The accuracy of static computer‐aided implant surgery: A systematic review and meta‐analysis

OBJECTIVES To assess the literature on the accuracy of static computer-assisted implant surgery in implant dentistry. MATERIALS AND METHODS Electronic and manual literature searches were conducted to collect information about the accuracy of static computer-assisted implant systems. Meta-regression analysis was performed to summarise the accuracy studies. RESULTS From a total of 372 articles. 20 studies, one randomised controlled trial (RCT), eight uncontrolled retrospective studies and 11 uncontrolled prospective studies were selected for inclusion for qualitative synthesis. A total of 2,238 implants in 471 patients that had been placed using static guides were available for review. The meta-analysis of the accuracy (20 clinical) revealed a total mean error of 1.2 mm (1.04 mm to 1.44 mm) at the entry point, 1.4 mm (1.28 mm to 1.58 mm) at the apical point and deviation of 3.5°(3.0° to 3.96°). There was a significant difference in accuracy in favour of partial edentulous comparing to full edentulous cases. CONCLUSION Different levels of quantity and quality of evidence were available for static computer-aided implant surgery (s-CAIS). Based on the present systematic review and its limitations, it can be concluded that the accuracy of static computer-aided implant surgery is within the clinically acceptable range in the majority of clinical situations. However, a safety marge of at least 2 mm should be respected. A lack of homogeneity was found in techniques adopted between the different authors and the general study designs.

[1]  Bassam Hassan,et al.  Registration of cone beam computed tomography data and intraoral surface scans – A prerequisite for guided implant surgery with CAD/CAM drilling guides , 2016, Clinical oral implants research.

[2]  N. Clelland,et al.  Split-mouth comparison of the accuracy of computer-generated and conventional surgical guides. , 2013, The International journal of oral & maxillofacial implants.

[3]  Scott R Makins,et al.  Artifacts interfering with interpretation of cone beam computed tomography images. , 2014, Dental clinics of North America.

[4]  David Schneider,et al.  In-vitro evaluation of the tolerance of surgical instruments in templates for computer-assisted guided implantology produced by 3-D printing. , 2015, Clinical oral implants research.

[5]  L. Chambrone,et al.  Efficacy of standard (SLA) and modified sandblasted and acid-etched (SLActive) dental implants in promoting immediate and/or early occlusal loading protocols: a systematic review of prospective studies. , 2015, Clinical oral implants research.

[6]  Michele Cassetta,et al.  Accuracy of implant placement with a stereolithographic surgical template. , 2012, The International journal of oral & maxillofacial implants.

[7]  N. Van Assche,et al.  Accuracy assessment of computer-assisted flapless implant placement in partial edentulism. , 2010, Journal of clinical periodontology.

[8]  Sumit Yadav,et al.  Artifacts in Cone Beam Computed Tomography Image Volumes: An Illustrative Depiction. , 2015, Journal of the Massachusetts Dental Society.

[9]  P. Shen,et al.  Accuracy evaluation of computer-designed surgical guide template in oral implantology. , 2015, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[10]  T. Joda,et al.  Time efficiency, difficulty, and operator's preference comparing digital and conventional implant impressions: a randomized controlled trial , 2017, Clinical oral implants research.

[11]  M. Cassetta,et al.  Depth deviation and occurrence of early surgical complications or unexpected events using a single stereolithographic surgi-guide. , 2011, International journal of oral and maxillofacial surgery.

[12]  Francisco Martínez-Rus,et al.  Accuracy of a digital impression system based on active wavefront sampling technology for implants considering operator experience, implant angulation, and depth. , 2015, Clinical implant dentistry and related research.

[13]  F. Tzerbos,et al.  Restoration-Guided Implant Rehabilitation of the Complex Partial Edentulism: a Clinical Report , 2010, Journal of oral & maxillofacial research.

[14]  Reinhilde Jacobs,et al.  Cone beam computed tomography in implant dentistry: a systematic review focusing on guidelines, indications, and radiation dose risks. , 2014, The International journal of oral & maxillofacial implants.

