Advertisement
Journal of Prosthetic Dentistry

Accuracy of partially and fully guided surgical techniques for immediate implant placement: An in vitro assessment

Published:December 26, 2022DOI:https://doi.org/10.1016/j.prosdent.2022.11.020

      Abstract

      Statement of problem

      Optimal implant positioning is essential to achieving predictable results. Computer-guided surgery has been reported to be an accurate technique for implant placement in healed sites, but the accuracy of guided techniques for immediate implant placement into fresh sockets is still unclear.

      Purpose

      The purpose of this experimental randomized split-mouth study in pig jaws was to determine the accuracy of partially and fully guided surgical techniques for immediate implant placement into fresh sockets and to compare 2 different methods of implant position deviations analysis.

      Material and methods

      Twenty implants were installed in 10 pig jaws using 2 different techniques: partially guided (n=10) and fully guided (n=10). Cone beam computed tomography and digital scanning were performed before and after the surgical procedure to plan the virtual implant position and fabricate the surgical guide, as well as to determine implant position deviations. Two methods were used to evaluate implant deviations: tomographic and digital scanning. The Shapiro-Wilk test of normality was used. Deviation comparisons were carried out by using paired t tests (α=.05), and intraclass correlation coefficient (ICC) was computed to assess the agreement between the 2 methods of implant deviation analysis.

      Results

      In the tomographic analysis, the partially guided technique resulted in significantly higher global apical and lateral coronal deviations (2.25 ±0.59 mm; 0.96 ±0.55 mm) than fully guided (1.52 ±0.89 mm; 0.75 ±0.52 mm) (P<.01 and P<.05, respectively). The analysis performed using digital scanning showed significantly higher angular, global apical, and lateral apical deviations in the partially guided (6 ±3.28 degrees; 2.49 ±1.03 mm; 2.16 ±1.07 mm) technique than in the fully guided (3.32 ±1.84 degrees; 1.5 ±0.58 mm; 0.98 ±0.67 mm) (P<.05). An ICC of 0.522 between the 2 methods of implant deviation analysis was obtained.

