, respectively, were observed. Implants planned by experts exhibited statistically lower deviations compared to those planned by novices. Longer planning times resulted in lower deviations in the experts' group but not in the novices. Oral surgeons demonstrated lower crestal, but not angular and apical deviations than prosthodontists. The use of a setup only led to minor adjustments. Substantial inter- and intraindividual variability exists during implant positioning utilizing specialized software planning. The level of expertise and the time invested influenced the deviations of the implant position during the planning sequence.

Comparison of Implantation Accuracy Among Different Navigated Approaches: A Systematic Review and Network Meta-analysis.

Dental implants are a common treatment method after tooth loss, the accuracy of which directly affects efficacy and stability. Through a network meta-analysis, this study compared the accuracy of different modalities of implant placement: dynamic navigation (DN), fully guided static navigation (FG), partially guided static navigation (PG), and free handed (FH). This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines. An electronic literature search was conducted on October 2, 2022. The comparison of implant accuracy in all included randomized controlled trials (RCTs) conformed to at least one of the following: deviation at the implant crown, deviation at the apical portion of the implant, or angular deviation of the implant. Twenty-six articles were included for the qualitative analysis (17 RCTs, 3 prospective studies, and 6 retrospective studies), and the 17 RCTs were included for network meta-analysis. The data included in this study had high consistency, and the funnel plot showed that the articles had low publication bias. Compared to FH, FG and DN had higher accuracy for coronal deviation (P < .05), and FG, DN, and PG had higher accuracy for apical and angular deviations (P < .05). According to the SUCRA (surface under the cumulative ranking curves) value, FG had the highest accuracy for coronal deviation, while DN had the highest accuracy in apical and angular deviations. According to the present results, the accuracies for DN, FG, and PG were higher than those for FH. DN showed the highest accuracy in terms of apical deviation and angular deviation. FG had the best control over the coronal deviation. There was no statistical difference between DN and FG in terms of accuracy. Given the limitations of the current study, further validation is required.

Feasibility and accuracy of a task-autonomous robot for zygomatic implant placement

Zygomatic implants (ZIs) should be placed accurately as planned preoperatively to minimize complications and maximize the use of the remaining bone. Current digital techniques such as static guides and dynamic navigation are affected by human error; therefore, new techniques are required to improve the accuracy of ZI placement. The purpose of this clinical study was to assess the feasibility and accuracy of a task-autonomous robot for ZI placement. Patients indicated for ZI placement were enrolled, and an appropriate surgical positioning piece was selected based on the presence of natural teeth in the maxilla. Preoperative cone beam computed tomography (CBCT) scanning was performed with the surgical positioning piece, and virtual implant design and socket preparation procedures were initiated. Implant socket preparation and placement were automatically performed by the robot according to the preoperative plan under the supervision of the surgeon. Postoperative CBCT scanning was performed to evaluate deviations between the virtual and actual implants. All quantitative data were expressed as standardized descriptive statistics (mean, standard deviation, minimum, maximum, and 95% confidence interval [CI]). The Shapiro-Wilk test was used to assess the normal distribution of all variables (α=.05). Six participants were enrolled, and 8 ZIs were inserted. No intraoperative or postoperative complications were observed. Robotic ZI placement showed a global coronal deviation of 0.97mm (95% CI: 0.55 to 1.39 mm), a global apical deviation of 1.27mm (95% CI: 0.71 to 1.83 mm), and an angular deviation of 1.48 degrees (95% CI: 0.97 to 2.00 degrees). Task-autonomous robots can be used for ZI placement with satisfactory accuracy. Robotic ZI surgery can be an alternative to static guidance and dynamic navigation to improve the accuracy of implant placement.

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods

ObjectivesThis meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. DataIn vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. SourcesA systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. ResultsA total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. ConclusionsFully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. Clinical significanceTo our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.