Influence of augmented reality technique on the accuracy of autotransplanted teeth in surgically created sockets.

BACKGROUND: The objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth. MATERIALS AND METHODS: Forty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student's t-test and Mann-Whitney non-parametric statistical analysis were used to analyze the results. RESULTS: No statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different. CONCLUSION: The augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Digital technique to analyze the wear of screw-retained implant supported metal-ceramic dental prostheses and natural tooth as antagonist: a pilot study.

The aim of this study was to describe a novel digital technique to analyze the wear of screw-retained implant-supported metal-ceramic dental prostheses and natural tooth as antagonist.Materials and methods Ten patients were consecutively included to rehabilitate partial edentulism by dental implants. Both the screw-retained implant-supported metal-ceramic dental prostheses and the natural tooth as antagonist were submitted to a digital impression through an intraoral scan to generate a Standard Tessellation Language digital file preoperatively (STL1), at 3 months (STL2), and 6 months (STL3) follow-up. Afterwards, an alignment procedure of the digital files (STL1-STL3) was performed on a reverse engineering morphometric software (3D Geomagic Capture Wrap) and volume changes at the screw-retained implant-supported metal-ceramic dental prostheses and the natural tooth as antagonist were analyzed using Student's t-test. Moreover, Gage R&R statistical analysis was conducted to analyze the repeatability and reproducibility of the digital technique.Results Gage R&R showed a variability attributable to the digital technique of 3.8% (among the measures of each operator) and 4.5% (among operators) of the total variability; resulting repeatable and reproducible, since the variabilities were under 10%. In addition, statistically significant differences were shown at the wear volume (µm3) of both the natural tooth as antagonist (p < 0.0001) and the screw-retained implant-supported metal-ceramic dental prostheses between 3- and 6-months follow-up (p = 0.0002).Conclusion The novel digital measurement technique results repeatable and reproducible to analyze the wear of screw-retained implant-supported metal-ceramic dental prostheses and natural tooth as antagonist.

Influence of parallel pins on the angle deviation for placement of dental implants: an in vitro study.

The aim of the present study was to analyze and compare the angle deviation of two, four and six adjacent dental implants placed with and without straight parallel pins. MATERIALS AND METHODS: Two hundred and forty (240) dental implants were selected and randomly allocated into the following study groups: Two dental implants placed with straight parallel pins (Ref.: 144-100, BioHorizons, Birmingham, AL, USA) (n = 10) (2PP); Two dental implants placed without parallel pins (n = 10) (2withoutPP); Four dental implants placed with straight parallel pins hT(n = 10) (4PP); Four dental implants placed without parallel pins (n = 10) (4withoutPP); Six dental implants placed with straight parallel pins (n = 10) (6PP) and Six dental implants placed without parallel pins (n = 10) (6withoutPP). The dental implants randomly assigned to groups 2PP and 2withoutPP were placed into standardized polyurethane models of partially edentulous upper jaws in tooth positions 2.4 and 2.6, the dental implants randomly assigned to groups 4PP and 4withoutPP were placed into standardized polyurethane models of fully edentulous upper jaws in tooth positions 1.6, 1.4, 2.4 and 2.6, and the dental implants randomly assigned to groups 6PP and 6withoutPP were placed into standardized polyurethane models of fully edentulous upper jaws in tooth positions 1.6, 1.4, 1.2, 2.2, 2.4 and 2.6. Afterwards, postoperative CBCT scans and digital impressions were aligned in a 3D implant-planning software to compare the angle deviation (°) of two, four and six adjacent dental implants placed with and without straight parallel pins using the General Linear Model statistical analysis. RESULTS: Statistically significant differences were found between the angle deviation of 2 dental implants placed with straight parallel pins (p < 0.0001) and between the angle deviation of 4 dental implants placed with straight parallel pins (p = 0.0024); however, no statistically significant differences were found in the angle deviation of 6 dental implants placed with straight parallel pins (p = 0.9967). CONCLUSION: The use of a straight parallelization pin results in lower angle deviation between two and four adjacent dental implants; however, it is not effective for a larger number of dental implants.

