Use Of Surgical Guides Research Articles

Accurate pre-surgical determination for self-drilling miniscrew implant placement using surgical guides and cone-beam computed tomography

Miniscrew implants have proven to be effective in providing absolute orthodontic anchorage. However, as self-drilling miniscrew implants have become more popular, a problem has emerged, i.e. root contact, which can lead to perforation and other root injuries. To avoid possible root damage, a surgical guide was fabricated and cone-beam computed tomography (CBCT) was used to incorporate guide tubes drilled in accordance with the planned direction of the implants. Eighteen patients (5 males and 13 females; mean age 23.8 years; minimum 10.7, maximum 45.5) were included in the study. Forty-four self-drilling miniscrew implants (diameter 1.6, and length 8 mm) were placed in interradicular bone using a surgical guide procedure, the majority in the maxillary molar area. To determine the success rates, statistical analysis was undertaken using Fisher's exact probability test. CBCT images of post-surgical self-drilling miniscrew implant placement showed no root contact (0/44). However, based on CBCT evaluation, it was necessary to change the location or angle of 52.3 per cent (23/44) of the guide tubes prior to surgery in order to obtain optimal placement. If orthodontic force could be applied to the screw until completion of orthodontic treatment, screw anchorage was recorded as successful. The total success rate of all miniscrews was 90.9 per cent (40/44). Orthodontic self-drilling miniscrew implants must be inserted carefully, particularly in the case of blind placement, since even guide tubes made on casts frequently require repositioning to avoid the roots of the teeth. The use of surgical guides, fabricated using CBCT images, appears to be a promising technique for placement of orthodontic self-drilling miniscrew implants adjacent to the dental roots and maxillary sinuses.

Computer-aided manufacturing technologies for guided implant placement

Implant treatment increasingly focuses on the reduction of treatment time and postoperative impairment. The improvement of 3D dental diagnosis by ConeBeam computed tomography allows detailed preparation for the surgical placement of dental implants under prosthetic considerations. While the first generation of implant planning software used high-contrast multislice computed tomography, software that has been specifically designed for ConeBeam computed tomography is now available. Implant placement can be performed using surgical guides or under the control of optical tracking systems. Surgical guides are more commonly used in private office owing to their availability. The accuracy for both techniques is clinically acceptable for achieving implant placement in critical anatomical indications. When using prefabricated superstructures and in flapless surgery, special abutments or an adjusted workflow are still necessary to compensate misfits of between 150 and 600 µm. The proposition to ensure proper implant placement by dentists with limited surgical experience through the use of surgical guides is unlikely to be successful, because there is also a specific learning curve for guided implant placement. Current and future development will continue to decrease the classical laboratory-technician work and will integrate the fabrication of superstructures with virtual treatment planning from the start.

Bone Biology, Harvesting, Grafting for Dental Implants: Rationale and Clinical Applications Arun K. Garg

Bone Biology, Harvesting, Grafting for Dental Implants: Rationale and Clinical Applications Arun K. Garg