[15]  Wael Att,et al.  Precision of Dental Implant Digitization Using Intraoral Scanners. , 2016, The International journal of prosthodontics.

[16]  Regina Mericske-Stern,et al.  Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study. , 2009, Clinical implant dentistry and related research.

[17]  Sang J. Lee,et al.  Accuracy of digital versus conventional implant impressions. , 2015, Clinical oral implants research.

[18]  Daisuke Sato,et al.  Factors affecting accuracy of implant placement with mucosa-supported stereolithographic surgical guides in edentulous mandibles , 2013, Comput. Biol. Medicine.

[19]  H. Rudolph,et al.  Retrospective study to determine the accuracy of template-guided implant placement using a novel nonradiologic evaluation method. , 2016, Oral surgery, oral medicine, oral pathology and oral radiology.

[20]  Tiny Boumans,et al.  A clinically relevant accuracy study of computer-planned implant placement in the edentulous maxilla using mucosa-supported surgical templates. , 2015, Clinical implant dentistry and related research.

[21]  Reinhilde Jacobs,et al.  A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template. , 2014, Journal of clinical periodontology.

[22]  Alexander Schramm,et al.  Accuracy of computer-assisted implant placement with insertion templates , 2016, GMS Interdisciplinary plastic and reconstructive surgery DGPW.

[23]  Jun Li,et al.  Accuracy of different types of computer-aided design/computer-aided manufacturing surgical guides for dental implant placement. , 2015, International journal of clinical and experimental medicine.

[25]  André Gahleitner,et al.  Computed tomography-based evaluation of template (NobelGuide™)-guided implant positions: a prospective radiological study. , 2011, Clinical oral implants research.

[26]  Ersilia Barbato,et al.  The Influence of the Tolerance between Mechanical Components on the Accuracy of Implants Inserted with a Stereolithographic Surgical Guide: A Retrospective Clinical Study. , 2015, Clinical implant dentistry and related research.

[27]  L. Hedges,et al.  Fixed- and random-effects models in meta-analysis. , 1998 .

[28]  Bruno Salles Sotto-Maior,et al.  Clinical accuracy of flapless computer-guided surgery for implant placement in edentulous arches. , 2013, The International journal of oral & maxillofacial implants.

[29]  D. Wismeijer,et al.  Digital protocol for reference-based guided surgery and immediate loading: a prospective clinical study. , 2011, The International journal of oral & maxillofacial implants.

[30]  J. D. da Silva,et al.  Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. , 2012, Journal of periodontology.

[31]  Ai Komiyama,et al.  Accuracy of virtually planned and template guided implant surgery on edentate patients. , 2012, Clinical implant dentistry and related research.

[32]  K. Orhan,et al.  Correlation Between Bone Density and Angular Deviation of Implants Placed Using CT-Generated Surgical Guides , 2011, The Journal of craniofacial surgery.

[33]  A. Suomalainen,et al.  Dentomaxillofacial imaging with panoramic views and cone beam CT , 2015, Insights into Imaging.

[34]  Francisco Martínez-Rus,et al.  Accuracy of two digital implant impression systems based on confocal microscopy with variations in customized software and clinical parameters. , 2015, The International journal of oral & maxillofacial implants.

[35]  Nikolaus Behneke,et al.  Accuracy assessment of cone beam computed tomography-derived laboratory-based surgical templates on partially edentulous patients. , 2012, Clinical oral implants research.

[36]  Jong-Ho Lee,et al.  An assessment of template-guided implant surgery in terms of accuracy and related factors , 2013, The journal of advanced prosthodontics.

[37]  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.

[38]  Wim Teughels,et al.  The accuracy of guided surgery via mucosa-supported stereolithographic surgical templates in the hands of surgeons with little experience. , 2015, Clinical oral implants research.

[39]  Saad A Al-Harbi,et al.  Implant Placement Accuracy When Using Stereolithographic Template as a Surgical Guide: Preliminary Results , 2009, Implant dentistry.