Comparative analysis of two navigation techniques based on augmented reality technology for the orthodontic mini-implants placement.

To analyze and compare the accuracy and root contact prevalence, comparing a conventional freehand technique and two navigation techniques based on augmented reality technology for the orthodontic self-drilling mini-implants placement. Methods Two hundred and seven orthodontic self-drilling mini-implants were placed using either a conventional freehand technique (FHT) and two navigation techniques based on augmented reality technology (AR TOOTH and AR SCREWS). Accuracy across different dental sectors was also analyzed. CBCT and intraoral scans were taken both prior to and following orthodontic self-drilling mini-implants placement. The deviation angle and horizontal were then analyzed; these measurements were taken at the coronal entry point and apical endpoint between the planned and performed orthodontic self-drilling mini-implants. In addition, any complications resulting from mini-implant placement, such as spot perforations, were also analyzed across all dental sectors.Results The statistical analysis showed significant differences between study groups with regard to the coronal entry-point (p < 0.001), apical end-point(p < 0.001) and angular deviations (p < 0.001). Furthermore, statistically significant differences were shown between the orthodontic self-drilling mini-implants placement site at the coronal entry-point (p < 0.0001) and apical end-point (p < 0.001). Additionally, eight root perforations were observed in the FHT group, while there were no root perforations in the two navigation techniques based on augmented reality technology.Conclusions The navigation techniques based on augmented reality technology has an effect on the accuracy of orthodontic self-drilling mini-implants placement and results in fewer intraoperative complications, comparing to the conventional free-hand technique. The AR TOOTH augmented reality technique showed more accurate results between planned and placed orthodontic self-drilling mini-implants, comparing to the AR SCREWS and conventional free-hand techniques. The navigation techniques based on augmented reality technology showed fewer intraoperative complications, comparing to the conventional free-hand technique.

Accuracy of computer-aided static and dynamic navigation systems in the placement of zygomatic dental implants.

BACKGROUND: Zygomatic implants are widely used in the rehabilitation of severely atrophic maxillae, but implant placement is not without risks, and it can potentially cause damage to related anatomical structures. The aim of this study was to perform a comparative analysis of the accuracy of static navigation systems in placing zygomatic dental implants in comparison to dynamic navigation systems. METHODS: Sixty zygomatic dental implants were randomly allocated to one of three study groups, categorized by which implant placement strategy was used: A: computer-aided static navigation system (n = 20) (GI); B: computer-aided dynamic navigation system (n = 20) (NI); or C: free-hand technique (n = 20) (FHI). For the computer-aided study groups, a preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed in order to plan the approach to be used during surgery. Four zygomatic dental implants were inserted in each of fifteen polyurethane stereolithographic models (n = 15), with a postoperative CBCT scan taken after the intervention. The pre- and postoperative CBCT scans were then uploaded to a software program used in dental implantology to analyze the angular deviations, apical end point, and coronal entry point. Student's t-test was used to analyze the results. RESULTS: The results found statistically significant differences in apical end-point deviations between the FHI and NI (p = 0.0053) and FHI and GI (p = 0.0004) groups. There were also statistically significant differences between the angular deviations of the FHI and GI groups (p = 0.0043). CONCLUSIONS: The manual free-hand technique may enable more accurate placement of zygomatic dental implants than computer-assisted surgical techniques due to the different learning curves required for each zygomatic dental implant placement techniques.

Effect of the computer-aided static navigation technique on the accuracy of bicortical mini-implants placement site for maxillary skeletal expansion appliances: an in vitro study.

