DOI QR코드

DOI QR Code

Reliability of a chairside CAD-CAM surgical guide for dental implant surgery on the anterior maxilla: An in vitro study

  • Phyo Ei Ei Htay (Department of Prosthodontics, College of Dentistry, Kyung Hee University) ;
  • Richard Leesungbok (Department of Biomaterials and Prosthodontics, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong) ;
  • Suk Won Lee (Department of Biomaterials and Prosthodontics, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong) ;
  • Yu-Jin Jee (Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong) ;
  • Kyung Lhi Kang (Department of Periodontics, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong) ;
  • Sung Ok Hong (Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Dental Hospital at Gangdong)
  • Received : 2023.07.11
  • Accepted : 2023.10.25
  • Published : 2023.10.31

Abstract

PURPOSE. This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience. MATERIALS AND METHODS. Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05). RESULTS. There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists' groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05). CONCLUSION. CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.

Keywords

References

  1. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res 2008;19:119-30.  https://doi.org/10.1111/j.1600-0501.2007.01453.x
  2. French D, Ofec R, Levin L. Long term clinical performance of 10871 dental implants with up to 22years of follow-up: A cohort study in 4247 patients. Clin Implant Dent Relat Res 2021;23:289-97.  https://doi.org/10.1111/cid.12994
  3. Kiatkroekkrai P, Takolpuckdee C, Subbalekha K, Mattheos N, Pimkhaokham A. Accuracy of implant position when placed using static computer-assisted implant surgical guides manufactured with two different optical scanning techniques: a randomized clinical trial. Int J Oral Maxillofac Surg 2020;49:377-83.  https://doi.org/10.1016/j.ijom.2019.08.019
  4. Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19 Suppl:43-61. 
  5. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodontics Restorative Dent 2005;25:113-9. 
  6. Monje A, Insua A, Wang HL. Understanding peri-implantitis as a plaque-associated and site-specific entity: on the local predisposing factors. J Clin Med 2019;8:279. 
  7. Leesungbok R. Dr. Lee's Top-Down implant dentistry. Seoul; Myoungmoon Publishing; 2004. p. 8-24. 
  8. Garber DA, Belser UC. Restoration-driven implant placement with restoration-generated site development. Compend Contin Educ Dent 1995;16:796, 798-802, 804. 
  9. Brugnami F, Caleffi C. Prosthetically driven implant placement. How to achieve the appropriate implant site development. Keio J Med 2005;54:172-8.  https://doi.org/10.2302/kjm.54.172
  10. Ramasamy M, Giri, Raja R, Subramonian, Karthik, Narendrakumar R. Implant surgical guides: From the past to the present. J Pharm Bioallied Sci 2013;5(Suppl 1):S98-102.  https://doi.org/10.4103/0975-7406.113306
  11. Blustein R, Jackson R, Rotskoff K, Coy RE, Godar D. Use of splint material in the placement of implants. Int J Oral Maxillofac Implants 1986;1:47-9. 
  12. Engelman MJ, Sorensen JA, Moy P. Optimum placement of osseointegrated implants. J Prosthet Dent 1988;59:467-73.  https://doi.org/10.1016/0022-3913(88)90044-3
  13. Balshi TJ, Garver DG. Surgical guidestents for placement of implants. J Oral Maxillofac Surg 1987;45:463-5.  https://doi.org/10.1016/0278-2391(87)90020-6
  14. Meitner SW, Tallents RH. Surgical templates for prosthetically guided implant placement. J Prosthet Dent 2004;92:569-74.  https://doi.org/10.1016/j.prosdent.2004.08.020
  15. Vercruyssen M, Coucke W, Naert I, Jacobs R, Teughels W, Quirynen M. Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template. Clin Oral Implants Res 2015;26:1315-20.  https://doi.org/10.1111/clr.12460
  16. Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle CH, Tahmaseb A. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants 2009;24 Suppl:92-109. 
  17. Chackartchi T, Romanos GE, Parkanyi L, Schwarz F, Sculean A. Reducing errors in guided implant surgery to optimize treatment outcomes. Periodontol 2000 2022;88:64-72.  https://doi.org/10.1111/prd.12411
  18. Joda T, Gallucci GO. The virtual patient in dental medicine. Clin Oral Implants Res 2015;26:725-6.  https://doi.org/10.1111/clr.12379
  19. D'Souza KM, Aras MA. Types of implant surgical guides in dentistry: a review. J Oral Implantol 2012;38:643-52.  https://doi.org/10.1563/AAID-JOI-D-11-00018
