Computer technology applications in surgical implant dentistry: a systematic review.

PURPOSE To assess the literature on the accuracy and clinical performance of static computer-assisted implant surgery in implant dentistry. MATERIALS AND METHODS Electronic and manual literature searches were applied to collect information about (1) the accuracy and (2) clinical performance of static computer-assisted implant systems. Meta-regression analysis was performed to summarize the accuracy studies. Failure/complication rates were investigated using a generalized linear mixed model for binary outcomes and a logit link to model implant failure rate. RESULTS From 2,359 articles, 14 survival and 24 accuracy studies were included in this systematic review. Nine different static image guidance systems were involved. The meta-analysis of the accuracy (24 clinical and preclinical studies) revealed a total mean error of 1.12 mm (maximum of 4.5 mm) at the entry point measured in 1,530 implants and 1.39 mm at the apex (maximum of 7.1 mm) measured in 1,465 implants. For the 14 included survival studies (total of 1,941 implants) using static computer-assisted implant dentistry, the mean failure rate was 2.7% (0% to 10%) after an observation period of at least 12 months. In 36.4% of the treated cases, intraoperative or prosthetic complications were reported, which included: template fractures during the surgery, change of plan because of factors such as limited primary implant stability, need for additional grafting procedures, prosthetic screw loosening, prosthetic misfit, and prosthesis fracture. CONCLUSION Different levels of quantity and quality of evidence were available for static computer-assisted implant placement, with tight-fitting high implant survival rates after only 12 months of observation in different indications achieving a variable level of accuracy. Future long-term clinical data are necessary to identify clinical indications; detect accuracy; assess risk; and justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.

[1]  H. De Bruyn,et al.  A prospective study on implants installed with flapless-guided surgery using the all-on-four concept in the mandible. , 2013, Clinical oral implants research.

[2]  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.

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

[4]  Franz Kainberger,et al.  Computer-enhanced stereoscopic vision in a head-mounted display for oral implant surgery. , 2002, Clinical oral implants research.

[5]  J E Zöller,et al.  Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites. , 2001, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[6]  Daniel Wismeijer,et al.  Computer-guided implant placement: 3D planning software, fixed intraoral reference points, and CAD/CAM technology. A case report. , 2009, The International journal of oral & maxillofacial implants.

[7]  Werner Jaschke,et al.  In vitro accuracy of a novel registration and targeting technique for image-guided template production. , 2005, Clinical oral implants research.

[8]  Silvio Mario Meloni,et al.  Implant treatment software planning and guided flapless surgery with immediate provisional prosthesis delivery in the fully edentulous maxilla. A retrospective analysis of 15 consecutively treated patients. , 2010, European journal of oral implantology.

[9]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[10]  Thomas J Balshi,et al.  Guided Implant Placement and Immediate Prosthesis Delivery Using Traditional Brånemark System Abutments: A Pilot Study of 23 Patients , 2008, Implant dentistry.

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

[12]  J E Zöller,et al.  Comparison of static and dynamic computer-assisted guidance methods in implantology. , 2006, International journal of computerized dentistry.

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

[14]  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.

[15]  A. Zangerl,et al.  Comparison of the accuracy of invasive and noninvasive registration methods for image-guided oral implant surgery. , 2010, The International journal of oral & maxillofacial implants.

[16]  Márcio Macedo Soares,et al.  An in vitro model to evaluate the accuracy of guided surgery systems. , 2012, The International journal of oral & maxillofacial implants.

[17]  Renaud Noharet,et al.  Guided surgery and presurgical prosthesis: preliminary results of 33 fully edentulous maxillae treated in accordance with the NobelGuide protocol. , 2008, Clinical implant dentistry and related research.

[18]  Jean Loup Coudert,et al.  Reliability of preoperative planning of an image-guided system for oral implant placement based on 3-dimensional images: an in vivo study. , 2003, The International journal of oral & maxillofacial implants.

[19]  Reinhilde Jacobs,et al.  State-of-the-art on cone beam CT imaging for preoperative planning of implant placement , 2006, Clinical Oral Investigations.

[20]  Georg Eggers,et al.  Accuracy of image-guided implantology. , 2005, Clinical oral implants research.

[21]  M. Zwahlen,et al.  A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth--implant-supported FPDs. , 2004, Clinical oral implants research.

[22]  Franz Kainberger,et al.  Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy. , 2003, Clinical oral implants research.

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

[24]  G Schultes,et al.  Navigational precision of drilling tools preventing damage to the mandibular canal. , 2001, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[25]  Computer-guided flapless transmucosal implant placement in the mandible: a new combination of two innovative techniques. , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[26]  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.

[27]  Franz Kainberger,et al.  Evaluation of accuracy of computer-aided intraoperative positioning of endosseous oral implants in the edentulous mandible. , 2002, Clinical oral implants research.

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

[29]  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.

[30]  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.

[31]  Hans Nilson,et al.  Digitally planned, immediately loaded dental implants with prefabricated prostheses in the reconstruction of edentulous maxillae: a 1-year prospective, multicenter study. , 2009, Clinical implant dentistry and related research.

[32]  David P Sarment,et al.  Advanced Surgical Guidance Technology: A Review , 2006, Implant dentistry.

[33]  W. Birkfellner,et al.  Prospective randomized clinical comparison of 2 dental implant navigation systems. , 2007, The International journal of oral & maxillofacial implants.

