Mucosa-supported Surgical Template Research Articles

Comparison of Positioning Accuracy Between 2 Different Implant Systems Using Mucosa-Supported Surgical Templates: A Retrospective Clinical Study.

Although guided implant surgery is widely practiced, clinical studies examining the differences in accuracy between implanting systems that use the same surgical guide are currently lacking. This study aimed to evaluate and compare the effects of different dental implanting systems on positioning accuracy using a uniform type of stereolithographic surgical guide to account for cumulative errors in guide production. One hundred BEGO Semados S implants (group A) and 91 NobelActive implants (group B) were inserted into patients using the same type of guide. The accuracy was assessed by matching the preoperative and postoperative cone-beam computerized tomography. The implant shoulder, tip, depth, and angular deviation were registered. Statistically significant differences between groups were determined using Student t test, bivariate correlation test, and generalized estimating equation. The angular deviation was 3.16 ± 1.74° in group A and 2.58 ± 1.41° in group B (P = .013); the depth deviation was 0.44 ± 0.23 mm in group A and 0.51 ± 0.22 mm in group B (P = .032). In terms of vertical accuracy, the Bego implant system is superior to the Nobel implant system using the same type of surgical guide, while the angle accuracy is opposite. Therefore, it is important to control the depth when using the template-guided surgery with the Nobel implant system. Similarly, angle control should be emphasized in the Bego implant system. Measurements of the deviations provide the basis for a clinical reference that will be useful in preoperative analysis for improving the safety and accuracy of guided implant surgical procedures.

The Influence of Surgical Experience and Bone Density on the Accuracy of Static Computer-Assisted Implant Surgery in Edentulous Jaws Using a Mucosa-Supported Surgical Template with a Half-Guided Implant Placement Protocol—A Randomized Clinical Study

The aim of our randomized clinical study was to analyze the influence of surgical experience and bone density on the accuracy of static computer-assisted implant surgery (CAIS) in edentulous jaws using a mucosa-supported surgical template with a half-guided implant placement protocol. Altogether, 40 dental implants were placed in the edentulous jaws of 13 patients (novice surgeons: 18 implants, 6 patients (4 male), age 71 ± 10.1 years; experienced surgeons: 22 implants, 7 patients (4 male), age 69.2 ± 4.55 years). Angular deviation, coronal and apical global deviation and grey level measurements were calculated for all implants by a blinded investigator using coDiagnostiX software. 3DSlicer software was applied to calculate the bone volume fraction (BV/TV) for each site of implant placement. There were no statistically significant differences between the two study groups in either of the primary outcome variables. There was a statistically significant negative correlation between angular deviation and both grey level measurements (R-value: −0.331, p < 0.05) and BV/TV (R-value: −0.377, p < 0.05). The results of the study suggest that surgical experience did not influence the accuracy of implant placement. The higher the bone density at the sites of implant placement, the higher the accuracy of static CAIS.

Accuracy of a flapless protocol for computer-guided zygomatic implant placement in human cadavers: expectations and reality.

This work evaluated the accuracy and safety of a protocol for minimally-invasive flapless zygomatic implant placement that uses computer-guided stereolithographic mucosa-supported surgical templates. A total of six zygomatic implants were placed in three formalin-fixed human cadaver heads, with edentulous and severely atrophic posterior maxillae. CT scans of each cadaver head were performed after zygomatic implant placement, to evaluate the lateral error (LE) at implant tip and base, and the angular error (AE) of the implant body. Excluding the implant placed outside the drilling channel, the LE at the implant base was less than 1 mm in all cases. The average LE at the tip was 3.86 mm, and the AE was less than 6° in all cases, with an average of 4.5°. Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential.

An Accuracy Study of Computer-Planned Implant Placement in the Augmented Maxilla Using Mucosa-Supported Surgical Templates.

