Journal of Prosthetic Dentistry
Research Article| Volume 108, ISSUE 3, P181-188, September 2012

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Accuracy of three different types of stereolithographic surgical guide in implant placement: An in vitro study

  • Sarah Katherine Turbush
    Resident, Graduate Prosthodontics, Department of Prosthodontics, Lackland Air Force Base, San Antonio, Texas
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  • Ilser Turkyilmaz
    Corresponding author: Dr Ilser Turkyilmaz, Dental School Implant Clinic, Department of Comprehensive Dentistry, The University of Texas Health Science Center, 7703 Floyd Curl Drive, MSC 7914, San Antonio, TX 78229-3900, Fax: 210-567-6376
    Assistant Professor, Director, Dental School Implant Clinic, Department of Comprehensive Dentistry, The University of Texas Health Science Center, San Antonio, Texas
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      Statement of problem

      Precise treatment planning before implant surgery is necessary to identify vital structures and to ensure a predictable restorative outcome.


      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.


      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.


      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.
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        • Turkyilmaz I
        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
        • Turkyilmaz I
        • Tözüm TF
        • Tumer C
        Early versus delayed loading of mandibular implant-supported overdentures: 5-year results.
        Clin Implant Dent Relat Res. 2010; 12: e39-e46
        • Chiapasco M
        • Zaniboni M
        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
        • Van Assche N
        • van Steenberghe D
        • Guerrero ME
        • Hirsch E
        • Schutyser F
        • Quirynen M
        • et al.
        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
        • Valente F
        • Schiroli G
        • Sbrenna A
        Accuracy of computer-aided oral implant surgery: a clinical and radiographic study.
        Int J Oral Maxillofac Implants. 2009; 24: 234-242
        • Palmer RM
        Risk management in clinical practice. Part 9. Dental implants.
        Br Dent J. 2010; 209: 499-506
        • Levine RA
        • Nack G
        Team treatment planning for the replacement of esthetic zone teeth with dental implants.
        Compend Contin Educ Dent. 2011; 32: 44-50
        • Attard NJ
        • Zarb GA
        Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto Study.
        Int J Prosthodont. 2004; 17: 417-424
        • Adell R
        • Eriksson B
        • Lekholm U
        • Brånemark PI
        • Jemt T
        Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws.
        Int J Oral Maxillofac Implants. 1990; 5: 347-359
        • Jayme SJ
        • Muglia VA
        • de Oliveira RR
        • Novaes AB
        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
        • Katsoulis J
        • Pazera P
        • Mericske-Stern R
        Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study.
        Clin Implant Dent Relat Res. 2009; 11: 238-245
        • Mischkowski RA
        • Pulsfort R
        • Ritter L
        • Neugebauer J
        • Brochhagen HG
        • Keeve E
        • et al.
        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
        • Amorfini L
        • Storelli S
        • Romeo E
        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
        • Chen X
        • Yuan J
        • Wang C
        • Huang Y
        • Kang L
        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
        • Nikzad S
        • Azari A
        A novel stereolithographic surgical guide template for planning treatment involving a mandibular dental implant.
        J Oral Maxillofac Surg. 2008; 66: 1446-1454
        • Lal K
        • White GS
        • Morea DN
        • Wright RF
        Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part I. The concept.
        J Prosthodont. 2006; 15: 51-58
        • Arisan V
        • Karabuda ZC
        • Ozdemir T
        Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study.
        J Periodontol. 2010; 81: 43-51
        • Bedi A
        • Michalakis KX
        • Mariani Jr, EJ
        • Zourdos DM
        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
        • Al-Harbi SA
        • Sun AY
        Implant placement accuracy when using stereolithographic template as a surgical guide: preliminary results.
        Implant Dent. 2009; 18: 46-56
        • Sarment DP
        • Sukovic P
        • Clinthorne N
        Accuracy of implant placement with a stereolithographic surgical guide.
        Int J Oral Maxillofac Implants. 2003; 18: 571-577
        • Balshi SF
        • Wolfinger GJ
        • Balshi TJ
        Guided implant placement and immediate prosthesis delivery using traditional Brånemark System abutments: a pilot study of 23 patients.
        Implant Dent. 2008; 17: 128-135
        • Horwitz J
        • Zuabi O
        • Machtei EE
        Accuracy of a computerized tomography-guided template-assisted implant system: an in vitro study.
        Clin Oral Implants Res. 2009; 20: 1156-1162
        • Ruppin J
        • Popovic A
        • Strauss M
        • Spüntrup E
        • Steiner A
        • Stoll C
        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
        • Di Giacomo GA
        • Cury PR
        • de Araujo NS
        • Sendyk WR
        • Sendyk CL
        Clinical application of stereolithographic surgical guides for implant placement: preliminary results.
        J Periodontol. 2005; 76: 503-507
        • Ersoy AE
        • Turkyilmaz I
        • Ozan O
        • McGlumphy EA
        Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.
        J Periodontol. 2008; 79: 1339-1345
        • Ozan O
        • Turkyilmaz I
        • Ersoy AE
        • McGlumphy EA
        • Rosenstiel SF
        Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement.
        J Oral Maxillofac Surg. 2009; 67: 394-401
        • Jemt T
        • Stenport V
        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