Accuracy of an autonomous dental implant robotic system in partial edentulism: A pilot clinical study.

OBJECTIVES: Robots are increasingly being used for surgical procedures in various specialties. However, information about the accuracy of robot-assisted dental implant surgery is lacking. This pilot clinical study aimed to investigate the accuracy of an autonomous dental implant robotic (ADIR) system in partially edentulous cases. MATERIAL AND METHODS: The ADIR system was used to place a total of 20 implants in 13 participants. Implant deviation from the planned positions was assessed to determine accuracy. The entry, apex, and angular deviations were described as means ± standard deviation. A two-sample t test was used to compare implant deviation between the flap and flapless groups and between maxillary and mandibular implants (α = .05). RESULTS: The entry, apex, and angular deviations were 0.65 ± 0.32 mm, 0.66 ± 0.34 mm, and 1.52 ± 1.01°, respectively, with no statistically significant difference between the flap and flapless approaches (P > .05). No adverse events were encountered in any of the participants. CONCLUSIONS: DIR accuracy in this clinical series was comparable to that reported for static and dynamic computer-assisted implant surgery. Robotic computer-assisted implant surgery may be useful for dental implant placement, potentially improving the quality and safety of the procedure. CLINICAL RELEVANCE: The findings of this study showed that the ADIR system could be useful for dental implant surgery.

Robot-assisted surgery for dental implant placement: A narrative review.

OBJECTIVE: To determine the current status and accuracy of robotic computer-assisted implant surgery (CAIS) applications by examining the associated clinical and experimental outcomes. DATA AND SOURCES: PubMed, Medline, and Cochrane Library databases were searched for relevant studies published between January 2000 and November 2023, and focusing on robotic CAIS in dental implant surgery. All search results were then manually reviewed to identify only the pertinent articles. Only in vitro and clinical studies were included in this narrative review, with implant placement accuracy considered the main outcome. RESULT: Based on our inclusion and exclusion criteria, we included 21 studies (with 1085 implant sites); of them, 8 were clinical studies, 12 were in vitro studies, and 1 included both an in vitro study and a case series. The ranges of the mean implant shoulder, apical, and angular deviations were respectively 0.43-1.04 mm, 0.53-1.06 mm, and 0.77°-3.77° in the clinical studies and 0.23-1.04 mm, 0.24-2.13 mm, and 0.43°-3.78° in the in vitro studies, respectively. CONCLUSION: The accuracy of robotic CAIS in dental implant procedures appears to be within the clinically acceptable ranges. However, further relevant clinical trials validating the existing evidence are needed. CLINICAL SIGNIFICANCE: Robotic CAIS can achieve clinically acceptable implant placement accuracy. This innovative technology may improve the precision and success rates of dental implant procedures, with benefit for surgeons and patients.

Modified Suture Technique for Stabilization of Connective Tissue Graft in Immediate Implant Placement and Provisionalization: A Short Technical Report.

Immediate implant placement and provisionalization with subepithelial connective tissue graft is considered the reference therapy for achieving a good esthetic outcome, especially in cases with a thin periodontal phenotype. Positioning sutures are usually required to maintain graft stability. This article describes the use of a modified suture technique involving vertical/horizontal double-parallel mattress sutures in immediate implant placement to achieve stable passive fixation of the graft in the appropriate position and to provide a more equal distribution of tension in the wound. A novel, simplified, reproducible technique is described in two cases of immediate implant placement and provisionalization with subepithelial connective tissue grafting and double-parallel mattress sutures.

Classification of premolars sagittal root position and angulation for immediate implant placement: a cone beam computed tomography study.

OBJECTIVES: Sagittal root position (SRP) and buccal plate thickness are important considerations in implant treatment planning. The objective of this study was to classify the relationship of the SRP and angulation to the osseous housing to assist treatment plan making for immediate implant placement in the premolar region. STUDY DESIGN: We classified the SRP and angulations of the maxillary and mandibular premolars and measured the buccal plate thickness of 150 patients using cone beam computed tomography to support clinical decision making. RESULTS: Regarding SRP types, 41.67%, 51.83%, 3.67%, and 2.83% of maxillary premolars and 84.33%, 15%, 0%, and 0.67% of mandibular premolars were classified as types B, M, L, and N, respectively. In terms of angulation, 20.83%, 46%, 32.17%, and 1% of maxillary premolars and 2%, 5.33%, 36.67%, and 56% of mandibular premolars were grouped into classes 1, 2, 3, and 4, respectively. The buccal bone thickness at most locations in premolar regions was <1 mm. CONCLUSIONS: The classification of SRP and angulation will assist in treatment plan making for immediate implant placement in the premolar region.

Short Implants versus Longer Implants with Sinus Floor Elevation: A Systemic Review and Meta-Analysis of Randomized Controlled Trials with a Post-Loading Follow-Up Duration of 5 Years.

