Accuracy assessment of computer-assisted flapless implant placement in partial edentulism.

AIM To assess the accuracy of implants placed flapless by a stereolithographic template in partially edentulous patients. MATERIAL AND METHODS Eight patients, requiring two to four implants (maxilla or mandible), were consecutively recruited. Radiographical data were obtained by means of a cone beam or a multi-slice CT scan and imported in a software program. Implants (n=21) were planned in a virtual environment, leading to the manufacture of one stereolithographic template per patient to guide the implant placement in a one-stage flapless procedure. A postoperative cone beam CT was performed to calculate the difference between virtual implant (n=21) positions in the preoperative planning and postoperative situation. RESULTS A mean angular deviation of 2.7 degrees (range 0.4-8, SD 1.9), with a mean deviation at the apex of 1.0 mm (range 0.2-3.0, SD 0.7), was observed. If one patient, a dropout because of non-conformity with the protocol, was excluded, the angular deviation was reduced to 2.2 degrees (range 0.6-3.9, SD 1.1), and the apical deviation to 0.9 mm (range 0.2-1.8). CONCLUSION Based on this limited patient population, a flapless implant installation appears to be a useful procedure even when based on accurate and reliable 3D CT-based image data and a dedicated implant planning software.

[1]  Gerlig Widmann,et al.  Accuracy in computer-aided implant surgery--a review. , 2006, The International journal of oral & maxillofacial implants.

[2]  R Jacobs,et al.  Comparative study of image quality for MSCT and CBCT scanners for dentomaxillofacial radiology applications. , 2008, Radiation protection dosimetry.

[3]  R Jacobs,et al.  The use of CT scan based planning for oral rehabilitation by means of implants and its transfer to the surgical field: a critical review on accuracy. , 2008, Journal of oral rehabilitation.

[4]  I. Turkyilmaz,et al.  A preliminary report of patients treated with early loaded implants using computerized tomography-guided surgical stents: flapless versus conventional flapped surgery. , 2007, Journal of oral rehabilitation.

[5]  Eric Blanchet,et al.  Effect of flapless surgery on pain experienced in implant placement using an image-guided system. , 2006, The International journal of oral & maxillofacial implants.

[6]  R Jacobs,et al.  Predictability of a three-dimensional planning system for oral implant surgery. , 1999, Dento maxillo facial radiology.

[7]  Guy Marchal,et al.  Multimodality image registration by maximization of mutual information , 1997, IEEE Transactions on Medical Imaging.

[8]  Scott D Ganz Use of stereolithographic models as diagnostic and restorative aids for predictable immediate loading of implants. , 2003, Practical procedures & aesthetic dentistry : PPAD.

[9]  C. Malevez,et al.  Clinical outcome of 103 consecutive zygomatic implants: a 6-48 months follow-up study. , 2004, Clinical oral implants research.

[10]  M. Strauss,et al.  Evaluation of the accuracy of three different computer-aided surgery systems in dental implantology: optical tracking vs. stereolithographic splint systems. , 2008, Clinical oral implants research.

[11]  P. Suetens,et al.  A comparison of jaw dimensional and quality assessments of bone characteristics with cone-beam CT, spiral tomography, and multi-slice spiral CT. , 2007, The International journal of oral & maxillofacial implants.

[12]  N. Van Assche,et al.  Tolerance within a surgical guide. , 2010, Clinical oral implants research.

[13]  Patricia R Cury,et al.  Clinical application of stereolithographic surgical guides for implant placement: preliminary results. , 2005, Journal of periodontology.

[14]  Daniel van Steenberghe,et al.  Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: a cohort study of consecutive patients. , 2007, The Journal of prosthetic dentistry.

[15]  C Politis,et al.  Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. , 2003, International journal of oral and maxillofacial surgery.

[16]  L. T. Yong,et al.  Complications of computer-aided-design/computer-aided-machining-guided (NobelGuide) surgical implant placement: an evaluation of early clinical results. , 2008, Clinical implant dentistry and related research.

[17]  Ilser Turkyilmaz,et al.  Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants. , 2008, Journal of periodontology.

[18]  P Suetens,et al.  Computer-assisted planning of oral implant surgery: a three-dimensional approach. , 1996, The International journal of oral & maxillofacial implants.

[19]  Paul Suetens,et al.  A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. , 2002, The International journal of oral & maxillofacial implants.

[20]  R Jacobs,et al.  Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images: a pilot study. , 2007, Journal of clinical periodontology.

[21]  R. Jacobs,et al.  Neurovascular disturbance associated with implant placement in the anterior mandible and its surgical implications: literature review including report of a case , 2008 .

[22]  Filip Schutyser,et al.  A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. , 2005, Clinical implant dentistry and related research.

[23]  S. Rosenstiel,et al.  Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement. , 2009, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[24]  Predrag Sukovic,et al.  Accuracy of implant placement with a stereolithographic surgical guide. , 2003, The International journal of oral & maxillofacial implants.

[25]  R Jacobs,et al.  Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. , 2009, European journal of radiology.