The objective of the present study was to evaluate and compare the effect of the computer-aided static navigation technique on the accuracy of the maxillary skeletal expansion (MSE) appliances. MATERIAL AND METHODS: Forty orthodontic self-drilling mini-implants were placed in ten anatomically based standardized polyurethane models of a completely edentulous upper maxilla, manufactured using a 3D impression procedure. The four orthodontic self-drilling mini-implants for anchoring the MSE appliance were digitally planned on 3D planning software, based on preoperative cone-beam computed tomography (CBCT) scan and a 3D extraoral surface scan. Afterwards, the surgical templates were virtually planned and manufactured using stereolithography. Subsequently, the orthodontic self-drilling mini-implants were placed an postoperative CBCT scans were performed. Finally, coronal entry-point, apical end-point and angular deviations were calculated using a t-test for independent samples or a non-parametric Signed Rank test. RESULTS: Statistically significant differences were not shown at coronal entry-point (p = 0.13), apical end-point (p = 0.41) and angular deviations (p = 0.27) between the planned and performed orthodontic self-drilling mini-implants. CONCLUSIONS: Computer-aided static navigation technique enables accurate orthodontic mini-implant placement for the MSE appliances.

Accuracy of zygomatic dental implant placement using computer-aided static and dynamic navigation systems compared with a mixed reality appliance. An in vitro study.

Background: Analyze and compare the accuracy of zygomatic dental implant placement carried out using a static navigation surgery, a dynamic navigation surgery and an augmented reality appliance. Material and Methods: Eighty (80) zygomatic dental implants were randomly assigned to one of four study groups: A: static navigation implant surgery (n = 20) (GI); B: dynamic navigation implant surgery (n = 20) (NI); C: augmented reality appliance implant placement (n = 20) (ARI) and D: free hand technique (n = 20) (FHI). A preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed to plan the surgical approach for the computer assisted implant surgery study groups. Four zygomatic dental implants were placed in anatomical-based polyurethane models (n = 20) manufactured by stereolithography, and a postoperative CBCT scan was taken. Subsequently, the preoperative planning and postoperative CBCT scans were uploaded to dental implant software to analyze the coronal global, apical global, and angular deviations. Results were analyzed using linear regression models with repeated measures to assess the differences according to the group, according to the position, and the interaction between both variables. If statistically significant differences were detected, 2-to-2 comparisons were made between the groups/positions. Results: The results did not show statistically significant differences between the coronal global deviations of GI (5.54 ± 1.72 mm), NI (5.43 ± 2.13 mm), ARI (5.64 ± 1.11 mm) and FHI (4.75 ± 1.58 mm). However, showed statistically significant differences between the apical global deviations of FHI (3.20 ± 1.45 mm) and NI (4.92 ± 1.89 mm) (p = 0.0078), FHI and GI (5.33 ± 2.14 mm) (p = 0.0005) and FHI and ARI (4.88 ± 1.54 mm) (p = 0.0132). In addition, the results showed also statistically significant differences between the angular deviations of FHI (8.47º ± 4.40º) and NI (7.36º ± 4.12º) (p = 0.0086) and between GI (5.30º ± 2.80º) and ARI (9.60º ± 4.25º) (p = 0.0005). Conclusions: Free-hand technique provides greater accuracy of zygomatic dental implant placement than computer-assisted implant surgical techniques, and zygomatic dental implants placed in the anterior region are more accurate than in the posterior region. However, it is an in vitro study and further clinical studies must be conducted to extrapolate the results to the clinical setting. Key words:Implantology, computer assisted implant surgery, image-guided surgery, augmented reality, navigation surgery, zygomatic implants.

Removal capability, implant-abutment connection damage and thermal effect using ultrasonic and drilling techniques for the extraction of fractured abutment screws: an in vitro study.