      Conclusions

      The partially guided technique was less accurate than the fully guided technique for immediate implant placement into fresh sockets. A moderate concordance was observed between cone beam computed tomography and digital scanning analyses, suggesting that more studies are required to validate and to define the most reliable method of measuring implant deviation.
      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 access
      One-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 Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sun T.M.
        • Lee H.E.
        • Lan T.H.
        Comparing accuracy of implant installation with a Navigation System (NS), a Laboratory Guide (LG), NS with LG, and freehand drilling.
        Int J Environ Res Public Health. 2020; 17: 2107
        • Colombo M.
        • Mangano C.
        • Mijiritsky E.
        • Krebs M.
        • Hauschild U.
        • Fortin T.
        Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized controlled trials.
        BMC Oral Health. 2017; 17: 150
        • Deepanandan L.
        • Karthikrajan G.
        Drill bit guiding system for implant placement.
        Ann Maxillofac Surg. 2018; 8: 230-233
        • Younes F.
        • Cosyn J.
        • De Bruyckere T.
        • Cleymaet R.
        • Bouckaert E.
        • Eghbali A.
        A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients.
        J Clin Periodontol. 2018; 45: 721-732
        • Pettersson A.
        • Kero T.
        • Gillot L.
        • et al.
        Accuracy of CAD/CAM-guided surgical template implant surgery on human cadavers: Part I.
        J Prosthet Dent. 2010; 103: 334-342
        • Schneider D.
        • Sancho-Puchades M.
        • Mir-Mari J.
        • Muhlemann S.
        • Jung R.
        • Hammerle C.
        A randomized controlled clinical trial comparing conventional and computer-assisted implant planning and placement in partially edentulous patients. Part 4: accuracy of implant placement.
        Int J Periodontics Restorative Dent. 2019; 39: e111-e122
        • Joda T.
        • Derksen W.
        • Wittneben J.G.
        • Kuehl S.
        Static computer-aided implant surgery (s-CAIS) analysing patient-reported outcome measures (PROMs), economics and surgical complications: a systematic review.
        Clin Oral Implants Res. 2018; 29: 359-373
        • Behneke A.
        • Burwinkel M.
        • Behneke N.
        Factors influencing transfer accuracy of cone beam CT-derived template-based implant placement.
        Clin Oral Implants Res. 2012; 23: 416-423
        • Kraft B.
        • Frizzera F.
        • de Freitas R.M.
        • de Oliveira G.
        • Marcantonio Junior E.
        Impact of fully or partially guided surgery on the position of single implants immediately placed in maxillary incisor sockets: a randomized controlled clinical trial.
        Clin Implant Dent Relat Res. 2020; 22: 631-637
        • Frizzera F.
        • de Freitas R.M.
        • Munoz-Chavez O.F.
        • Cabral G.
        • Shibli J.A.
        • Marcantonio E.
        Impact of soft tissue grafts to reduce peri-implant alterations after immediate implant placement and provisionalization in compromised sockets.
        Int J Periodontics Restorative Dent. 2019; 39: 381-389
        • De Santis D.
        • Gelpi F.
        • Zambotti T.
        • et al.
        The use of computer-guided flapless dental implant surgery (Nobel guide(R)) and immediate function to support a fixed full-arch prosthesis in fresh frozen homologous bone grafted patients: a retrospective cohort study with 5 to 8-year follow-up.
        J Biol Regul Homeost Agents. 2020; 34: 49-61
        • Gargallo-Albiol J.
        • Barootchi S.
        • Salomo-Coll O.
        • Wang H.L.
        Advantages and disadvantages of implant navigation surgery. A systematic review.
        Ann Anat. 2019; 225: 1-10
        • Schneider D.
        • Sancho-Puchades M.
        • Benic G.I.
        • Hammerle C.H.
        • Jung R.E.
        A randomized controlled clinical trial comparing conventional and computer-assisted implant planning and placement in partially edentulous patients. Part 1: clinician-related outcome measures.
        Int J Periodontics Restorative Dent. 2018; 38: s49-s57
        • Chen Z.
        • Li J.
        • Sinjab K.
        • Mendonca G.
        • Yu H.
        • Wang H.L.
        Accuracy of flapless immediate implant placement in anterior maxilla using computer-assisted versus freehand surgery: a cadaver study.
        Clin Oral Implants Res. 2018; 29: 1186-1194
        • Abduo J.
        • Lau D.
        Accuracy of static computer-assisted implant placement in anterior and posterior sites by clinicians new to implant dentistry: in vitro comparison of fully guided, pilot-guided, and freehand protocols.
        Int J Implant Dent. 2020; 6: 10
        • Frizzera F.
        • Calazans N.N.N.
        • Pascoal C.H.
        • Martins M.E.
        • Mendonca G.
        Flapless guided implant surgeries compared with conventional surgeries performed by nonexperienced individuals: randomized and controlled split-mouth clinical trial.
        Int J Oral Maxillofac Implants. 2021; 36: 755-761
        • El Kholy K.
        • Lazarin R.
        • Janner S.F.M.
        • Faerber K.
        • Buser R.
        • Buser D.
        Influence of surgical guide support and implant site location on accuracy of static computer-assisted implant surgery.
        Clin Oral Implants Res. 2019; 30: 1067-1075
        • Ramaglia L.
        • Toti P.
        • Sbordone C.
        • Guidetti F.
        • Martuscelli R.