This study compared the outcome of fixed prostheses supported by short implants (<8 mm) and longer implants (≥8 mm) with an elevated sinus floor after 5 years of follow-up. The literature searches were performed electronically and manually in PubMed, EMBASE, and Web of Science databases to identify relevant articles published from 1 January 2013 to 31 January 2020. We selected eligible studies using inclusion criteria and assessed their quality. From 1688 identified studies, five randomized controlled trials were included. Between the short implant group and the control group, the implant failure-related pooled risk ratio (RR) was 3.64 (p = 0.07). The RR for technical complications was 2.61 (p = 0.0002), favoring longer implants. Marginal peri-implant bone loss after 1 and 5 years of function showed statistically significant less bone loss at short implants (1 year: mean difference = 0.21 mm; p < 0.00001; 5 years: mean difference = 0.26 mm; p = 0.02). The implant failure and the biological failure of both groups were similar after 5 years of follow-up. Short implants could be an alternative to long implants with an elevated sinus floor for atrophic maxillae in aging populations. Studies with larger trials and longer periods of follow-up (10 years) remain essential.

Vertical Deviation Caused by Tightening Torque on Implant Scan Body: An In Vitro Study.

PURPOSE: This study evaluated the effects of manipulator level (ML) on implant scan body (ISB) seating. It also investigated ISB vertical deviation with various levels of tightening torque. MATERIALS AND METHODS: In total, 10 standard acrylic resin models were prepared with the implant on the first molar site. ISBs were placed on the models by six operators with three MLs, manually and with a torque of 15 Ncm using an electronic torque driver. Digital scans were completed with an intraoral scan device. After superimposition in the software, ISB vertical deviation was compared between the 15 Ncm torque level and manual operation. One experienced operator then placed the ISB with different torque levels (20, 25, 30, and 35 Ncm) using an electronic torque driver. The ISB vertical deviation was also compared among torque levels. Vertical deviations within ML were analyzed using one-way analysis of variance (ANOVA). One-way repeated measures ANOVA was used to analyze the differences between torque levels (α = .05). RESULTS: ISB vertical deviations differed among MLs (P < .01). Significant vertical deviations were observed between 20 and 30 Ncm (P < .01), 20 and 35 Ncm (P < .05), and 25 and 35 Ncm (P < .05). The largest estimated marginal mean was 13.5 ± 4.11 µm with a torque of 35 Ncm. CONCLUSION: Significant differences in ISB vertical deviation were observed according to MLs and tightening torque levels. The amounts of those deviations did not exceed the previously described occlusal threshold.

Comparison of Implant Placement Accuracy in Healed and Fresh Extraction Sockets between Static and Dynamic Computer-Assisted Implant Surgery Navigation Systems: A Model-Based Evaluation.

The aim of this model-base study was to compare the accuracy of implant placement between static and dynamic computer-assisted implant surgery (CAIS) systems in a fresh extraction socket and healed ridge. A randomized in vitro study was conducted. Twenty 3D-printed maxillary models and 80 implants were used. One experienced researcher placed the implants using either the static navigation or dynamic navigation system. Accuracy was measured by overlaying the real position in the postoperative CBCT on the virtual presurgical placement of the implant in a CBCT image. Descriptive and bivariate analyses of the data were performed. In the fresh sockets, the mean deviation was 1.24 ± 0.26 mm (entry point), 1.69 ± 0.34 mm (apical point), and 3.44 ± 1.06° (angle discrepancy) in the static CAIS group, and 0.60 ± 0.29 mm, 0.78 ± 0.33 mm, and 2.47 ± 1.09° in the dynamic CIAS group, respectively. In the healed ridge, the mean deviation was 1.09 ± 0.17 mm and 1.40 ± 0.30 mm, and 2.12 ± 1.11° in the static CAIS group, and 0.80 ± 0.29 mm, 0.98 ± 0.37 mm, and 1.69 ± 0.76° in the dynamic CIAS group, respectively. Compared with the static CAIS system, the dynamic CAIS system resulted in significantly lower entry and apical errors in both fresh sockets and healed ridges. Differences in bone morphology therefore seem to have little effect on accuracy in the dynamic CAIS group.

Effectiveness of acellular dermal matrix graft with a coronally advanced flap for the treatment of Miller Class I/II single gingival recession with thin gingival phenotype: study protocol for a split-mouth randomised controlled trial.