The aim of this work was to analyze and compare the removal capability, conical internal hex implant-abutment connection damage and thermal effect using ultrasonic and drilling techniques for the extraction of fractured abutment screws. Twenty abutment screws were randomly fractured into twenty dental implants and randomly extracted using the following removal techniques: Group A: drilling technique without irrigation (n = 10) (DT) and Group B: ultrasonic technique without irrigation (n = 10) (UT). The dental implants were submitted to a preoperative and postoperative micro-computed tomography (micro-CT) scan to obtain a Standard Tessellation Language (STL) digital file that determined the wear comparison by morphometry. Moreover, the thermographic effects generated by the DT and UT removal techniques were registered using a thermographic digital camera. Comparative analysis was performed by comparing the volumetric differences (mm3) between preoperative and postoperative micro-CT scans and thermographic results (°C) using the Student t test. The DT extracted 8/10 and the US 9/10 abutment screws. The pairwise comparison revealed statistically significant differences between the volumetric differences of postoperative and preoperative micro-CT scans of the DT (- 0.09 ± - 0.02mm3) and UT (- 0.93 ± - 0.32mm3) study groups (p = 0.0042); in addition, the pairwise comparison revealed statistically significant differences between the thermographic values of the DT (38.12 ± - 10.82 °C) and UT (78.52 ± 5.43 °C) study groups (p < 0.001). The drilling technique without irrigation provides a less removal capability, less conical internal hex implant-abutment connection damage and less thermal effect than ultrasonic technique for the extraction of fractured abutment screws; however, the ultrasonic technique resulted more effective for the extraction of fractured abutment screws.

Accuracy of Endodontic Access Cavities Performed Using an Augmented Reality Appliance: An In Vitro Study.

INTRODUCTION: The purpose of this study was to compare and contrast the accuracy of endodontic access cavities created using an augmented reality appliance to those performed using the conventional technique. MATERIALS AND METHODS: 60 single-rooted anterior teeth were chosen for study and randomly divided between two study groups: Group A-endodontic access cavities created using an augmented reality appliance as a guide (n = 30) (AR); and Group B-endodontic access cavities performed with the manual (freehand) technique (n = 30) (MN). A 3D implant planning software was used to plan the endodontic access cavities for the AR group, with a cone-beam computed tomography (CBCT) and 3D intraoral surface scan taken preoperatively and subsequently transferred to the augmented reality device. A second CBCT scan was taken after performing the endodontic access cavities to compare the planned and performed endodontic access for accuracy. Therapeutic planning software and Student's t-test were used to analyze the cavities at the apical, coronal, and angular levels. The repeatability and reproducibility of the digital measurement technique were analyzed using Gage R&R statistical analysis. RESULTS: The paired t-test found statistically significant differences between the study groups at the coronal (p = 0.0029) and apical (p = 0.0063) levels; no statistically significant differences were found between the AR and MN groups at the angular (p = 0.6596) level. CONCLUSIONS: Augmented reality devices enable the safer and more accurate performance of endodontic access cavities when compared with the conventional freehand technique.

Accuracy of a Computer-Aided Dynamic Navigation System in the Placement of Zygomatic Dental Implants: An In Vitro Study.

The objective of this in vitro study was to evaluate and compare the accuracy of zygomatic dental implant (ZI) placement carried out using a dynamic navigation system. Materials and Methods: Forty (40) ZIs were randomly distributed into one of two study groups: (A) ZI placement via a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)); and (B) ZI placement using a conventional free-hand technique (n = 20) (free-hand implant (FHI)). A cone-beam computed tomography (CBCT) scan of the existing situation was performed preoperatively to plan the surgical approach for the computer-aided study group. Four zygomatic dental implants were placed in anatomically based polyurethane models (n = 10) manufactured by stereolithography, and a postoperative CBCT scan was performed. Subsequently, the preoperative planning and postoperative CBCT scans were added to dental implant software to analyze the coronal entry point, apical end point, and angular deviations. Results were analyzed using the Student's t-test. Results: The results showed statistically significant differences in the apical end-point deviations between FHI and NI (p = 0.0018); however, no statistically significant differences were shown in the coronal entry point (p = 0.2617) or in the angular deviations (p = 0.3132). Furthermore, ZIs placed in the posterior region showed more deviations than the anterior region at the coronal entry point, apical end point, and angular level. Conclusions: The conventional free-hand technique enabled more accurate placement of ZIs than the computer-assisted surgical technique. In addition, placement of ZIs in the anterior region was more accurate than that in the posterior region.

Influence of Static Navigation Technique on the Accuracy of Autotransplanted Teeth in Surgically Created Sockets.