  20. Fortin T, Champleboux G, Bianchi S, Buatois H, Coudert JL. Precision of transfer of preoperative planning for oral implants based on cone-beam CT-scan images through a robotic drilling machine. Clin Oral Implants Res 2002;13:651-6.  https://doi.org/10.1034/j.1600-0501.2002.130612.x
  21. Park JM, Yi TK, Koak JY, Kim SK, Park EJ, Heo SJ. Comparison of five-axis milling and rapid prototyping for implant surgical templates. Int J Oral Maxillofac Implants 2014;29:374-83.  https://doi.org/10.11607/jomi.3265
  22. Hinckfuss S, Conrad HJ, Lin L, Lunos S, Seong WJ. Effect of surgical guide design and surgeon's experience on the accuracy of implant placement. J Oral Implantol 2012;38:311-23.  https://doi.org/10.1563/AAID-JOI-D-10-00046
  23. Park SJ, Leesungbok R, Cui T, Lee SW, Ahn SJ. Reliability of a CAD/CAM surgical guide for implant placement: an in vitro comparison of surgeons' experience levels and implant sites. Int J Prosthodont 2017;30:367-9.  https://doi.org/10.11607/ijp.5179
  24. Graf T, Keul C, Wismeijer D, Guth JF. Time and costs related to computer-assisted versus non-computer-assisted implant planning and surgery. A systematic review. Clin Oral Implants Res 2021;32 Suppl 21:303-17.  https://doi.org/10.1111/clr.13862
  25. Hyun SW, Leesungbok R, Lee SW, Cho YE. Computer-guided implant surgery and immediate provisionalization by chair-side CAD-CAM: A case report. J Korean Acad Prosthodont 2021;59:478-86.  https://doi.org/10.4047/jkap.2021.59.4.478
  26. Song YW, Kim J, Kim JH, Park JM, Jung UW, Cha JK. Accuracy of dental implant placement by a novel inhouse model-free and zero-setup fully guided surgical template made of a light-cured composite resin (VARO Guide®): a comparative in vitro study. Materials (Basel) 2021;14:4023. 
  27. Misch CE. Density of bone: effect on treatment plans, surgical approach, healing, and progressive boen loading. Int J Oral Implantol 1990;6:23-31. 
  28. 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;112:526-32.  https://doi.org/10.1016/j.prosdent.2013.12.013
  29. Vermeulen J. The accuracy of implant placement by experienced surgeons: guided vs freehand approach in a simulated plastic model. Int J Oral Maxillofac Implants 2017;32:617-24.  https://doi.org/10.11607/jomi.5065
  30. Chen Z, Li J, Sinjab K, Mendonca G, Yu H, Wang HL. Accuracy of flapless immediate implant placement in anterior maxilla using computer-assisted versus freehand surgery: A cadaver study. Clin Oral Implants Res 2018;29:1186-94.  https://doi.org/10.1111/clr.13382
  31. 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 Suppl 16:416-35. https://doi.org/10.1111/clr.13346
  32. 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. 
  33. Schneider D, Sax C, Sancho-Puchades M, Hammerle CHF, Jung RE. Accuracy of computer-assisted, template-guided implant placement compared with conventional implant placement by hand-An in vitro study. Clin Oral Implants Res 2021;32:1052-60.  https://doi.org/10.1111/clr.13799
  34. Rungcharassaeng K, Caruso JM, Kan JY, Schutyser F, Boumans T. Accuracy of computer-guided surgery: a comparison of operator experience. J Prosthet Dent 2015;114:407-13.  https://doi.org/10.1016/j.prosdent.2015.04.004
  35. Cushen SE, Turkyilmaz I. Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study. J Prosthet Dent 2013;109:248-54.  https://doi.org/10.1016/S0022-3913(13)60053-0
  36. Wang X, Shaheen E, Shujaat S, Meeus J, Legrand P, Lahoud P, do Nascimento Gerhardt M, Politis C, Jacobs R. Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches. Int J Implant Dent 2022;8:42. 
  37. Furhauser R, Mailath-Pokorny G, Haas R, Busenlechner D, Watzek G, Pommer B. Esthetics of flapless single-tooth implants in the anterior maxilla using guided surgery: association of three-dimensional accuracy and pink esthetic score. Clin Implant Dent Relat Res 2015;17 Suppl 2:e427-33.  https://doi.org/10.1111/cid.12264
  38. Singthong W, Serichetaphongse P, Chengprapakorn W. A randomized clinical trial on the accuracy of guided implant surgery between two implant-planning programs used by inexperienced operators. J Prosthet Dent 2022:S0022-3913(22)00104-4. 
  39. Verhamme LM, Meijer GJ, Boumans T, de Haan AF, Berge SJ, Maal TJ. A clinically relevant accuracy study of computer-planned implant placement in the edentulous maxilla using mucosa-supported surgical templates. Clin Implant Dent Relat Res 2015;17:343-52.  https://doi.org/10.1111/cid.12112
  40. El Kholy K, Lazarin R, Janner SFM, 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;30:1067-75. https://doi.org/10.1111/clr.13520