INTRODUCTION: Gingival recession is one of the most common mucogingival deformities requiring surgical correction. The American Academy of Periodontology Regeneration Workshop recommended connective tissue graft (CTG) combined with coronally advanced flap (CAF) for the treatment of Miller Class I and II single-tooth gingival recession. The disadvantages of harvesting autogenous tissue include postoperative bleeding, pain and discomfort at the donor site, restricted tissue supply, increased morbidity and prolonged operative times. Acellular dermal matrix (ADM) contains undamaged collagen and elastin matrices that can be used as a substitute for CTG during root coverage procedures. However, the use of ADM is still controversial. The objective of this split-mouth; randomised, controlled, clinical study is to evaluate the long-term effects of ADM graft (ADMG) combined with CAF on root coverage, aesthetics and patient satisfaction for the treatment of single gingival recession with thin gingival phenotype. METHODS AND ANALYSIS: Forty participants with bilateral Miller Class I/II gingival recession will be randomised to receive an ADMG on one side and CTG on the contralateral side, combined with CAF. Gingival recession depth, gingival recession width and keratinised tissue width will be measured at baseline, 2 weeks and 1, 3, 6, 12 and 24 months. Mean root coverage, complete root coverage, root coverage aesthetic score, colour change (∆E) and patient satisfaction will be assessed during follow-up visits. ETHICS AND DISSEMINATION: The present study has received approval from the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-202054029). Data of this study will be registered with the International Clinical Trials Registry Platform. Additionally, we will disseminate the results through scientific journal. TRIAL REGISTRATION NUMBER: ChiCTR2000033230.

Digital workflow for prosthetically driven implant navigation surgery in a fully edentulous patient: a case report.

BACKGROUND: Dynamic navigation has important potential advantages over the static approach for fully edentulous patients. To the best of the authors' knowledge, this is the first published case report describing the use of a dynamic implant navigation technique for a fully edentulous patient. CASE REPORT: A 55-year-old female presented for the replacement of missing teeth. Treatment with an implant-supported fixed dental prosthesis was proposed. A digital navigation implant surgery/immediate provisionalization protocol was used. An acrylic resin denture was fabricated as a radiographic guide. Digital data were obtained through the double scan technique, and a prosthetically driven 3D implant positioning was designed. Four titanium mini screws were inserted into the mandible for registration. The first implant was inserted in a freehand manner and attached to a patient tracker. After calibration and registration, the navigation system was set up. The other five implants were inserted using the navigation system. The procedure followed for the maxilla was similar. After surgery, a loading procedure was performed within 24 h. RESULTS: Following implant placement, a postoperative CBCT scan was performed. The results showed that all implants were placed precisely, in accordance with the treatment plan. CONCLUSION: From the results obtained it appears that a fully digital workflow for prosthetically driven implant navigation surgery is suitable for the treatment of fully edentulous patients requiring an implant-supported fixed restoration. High-level evidence is needed to determine the accuracy and precision of this workflow.

Evaluation of a dynamic navigation system for training students in dental implant placement.

OBJECTIVE: Computer-guided simulation systems may offer a novel training approach in many surgical fields. This study aimed to compare dental students' learning progress in dental implants placement between a dynamic navigation system and a traditional training method using a simulation model. METHODS: Senior dental students with no implant placement experience were randomly assigned to implant placement training using a dynamic navigation system or a traditional freehand protocol. After training, 3-dimensional (3D) deviation at implant platform, 3D deviation at implant apex, and deviation of implant axis between the planned and placed implant positions were measured using superimposed cone beam computed tomography scans. RESULTS: Six students were trained in this study. Students showed significantly greater improvement in implant placement after training using the dynamic navigation system than after using the traditional freehand protocol. Overall deviation of implant axis (P < 0.001) and 3D apex deviation (P = 0.014) improved with training using the dynamic navigation system, but differences in 3D platform deviation (P = 0.513) were not statistically significant. CONCLUSIONS: A dynamic navigation system may be a useful teaching tool in the early development of clinical skills in implant placement for the novice practitioners. Novice practitioners exhibited significant improvement in angulation deviation across implant placement attempts with dynamic navigation system training.

[Comparative analysis of two surgical techniques for controlling nasal width after Le Fort I osteotomy].

OBJECTIVE: To compare the efficacy of two surgical techniques for controllong nasal width after Le Fort I osteotomy. METHODS: Fifty-five patients who received the Le Fort I osteotomy have been included in this study. They were randomly divided into 2 groups. The experimental group received extraoral ABS, and the control group received traditional intraoral ABS. 3D photos of the patient's face were taken before operation and at postoperative 3 months. Alar width was measured on the 3D photos. Data was reported as means and standard deviations, and statistic analysis was done by using student t test. RESULTS: Compared with presurgical data, G. lat-G. lat increased by (2.66 +/- 1.47) mm, Al-Al increased by (2.20 +/- 1.22) mm and Sbal-Sbal increased by (1.30 +/- 1.33) mm in experimental group. G. lat-G. lat increased by (1.38 +/- 1.29) mm, Al-Al increased by (1.06 +/- 0.95) mm and Sbal-Sbal increased by (0.36 +/- 1.33) mm in the control group. There was significant difference between two groups. CONCLUSIONS: The surgical technique of ABS is the most important factor for determining the postoperative alar width. Both techniques have better effect on the Sbal-Sbal width control than the G. lat-G. lat and Al-Al width control. Traditional intraoral ABS can more effectively control the alar width. Both techniques cannot completely control the alar base widening after Le Fort I osteotomy.