        • Sbordone L.
        Implant angulation: 2-year retrospective analysis on the influence of dental implant angle insertion on marginal bone resorption in maxillary and mandibular osseous onlay grafts.
        Clin Oral Investig. 2015; 19: 769-779
        • Zhou W.
        • Liu Z.
        • Song L.
        • Kuo C.L.
        • Shafer D.M.
        Clinical factors affecting the accuracy of guided implant surgery-a systematic review and meta-analysis.
        J Evid Based Dent Pract. 2018; 18: 28-40
        • Pessoa R.
        • Siqueira R.
        • Li J.
        • et al.
        The impact of surgical guide fixation and implant location on accuracy of static computer-assisted implant surgery.
        J Prosthodont. 2022; 31: 155-164
        • Li J.
        • Chen Z.
        • Chan H.L.
        • Sinjab K.
        • Yu H.
        • Wang H.L.
        Does flap opening or not influence the accuracy of semi-guided implant placement in partially edentulous sites?.
        Clin Implant Dent Relat Res. 2019; 21: 1253-1261
        • Lou F.
        • Rao P.
        • Zhang M.
        • Luo S.
        • Lu S.
        • Xiao J.
        Accuracy evaluation of partially guided and fully guided templates applied to implant surgery of anterior teeth: a randomized controlled trial.
        Clin Implant Dent Relat Res. 2021; 23: 117-130
        • Meirelles M.S.
        • de Almeida D.C.F.
        • Velloso G.R.
        • Torres M.
        • Sartoretto S.C.
        • Moraschini V.
        Atrophic maxilla rehabilitation through dental implants using the v-4 strategy associated with guided surgery: a case report and technique description.
        J Oral Implantol. 2021; 47: 498-501
        • Noharet R.
        • Pettersson A.
        • Bourgeois D.
        Accuracy of implant placement in the posterior maxilla as related to 2 types of surgical guides: a pilot study in the human cadaver.
        J Prosthet Dent. 2014; 112: 526-532
        • Magrin G.L.
        • Rafael S.N.F.
        • Passoni B.B.
        • et al.
        Clinical and tomographic comparison of dental implants placed by guided virtual surgery versus conventional technique: a split-mouth randomized clinical trial.
        J Clin Periodontol. 2020; 47: 120-128
        • Lee J.H.
        • Lee J.B.
        • Park J.I.
        • Choi S.H.
        • Kim Y.T.
        Mechanical complication rates and optimal horizontal distance of the most distally positioned implant-supported single crowns in the posterior region: a study with a mean follow-up of 3 years.
        J Prosthodont. 2015; 24: 517-524
        • D'Haese J.
        • Van De Velde T.
        • Komiyama A.
        • Hultin M.
        • De Bruyn H.
        Accuracy and complications using computer-designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature.
        Clin Implant Dent Relat Res. 2012; 14: 321-335
        • Tattan M.
        • Chambrone L.
        • Gonzalez-Martin O.
        • Avila-Ortiz G.
        Static computer-aided, partially guided, and free-handed implant placement: a systematic review and meta-analysis of randomized controlled trials.
        Clin Oral Implants Res. 2020; 31: 889-916
        • Tahmaseb A.
        • Wu V.
        • Wismeijer D.
        • Coucke W.
        • Evans C.
        The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis.
        Clin Oral Implants Res. 2018; 29: 416-435
        • Gargallo-Albiol J.
        • Barootchi S.
        • Marques-Guasch J.
        • Wang H.L.
        Fully guided versus half-guided and freehand implant placement: systematic review and meta-analysis.
        Int J Oral Maxillofac Implants. 2020; 35: 1159-1169
        • de Almeida E.O.
        • Pellizzer E.P.
        • Goiatto M.C.
        • et al.
        Computer-guided surgery in implantology: review of basic concepts.
        J Craniofac Surg. 2010; 21: 1917-1921
        • Siqueira R.
        • Chen Z.
        • Galli M.
        • Saleh I.
        • Wang H.L.
        • Chan H.L.
        Does a fully digital workflow improve the accuracy of computer-assisted implant surgery in partially edentulous patients? A systematic review of clinical trials.
        Clin Implant Dent Relat Res. 2020; 22: 660-671
        • Naziri E.
        • Schramm A.
        • Wilde F.
        Accuracy of computer-assisted implant placement with insertion templates.
        GMS Interdiscip Plast Reconstr Surg DGPW. 2016; 5: Doc15
        • Smitkarn P.
        • Subbalekha K.
        • Mattheos N.
        • Pimkhaokham A.
        The accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery.
        J Clin Periodontol. 2019; 46: 949-957
        • Varga E.
        • Antal M.
        • Major L.
        • Kiscsatari R.
        • Braunitzer G.
        • Piffko J.
        Guidance means accuracy: a randomized clinical trial on freehand versus guided dental implantation.
        Clin Oral Implants Res. 2020; 31: 417-430
        • Aerssens J.
        • Boonen S.
        • Lowet G.
        • Dequeker J.
        Interspecies differences in bone composition, density, and quality: potential implications for in vivo bone research.
        Endocrinology. 1998; 139: 663-670
        • Pilawski I.
        • Tulu U.S.
        • Ticha P.
        • et al.
        Interspecies comparison of alveolar bone biology, part I: morphology and physiology of pristine bone.
        JDR Clin Trans Res. 2021; 6: 352-360
        • Erdogan O.
        • Ustun Y.
        • Tatli U.
        • Damlar I.
        • Daglioglu K.
        A pig model for the histomorphometric evaluation of hard tissue around dental implants.
        J Oral Implantol. 2013; 39: 551-557