The aim of this study was to analyse and compare the position of single-rooted autotransplanted teeth using computer-aided SNT drilling and conventional freehand (FT) drilling, by comparing the planned and performed position at the coronal, apical and angular level. MATERIALS AND METHODS: Forty single-root upper teeth were selected and distributed into the following study groups: A. Autotransplanted tooth using the computer-aided static navigation technique (SNT) (n = 20) and B. Autotransplanted tooth using the conventional free-hand technique (FT) (n = 20). Afterwards, the teeth were embedded into two experimental models and 10 single-root upper teeth were randomly autotransplanted in each experimental model. The experimental models were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan, in addition to a postoperative CBCT scan, after the autotransplantation. Datasets from postoperative CBCT scans of the two study groups were uploaded to the 3D implant planning software, aligned with the autotransplantation planning, and the coronal, apical and angular deviations were measured. The results were analysed using Student's t-test and Mann-Whitney non-parametric statistical analysis. RESULTS: Coronal (p = 0.079) and angular (p = 0.208) statistical comparisons did not present statistically significant differences; however, statistically significant differences between the apical deviation of the SNT and FT study groups (p = 0.038) were also observed. CONCLUSIONS: The computer-aided static navigation technique does not provide higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Influence of the Computer-Aided Static Navigation Technique and Mixed Reality Technology on the Accuracy of the Orthodontic Micro-Screws Placement. An In Vitro Study.

To analyze the effect of a computer-aided static navigation technique and mixed reality technology on the accuracy of orthodontic micro-screw placement. Material and methods: Two hundred and seven orthodontic micro-screws were placed using either a computer-aided static navigation technique (NAV), a mixed reality device (MR), or a conventional freehand technique (FHT). Accuracy across different dental sectors was also analyzed. CBCT and intraoral scans were taken both prior to and following orthodontic micro-screw placement. The deviation angle and horizontal deviation were then analyzed; these measurements were taken at the coronal entry point and apical endpoint between the planned and performed orthodontic micro-screws. In addition, any complications resulting from micro-screw placement, such as spot perforations, were also analyzed across all dental sectors. Results: The statistical analysis showed significant differences between study groups with regard to the coronal entry-point (p < 0.001). The NAV study group showed statistically significant differences from the FHT (p < 0.001) and MR study groups (p < 0.001) at the apical end-point (p < 0.001), and the FHT group found significant differences from the angular deviations of the NAV (p < 0.001) and MR study groups deviations (p = 0.0011). Different dental sectors also differed significantly. (p < 0.001) Additionally, twelve root perforations were observed in the FHT group, while there were no root perforations in the NAV group. Conclusions: Computer-aided static navigation technique enable more accurate orthodontic micro-screw placement and fewer intraoperative complications when compared with the mixed reality technology and conventional freehand techniques.

A Comparative Analysis of the Piezoelectric Ultrasonic Appliance and Trephine Bur for Apical Location: An In Vitro Study.

To compare and contrast the accuracy of piezoelectric ultrasonic insert (PUI) and trephine bur (TB) osteotomy site preparation techniques for apical location. (1) Material and methods: A total of 138 osteotomy site preparations were randomly distributed into one of two study groups. Group A: TB technique (n = 69) and B: PUI technique (n = 69). A preoperative cone-beam computed tomography scan and an intraoral scan were performed and uploaded to implant-planning software to plan the virtual osteotomy site preparations for apical location. Subsequently, the osteotomy site preparations were performed in the experimental models with both osteotomy site preparation techniques and a postoperative CBCT scan was performed and uploaded into the implant-planning software and matched with the virtually planned osteotomy site preparations to measure the deviation angle and horizontal deviation as captured at the coronal entry point and apical end-point between osteotomy site preparations using Student's t-test statistical analysis. (2) Results: The paired t-test found statistically significant differences at the coronal entry-point deviations (p = 0.0104) and apical end-point deviations (p = 0.0104) between the TB and PUI study groups; however, no statistically significant differences were found in the angular deviations (p = 0.309) between the trephine bur and piezoelectric ultrasonic insert study groups. (3) Conclusions: The results showed that the TB is more accurate than the PUI for apical location.

