Statement of problem
Precise treatment planning before implant surgery is necessary to identify vital structures
and to ensure a predictable restorative outcome.
Purpose
The purpose of this study was to compare the accuracy of implant placement by using
3 different types of surgical guide: bone-supported, tooth-supported, and mucosa-supported.
Material and methods
Thirty acrylic resin mandibles were fabricated with stereolithography (SLA) based
on data from the cone beam computerized tomography (CBCT) scan of an edentulous patient.
Ten of the mandibles were modified digitally before fabrication with the addition
of 4 teeth, and 10 of the mandibles were modified after fabrication with soft acrylic
resin to simulate mucosa. Each acrylic resin mandible had 5 implants virtually planned
in a 3-D software program. A total of 150 implants were planned and placed by using
SLA guides. Presurgical and postsurgical CBCT scans were superimposed to compare the
virtual implant placement with the actual implant placement. For statistical analyses,
a linear mixed models approach and t-test with the 2-sided alpha level set at .016 were used. All reported P values were adjusted by the Dunn-Sidak method to control the Type I error rate across
multiple pairwise comparisons.
Results
The mean angular deviation of the long axis between the planned and placed implants
was 2.2 ±1.2 degrees; the mean deviations in linear distance between the planned and
placed implants were 1.18 ±0.42 mm at the implant neck and 1.44 ±0.67 mm at the implant
apex for all 150 implants. After the superimposition procedure, the angular deviation
of the placed implants was 2.26 ±1.30 degrees with the tooth-supported, 2.17 ±1.02
degrees with the bone-supported, and 2.29 ±1.28 degrees with the mucosa-supported
SLA guide. The mean deviations in linear distance between the planned and placed implants
at the neck and apex were 1.00 ±0.33 mm and 1.15 ±0.42 mm for the tooth-supported
guides; 1.08 ±0.33 mm and 1.53 ±0.90 mm for the bone-supported guides; and 1.47 ±0.43
mm and 1.65 ±0.48 mm for the mucosa-supported SLA surgical guides.
Conclusions
The results of this study show that stereolithographic surgical guides may be reliable
in implant placement and that: 1) there was no statistically significant difference
among the 3 types of guide when comparing angular deviation and 2) mucosa-supported
guides were less accurate than both tooth-supported and bone-supported guides for
linear deviation at the implant neck and apex.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Prosthetic DentistryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 26-year follow-up of screw-retained fixed dental prostheses supported by machined-surface Brånemark implants: a case report.Tex Dent J. 2011; 128: 15-19
- Early versus delayed loading of mandibular implant-supported overdentures: 5-year results.Clin Implant Dent Relat Res. 2010; 12: e39-e46
- Failures in jaw reconstructive surgery with autogenous onlay bone grafts for pre-implant purposes: incidence, prevention and management of complications.Oral Maxillofac Surg Clin North Am. 2011; 23: 1-15
- Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images: a pilot study.J Clin Periodontol. 2007; 34: 816-821
- Accuracy of computer-aided oral implant surgery: a clinical and radiographic study.Int J Oral Maxillofac Implants. 2009; 24: 234-242
- Risk management in clinical practice. Part 9. Dental implants.Br Dent J. 2010; 209: 499-506
- Team treatment planning for the replacement of esthetic zone teeth with dental implants.Compend Contin Educ Dent. 2011; 32: 44-50
- Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto Study.Int J Prosthodont. 2004; 17: 417-424
- Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws.Int J Oral Maxillofac Implants. 1990; 5: 347-359
- Optimization in multi-implant placement for immediate loading in edentulous arches using a modified surgical template and prototyping: a case report.Int J Oral Maxillofac Implants. 2008; 23: 759-762
- Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study.Clin Implant Dent Relat Res. 2009; 11: 238-245
- Geometric accuracy of a newly developed cone-beam device for maxillofacial imaging.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 551-559
- Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on 8 implants placed with a bone-supported surgical computer-planned guide: a case report.J Oral Implantol. 2011; 37: 106-113
- Modular preoperative planning software for computer-aided oral implantology and the application of a novel stereolithographic template: a pilot study.Clin Implant Dent Relat Res. 2010; 12: 181-193
- A novel stereolithographic surgical guide template for planning treatment involving a mandibular dental implant.J Oral Maxillofac Surg. 2008; 66: 1446-1454
- Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part I. The concept.J Prosthodont. 2006; 15: 51-58
- Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study.J Periodontol. 2010; 81: 43-51
- Immediately loaded maxillary and mandibular dental implants with fixed CAD/CAM prostheses using a flapless surgical approach: a clinical report.J Prosthodont. 2011; 20: 319-325
- Implant placement accuracy when using stereolithographic template as a surgical guide: preliminary results.Implant Dent. 2009; 18: 46-56
- Accuracy of implant placement with a stereolithographic surgical guide.Int J Oral Maxillofac Implants. 2003; 18: 571-577
- Guided implant placement and immediate prosthesis delivery using traditional Brånemark System abutments: a pilot study of 23 patients.Implant Dent. 2008; 17: 128-135
- Accuracy of a computerized tomography-guided template-assisted implant system: an in vitro study.Clin Oral Implants Res. 2009; 20: 1156-1162
- Evaluation of the accuracy of three different computer-aided surgery systems in dental implantology: optical tracking vs. stereolithographic splint systems.Clin Oral Implants Res. 2008; 19: 709-716
- Clinical application of stereolithographic surgical guides for implant placement: preliminary results.J Periodontol. 2005; 76: 503-507
- Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.J Periodontol. 2008; 79: 1339-1345
- Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement.J Oral Maxillofac Surg. 2009; 67: 394-401
- Implant treatment with fixed prostheses in the edentulous maxilla. Part 2: prosthetic technique and clinical maintenance in two patient cohorts restored between 1986 and 1987 and 15 years later.Int J Prosthodont. 2011; 24: 356-362
Article info
Identification
Copyright
© 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