The purpose of this study was to determine the clinically relevant accuracy of implant placement in the augmented maxilla using computer planning and a mucosa-supported surgical template. Twenty-five consecutive edentulous patients with an extreme maxillar alveolar ridge resorption were treated with a bone augmentation procedure. In a second stage, six Brånemark MkIII Groovy (Nobel Biocare®, Zürich, Switzerland) implants were installed. Preoperatively, a cone beam computer tomography (CBCT) scan was acquired, followed by virtual implant planning and flapless implant placement using a surgical template. A postoperative CBCT scan was acquired and registered to the preoperative scan. The Implant Position Orthogonal Projection validation method was applied to measure implant deviations in both the buccolingual and mesio-distal plane. The influence of fixation pins and the position on the dental arch were investigated with regard to implant deviations, and rotations and translations of the surgical template. One hundred fifty implants were installed. In mesio-distal direction, a mean implant deviation of 1.50 mm was scored at the implant tip, 1.27 mm at the shoulder, -0.60 mm in depth, as well as a mean deviation of angulation of 2.50°. In buccolingual direction, a mean implant deviation of 0.99 mm was found at the implant tip, 0.76 mm at the implant shoulder, -0.57 mm in depth, and a deviation of angulation of 2.48°. Of all implants, 53% was placed too superficial compared with the planning. The use of fixation pins and implant deviations in both buccal and mesial directions as also for rotations and translation of the surgical template showed statistically significant differences. Computer-aided implant planning showed to be a clinically relevant tool. However, this study emphasizes that the surgeon should take into account that deviations are larger compared with implant placement without augmentation procedure. Deviations are mainly caused by angulations and translations of the surgical template.

A Clinically Relevant Accuracy Study of Computer-Planned Implant Placement in the Edentulous Maxilla Using Mucosa-Supported Surgical Templates

The purpose of the study is to determine the clinically relevant accuracy of implant placement in the edentulous maxilla using computer planning and a mucosa-supported surgical template. In each of in total 30 consecutive edentulous patients suffering from retention problems of their upper denture, two or four Brånemark MkIII Groovy (Nobel Biocare®, Zürich, Switzerland) implants in the maxilla were installed. Preoperatively, first, a cone-beam computer tomography (cone beam computer tomography) scan was acquired, followed by virtual implant planning. Hereafter, a surgical template was designed to allow flapless implant placement using the template as a guide. To inventory the accuracy of implant placement, a postoperative CBCT scan was obtained and matched to the preoperative scan. The accuracy of implant placement was validated three-dimensionally. The Implant Position Orthogonal Projection validation method was applied to measure the clinically relevant implant deviations (i.e., in both the bucco-lingual and mesio-distal plane). Also, the influence of type of surgery, use of fixation pins, and position on the dental arch were investigated with regard to implant deviations. In total, 104 implants were installed. In bucco-lingual direction, a mean implant deviation of 0.67 mm was scored at the implant tip, of 0.51 mm at the shoulder, of -0.83 mm in depth, as also a mean deviation of angulation of 1.74°. In mesio-distal direction, a mean implant deviation of 0.75 mm was found at the implant tip, of 0.60 mm at the implant shoulder, of -0.75 mm in depth, and a deviation of angulation of 1.94°. Of all implants, 74% was placed not deep enough compared with the planning. Implant position on the dental arch, the use of fixation pins, and type of surgery showed no significant effect on implant deviations. However, a significant difference for implant deviations in both buccal and mesial direction was observed, explained by a nonoptimal positioning of the surgical template. Computer-aided implant planning showed to be a clinically relevant tool for the placement of two or four implants in the maxilla of fully edentulous patients. Exact positioning of the surgical template in anterior/posterior direction is crucial in reducing implant deviations both in buccal and mesial direction.

Techniques to Preserve Keratinized Peri-Implant Mucosa in CT-Guided Oral Implant Surgery

Guided implant dentistry using computed tomographic (CT) scans, virtual planning software and mucosa-supported surgical templates is an upcoming technology with the potential for more predictable and less invasive implant placement. While generally associated with a flapless approach, soft tissue punching and removal may not be indicated if available width of keratinized mucosa is limited prior to implant surgery. Two techniques to preserve keratinized peri-implant mucosa (Punch Reposition Technique and Topical Flap Technique) are presented and indications outlined. Appreciation of soft tissue conditions as well as functional and esthetic consequences of mucosal deficiencies (mucosal-driven approach) is recommended to supplement bone- and prosthetic-driven considerations in guided oral implant placement (Trinity Approach).