Influence of Drilling Technique on the Radiographic, Thermographic, and Geomorphometric Effects of Dental Implant Drills and Osteotomy Site Preparations.

The aim of this comparative study is to analyze the influence of drilling technique on the radiographic, thermographic, and geomorphometric effects of dental implant drills and osteotomy site preparations. One hundred and twenty osteotomy site preparations were performed on sixty epoxy resin samples using three unused dental implant drill systems and four drilling techniques performed with a random distribution into the following study groups: Group A: drilling technique performed at 800 rpm with irrigation (n = 30); Group B: drilling technique performed at 45 rpm without irrigation (n = 30); Group C: drilling technique performed at 45 rpm with irrigation (n = 30); and Group D: drilling technique performed at 800 rpm without irrigation (n = 30). The osteotomy site preparation morphologies performed by the 4.1 mm diameter dental implant drills from each study group were analyzed and compared using a cone beam computed tomography (CBCT) scan. The termographic effects generated by the 4.1 mm diameter dental implant drills from each study group were registered using a termographic digital camera and the unused and 4.1 mm diameter dental implant drills that were used 30 times from each study group were exposed to a micro computed tomography (micro-CT) analysis to obtain a Standard Tessellation Language (STL) digital files that determined the wear comparison by geomorphometry. Statistically significant differences were observed between the thermographic and radiographic results of the study groups (p < 0.001). The effect of cooling significatively reduced the heat generation during osteotomy site preparation during high-speed drilling; furthermore, osteotomy site preparation was not affected by the wear of the dental implant drills after 30 uses, regardless of the drilling technique.

Accuracy of Computer-Aided Dynamic Navigation Compared to Computer-Aided Static Navigation for Dental Implant Placement: An In Vitro Study.

AIM: To analyze the accuracy capability of two computer-aided navigation procedures for dental implant placement. MATERIALS AND METHODS: A total of 40 dental implants were selected, which were randomly distributed into two study groups, namely, group A, consisting of those implants that were placed using a computer-aided static navigation system (n = 20) (guided implant (GI)) and group B, consisting of those implants that were placed using a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)). The placement of the implants from group A was performed using surgical templates that were designed using 3D implant-planning software based on preoperative cone-beam computed tomography (CBCT) and a 3D extraoral surface scan, and the placement of group B implants was planned and performed using the dynamic navigation system. After placing the dental implants, a second CBCT was performed and the degree of accuracy of the planning and placement of the implants was analyzed using therapeutic planning software and Student's t-test. RESULTS: The paired t-test revealed no statistically significant differences between GI and NI at the coronal (p = 0.6535) and apical (p = 0.9081) levels; however, statistically significant differences were observed between the angular deviations of GI and NI (p = 0.0272). CONCLUSION: Both computer-aided static and dynamic navigation procedures allow accurate implant placement.

Influence of the Digital Mock-Up and Experience on the Ability to Determine the Prosthetically Correct Dental Implant Position during Digital Planning: An In Vitro Study.

The purpose of this study was to analyze the influence of the digital mock-up and operator experience on the dental implant planning position. A total of 200 dental implants were planned, which were distributed into two study groups: A. dental implant planning by dental surgeons with 5-10 years of experience (n = 80); and B. dental implant planning by dental surgery students without experience (n = 120). Operators were required to plan eight dental implants in the same maxillary edentulous case uploaded in 3D implant-planning software, before and after using the digital mock-up. Deviations between the dental implant planning positions before and after using the digital mock-up were analyzed at platform, apical and angular levels, and were analyzed using a 3D implant-planning software using Student's t test. The paired t-test revealed statistically significant differences between the deviation levels of participants with 5-10 years' experience and no experience at the platform, apical and angular levels. Digital mock-ups allow for more accurate dental implant planning regardless of the experience of the operator. Nevertheless, they are more useful for operators without dental surgery experience.