Dataset Information

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches.

ABSTRACT:

Purpose

This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches.

Methods

A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. Each practitioner inserted 4 implants per approach randomly with a 1-week gap to avoid memory bias (4 insertion sites × 3 approaches × 6 practitioners = 72 implants). The performance of practitioners was assessed by comparing actual implant deviation to the planned position, time required for implant placement and questionnaire-based self-confidence evaluation of practitioners on a scale of 1-30.

Results

The navigation approach significantly improved angular deviation compared with freehand (P < 0.001) and surgical guide (P < 0.001) irrespective of the experience. Surgical time with navigation was significantly longer compared to the freehand approach (P < 0.001), where experienced practitioners performed significantly faster compared to novice practitioners (P < 0.001). Overall, self-confidence was higher in favor of novice practitioners with both guided approaches. In addition, the confidence of novice practitioners (median score = 26) was comparable to that of experienced practitioners (median score = 27) for placing implants with the navigation approach.

Conclusions

Dynamic navigation system could act as a viable tool for dental implant placement. Unlike freehand and static-guided approaches, novice practitioners showed comparable accuracy and self-confidence to that of experienced practitioners with the navigation approach.

SUBMITTER: Wang X

PROVIDER: S-EPMC9548458 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches.

Wang Xiaotong X Shaheen Eman E Shujaat Sohaib S Meeus Jan J Legrand Paul P Lahoud Pierre P do Nascimento Gerhardt Maurício M Politis Constantinus C Jacobs Reinhilde R

International journal of implant dentistry 20221010 1

<h4>Purpose</h4>This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches.<h4>Methods</h4>A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. E ...[more]

PMID: 36210395

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Project description:BACKGROUND:One of the challenges encountered by clinicians new to implant dentistry is the determination and controlling of implant location. This study compared the accuracy of fully guided (FG) and pilot-guided (PG) static computer-assisted implant placement (sCAIP) protocols against the conventional freehand (FH) protocol for placing single anterior and posterior implants by recently introduced clinicians to implant dentistry. MATERIAL AND METHODS:Ten clinicians new to implant dentistry inserted one anterior (central incisor) and one posterior (first molar) implants per protocol in training maxillary models. The FG protocol involved drilling and implant placement through the guide, while the PG protocol controlled the pilot drilling only. The FH implant placement was completed without the aid of any guide. A total of 30 models were used, and 60 implants were inserted. The implant vertical, horizontal neck, horizontal apex, and angle deviations from planned positions were calculated. RESULTS:The FG protocol provided the most accurate implant placement in relation to horizontal neck (0.47 mm-0.52 mm), horizontal apex (0.71 mm-0.74 mm), and angle deviations (2.42o-2.61o). The vertical deviation was not significantly different among the different protocols. The PG protocol was generally similar to the FH protocol with a horizontal neck deviation of 1.01 mm-1.14 mm, horizontal apex deviation of 1.02 mm-1.35 mm, and angle deviation of 4.65o-7.79o. The FG protocol showed similarity in the accuracy of the anterior and posterior implants. There was a tendency for inferior accuracy for posterior implants compared with anterior implants for the PG and FH protocols. CONCLUSIONS:In the hands of recently introduced clinicians to implant dentistry, it appears that the accuracy of the FG protocol was superior to the other protocols and was not influenced by the position of the implants. The PG and FH protocols showed inferior accuracy for posterior implants compared with anterior implants.

Project description:Image-guided surgery, prosthetic-based virtual planning, 3D printing, and CAD/CAM technology are changing head and neck ablative and reconstructive surgical oncology. Due to quality-of-life improvement, dental implant rehabilitation could be considered in every patient treated with curative intent. Accurate implant placement is mandatory for prosthesis long-term stability and success in oncologic patients. We present a prospective study, with a novel workflow, comprising 11 patients reconstructed with free flaps and 56 osseointegrated implants placed in bone flaps or remnant jaws (iliac crest, fibula, radial forearm, anterolateral thigh). Starting from CT data and jaw plaster model scanning, virtual dental prosthesis was designed. Then prosthetically driven dental implacement was also virtually planned and transferred to the patient by means of intraoperative infrared optical navigation (first four patients), and a combination of conventional static teeth supported 3D-printed acrylic guide stent, intraoperative dynamic navigation, and augmented reality for final intraoperative verification (last 7 patients). Coronal, apical, and angular deviation between virtual surgical planning and final guided intraoperative position was measured on each implant. There is a clear learning curve for surgeons when applying guided methods. Initial only-navigated cases achieved low accuracy but were comparable to non-guided freehand positioning due to jig registration instability. Subsequent dynamic navigation cases combining highly stable acrylic static guides as reference and registration markers result in the highest accuracy with a 1-1.5-mm deviation at the insertion point. Smartphone-based augmented reality visualization is a valuable tool for intraoperative visualization and final verification, although it is still a difficult technique for guiding surgery. A fixed screw-retained ideal dental prosthesis was achieved in every case as virtually planned. Implant placement, the final step in free flap oncological reconstruction, could be accurately planned and placed with image-guided surgery, 3D printing, and CAD/CAM technology. The learning curve could be overcome with preclinical laboratory training, but virtually designed and 3D-printed tracer registration stability is crucial for accurate and predictable results. Applying these concepts to our difficult oncologic patient subgroup with deep anatomic alterations ended in comparable results as those reported in non-oncologic patients.

Project description:BackgroundThe purpose of this in vitro study was to compare the accuracy of implant placement in model surgeries according to the design of the drills (straight drills or step drills) used to finalize the implant bed during pilot-guided static computer-assisted implant surgery (sCAIS).MethodsModel surgeries were carried out on resin models randomly assigned to three study groups. Virtual planning software (coDiagnostiX 10.6, Dental Wings, Montreal, Canada) was used to plan the implant positions. In Groups 1 and 2, pilot-guided sCAIS was performed. Straight drills were used in Group 1, and step drills were used in Group 2 to finalize the implant beds. In Group 3, fully guided sCAIS was performed using a universal fully guided kit (RealGUIDE Full Surgical Kit 3DIEMME, RealGUIDE, Cantù, Como, Italy). A total of 90 dental implants (Callus Pro, Callus Implant Solutions GmbH, Nuremberg, Germany) were placed (six implants per model, five models per study group). The primary outcome variables (angular deviation, coronal global deviation, and apical global deviation) were calculated for all implants based on the comparison of the preoperative surgical plan with the postoperative scans.ResultsGroup 2 (coronal global deviation, 0.78 ± 0.29 mm; apical global deviation, 1.02 ± 0.56 mm) showed significantly lower values of both global deviation variables than Group 1 (coronal global deviation, 0.95 ± 0.20 mm; apical global deviation, 1.42 ± 0.49 mm). However, there was no significant difference in angular deviation between Groups 1 and 2 (7.56 ± 2.92° and 6.44 ± 2.84°). Group 3 produced significantly lower values of all three primary outcome variables (angular deviation, 2.36 ± 0.90°; coronal global deviation, 0.59 ± 0.28 mm; apical global deviation, 0.90 ± 0.29 mm) than Group 1 and significantly lower angular deviation and coronal global deviation values than Group 2.ConclusionsThe design of the drills used to finalize implant osteotomies during pilot-guided sCAIS influences dental implant placement accuracy. Using step drills instead of straight drills for final osteotomies decreases deviation from the surgical plan. The fully guided approach performed better than the pilot-guided sCAIS.

Dataset Information

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches.

Purpose

Methods

Results

Conclusions

Publications

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches.

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