[40]  C P Marinello,et al.  Treatment plan for restoring the edentulous maxilla with implant-supported restorations: removable overdenture versus fixed partial denture design. , 1999, The Journal of prosthetic dentistry.

[41]  M. Cassetta,et al.  The intrinsic error of a stereolithographic surgical template in implant guided surgery. , 2013, International journal of oral and maxillofacial surgery.

[42]  Dmd Fmcds Mmi PhD Researcher Jimoh Olubanwo Agbaje Bds Accuracy of Dental Implant Placement Using CBCT-Derived Mucosa-Supported Stereolithographic Template , 2013 .

[43]  J. D'haese,et al.  A prospective study on the accuracy of mucosally supported stereolithographic surgical guides in fully edentulous maxillae. , 2012, Clinical implant dentistry and related research.

[44]  Volkan Arisan Dr. Med. Dent.,et al.  Conventional Multi-Slice Computed Tomography (CT) and Cone-Beam CT (CBCT) for Computer-Aided Implant Placement. Part II: Reliability of Mucosa-Supported Stereolithographic Guides , 2012 .

[45]  Ersilia Barbato,et al.  Accuracy of two stereolithographic surgical templates: a retrospective study. , 2013, Clinical implant dentistry and related research.

[46]  W. Teughels,et al.  Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template. , 2015, Clinical Oral Implants Research.

[47]  Min Wu,et al.  Accuracy of computer-guided implant surgery by a CAD/CAM and laser scanning technique. , 2014, The Chinese journal of dental research : the official journal of the Scientific Section of the Chinese Stomatological Association.

[48]  S. Bergé,et al.  An accuracy study of computer-planned implant placement in the augmented maxilla using osteosynthesis screws. , 2017, International journal of oral and maxillofacial surgery.

[49]  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.

[50]  Stephan Eitner,et al.  Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method - a combined in vivo - in vitro technique using cone-beam CT (Part II). , 2010, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[51]  L. Chambrone,et al.  Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. , 2010, Journal of clinical periodontology.

[52]  D. Altman,et al.  Chapter 8: Assessing risk of bias in included studies , 2008 .

[53]  Daniel Wismeijer,et al.  Computer technology applications in surgical implant dentistry: a systematic review. , 2014, The International journal of oral & maxillofacial implants.

[54]  Filip Schutyser,et al.  An Accuracy Study of Computer-Planned Implant Placement in the Augmented Maxilla Using Mucosa-Supported Surgical Templates. , 2015, Clinical implant dentistry and related research.

[55]  A. Parenti,et al.  Evaluation of accuracy and precision of a new guided surgery system: a multicenter clinical study. , 2014, The International journal of periodontics & restorative dentistry.

[56]  Nikolaus Behneke,et al.  Factors influencing transfer accuracy of cone beam CT-derived template-based implant placement. , 2012, Clinical oral implants research.

[57]  S. Stübinger,et al.  Deviations between placed and planned implant positions: an accuracy pilot study of skeletally supported stereolithographic surgical templates. , 2014, Clinical implant dentistry and related research.

[58]  R. Jacobs,et al.  Accuracy of a Dedicated Bone-Supported Surgical Template for Dental Implant Placement with Direct Visual Control. , 2015, Journal of healthcare engineering.

[59]  Michele Cassetta,et al.  Accuracy of positioning of implants inserted using a mucosa-supported stereolithographic surgical guide in the edentulous maxilla and mandible. , 2014, The International journal of oral & maxillofacial implants.

[60]  M. Cassetta,et al.  Accuracy of a computer-aided implant surgical technique. , 2013, The International journal of periodontics & restorative dentistry.

[61]  M. Lorenzoni,et al.  Three-dimensional accuracy of guided implant placement: indirect assessment of clinical outcomes. , 2013, Clinical implant dentistry and related research.

[62]  Su-Gwan Kim,et al.  Clinical problems of computer-guided implant surgery , 2016, Maxillofacial Plastic and Reconstructive Surgery.