[34]  Daniel Wismeijer,et al.  Parameters of passive fit using a new technique to mill implant-supported superstructures: an in vitro study of a novel three-dimensional force measurement-misfit method. , 2010, The International journal of oral & maxillofacial implants.

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

[36]  Jean Loup Coudert,et al.  An image-guided system-drilled surgical template and trephine guide pin to make treatment of completely edentulous patients easier: a clinical report on immediate loading. , 2004, Clinical implant dentistry and related research.

[37]  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.

[38]  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.

[39]  Michael Figl,et al.  Navigated flapless transmucosal implant placement in the mandible: a pilot study in 20 patients. , 2007, The International journal of oral & maxillofacial implants.

[40]  P. Cattin,et al.  Accuracy of full guided vs. half-guided implant surgery. , 2013, Clinical oral implants research.

[41]  Günter Schultes,et al.  Assessment of accuracy of navigated implant placement in the maxilla. , 2002, The International journal of oral & maxillofacial implants.

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

[43]  M. Quirynen,et al.  E.A.O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. , 2012, Clinical oral implants research.

[44]  Rikard Söderberg,et al.  Accuracy of CAD/CAM-guided surgical template implant surgery on human cadavers: Part I. , 2010, The Journal of prosthetic dentistry.

[45]  Stephan Eitner,et al.  Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates. , 2007, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[46]  R. Pagnoncelli,et al.  Transference of virtual planning and planning over biomedical prototypes for dental implant placement using guided surgery. , 2010, Clinical oral implants research.

[47]  I. Hozo,et al.  Estimating the mean and variance from the median, range, and the size of a sample , 2005, BMC medical research methodology.

[48]  M. Chiapasco,et al.  Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. , 2006, Clinical oral implants research.

[49]  Werner Jaschke,et al.  Use of a surgical navigation system for CT-guided template production. , 2007, The International journal of oral & maxillofacial implants.

[50]  Shinichi Yamada,et al.  Application of virtual reality force feedback haptic device for oral implant surgery. , 2006, Clinical oral implants research.

[51]  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.

[52]  Bjarni E Pjetursson,et al.  A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. , 2004, Clinical oral implants research.

[53]  Daniel Wismeijer,et al.  Reference-based digital concept to restore partially edentulous patients following an immediate loading protocol: a pilot study. , 2011, The International journal of oral & maxillofacial implants.

[54]  Abbas Azari,et al.  Custom-made radiographic template, computed tomography, and computer-assisted flapless surgery for treatment planning in partial edentulous patients: a prospective 12-month study. , 2010, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[55]  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.

[56]  R. Jung,et al.  A systematic review of the survival of implants in bone sites augmented with barrier membranes (guided bone regeneration) in partially edentulous patients. , 2002, Journal of clinical periodontology.

[57]  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.

[58]  Michael Schneider,et al.  Accuracy assessment of image-guided implant surgery: an experimental study. , 2005, The International journal of oral & maxillofacial implants.

[59]  W. Luk,et al.  Three-dimensional accuracy of implant placement in a computer-assisted navigation system. , 2006, The International journal of oral & maxillofacial implants.

[60]  S. Thompson,et al.  How should meta‐regression analyses be undertaken and interpreted? , 2002, Statistics in medicine.

[61]  T. van de Velde,et al.  The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. , 2010, Clinical oral implants research.

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

[63]  Volkan Arısan,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. , 2013, Clinical implant dentistry and related research.

[64]  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.

[65]  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.

[66]  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.

[67]  Volkan Arısan,et al.  Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study. , 2010, Journal of periodontology.

[68]  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.

[69]  David Schneider,et al.  Computer technology applications in surgical implant dentistry: a systematic review. , 2009, The International journal of oral & maxillofacial implants.

[70]  Bjarni E Pjetursson,et al.  A systematic review of the 5-year survival and complication rates of implant-supported single crowns. , 2008, Clinical oral implants research.

[71]  Joachim Mühling,et al.  Computer-guided insertion of dental implants - a clinical evaluation , 2001, CARS.

[72]  Gwen Swennen,et al.  Navigated vs. conventional implant insertion for maxillary single tooth replacement. , 2004, Clinical oral implants research.

[73]  S. Barter.  Computer-aided implant placement in the reconstruction of a severely resorbed maxilla-a 5-year clinical study. , 2010, The International journal of periodontics & restorative dentistry.

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

[75]  Gary P. Orentlicher,et al.  Application and success of two stereolithographic surgical guide systems for implant placement with immediate loading. , 2012, The International journal of oral & maxillofacial implants.

[76]  M. Zwahlen,et al.  A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. , 2004, Clinical oral implants research.

[77]  A. Wagner,et al.  Computer-guided flapless placement and immediate loading of four conical screw-type implants in the edentulous mandible. , 2007, Clinical oral implants research.

[78]  Ai Komiyama,et al.  Treatment outcome of immediately loaded implants installed in edentulous jaws following computer-assisted virtual treatment planning and flapless surgery. , 2008, Clinical oral implants research.

[79]  Carmen Pomares,et al.  A retrospective study of edentulous patients rehabilitated according to the 'all-on-four' or the 'all-on-six' immediate function concept using flapless computer-guided implant surgery. , 2010, European journal of oral implantology.

[80]  Jörg Neugebauer,et al.  Accuracy of a newly developed integrated system for dental implant planning. , 2009, Clinical oral implants research.

[81]  R Jacobs,et al.  Accuracy of computer-aided implant placement. , 2012, Clinical oral implants research.