Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: A translational study.

OBJECTIVES: Multiple generations of medical robots have revolutionized surgery. Their application to dental implants is still in its infancy. Co-operating robots (cobots) have great potential to improve the accuracy of implant placement, overcoming the limitations of static and dynamic navigation. This study reports the accuracy of robot-assisted dental implant placement in a preclinical model and further applies the robotic system in a clinical case series. MATERIALS AND METHODS: In model analyses, the use of a lock-on structure at robot arm-handpiece was tested in resin arch models. In a clinical case series, patients with single missing teeth or edentulous arch were included. Robot-assisted implant placement was performed. Surgery time was recorded. Implant platform deviation, apex deviation, and angular deviation were measured. Factors influencing implant accuracy were analyzed. RESULTS: The in vitro results showed that with a lock-on structure, the mean (SD) of platform deviation, apex deviation, and angular deviation were 0.37 (0.14) mm, 0.44 (0.17) mm, and 0.75 (0.29)°, respectively. Twenty-one patients (28 implants) were included in the clinical case series, 2 with arches and 19 with single missing teeth. The median surgery time for single missing teeth was 23 (IQ range 20-25) min. The surgery time for the two edentulous arches was 47 and 70 min. The mean (SD) of platform deviation, apex deviation, and angular deviation was 0.54 (0.17) mm, 0.54 (0.11) mm, and 0.79 (0.22)° for single missing teeth and for 0.53 (0.17) mm, 0.58 (0.17) mm, and 0.77 (0.26)° for an edentulous arch. Implants placed in the mandible had significantly larger apex deviation than those in the maxilla. CONCLUSION: Cobot-assisted dental implant placement showed excellent positional accuracy and safety in both the in vitro study and the clinical case series. More technological development and clinical research are needed to support the introduction of robotic surgery in oral implantology. Trial registered in ChiCTR2100050885.

Accuracy assessment of dynamic navigation during implant placement: A systematic review and meta-analysis of clinical studies in the last 10 years.

OBJECTIVES: To evaluate the accuracy of dynamic computer-aided implant surgery (dCAIS) and compare it with static computer-aided implant surgery (sCAIS) and freehand implant placement (FH) in partially or fully edentulous patients. DATA: Studies that analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients. SOURCES: This meta-analysis included studies published in English and Mandarin Chinese from January 2013 to February 2023 from MEDLINE/PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure). STUDY SELECTION: Only clinical studies were included. Accuracy was the primary outcome. Seventeen studies met the inclusion criteria. A total of 2,025 implants were analyzed. Meta-regression was conducted to compare the six different navigation systems. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted as a collective grading of the evidence. CONCLUSIONS: Dynamic navigation is a clinically reliable method for implant placement. Significantly lower angular deviation was observed for dCAIS compared to both sCAIS and FH, while significantly lower global platform and apex deviations were displayed between dCAIS and FH. Overall, dynamic navigation allowed for higher accuracy compared to both sCAIS and FH in a clinical setting; however, additional large sample RCT studies should be conducted, and patient-reported outcome measures (PROMs) reported. CLINICAL SIGNIFICANCE: This systematic review analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients compared with static navigation. The results demonstrated that dynamic navigation could decrease implant placement angular deviations.

Static computer-aided implant surgery (s-CAIS) analysing patient-reported outcome measures (PROMs), economics and surgical complications: A systematic review.

OBJECTIVE: To systematically evaluate the scientific literature for patient-reported outcome measures (PROMs) in static computer-aided implant surgery (s-CAIS). METHODS: A PICO strategy was executed using an electronic (MEDLINE, EMBASE, CENTRAL), plus manual search up to 15-06-2017 focusing on clinical studies investigating s-CAIS with regard to patients' pain & discomfort, economics and/or intra-operative complications. Search strategy was assembled from multiple conjunctions of MeSH Terms and unspecific free-text words. Assessment of risk of bias in selected studies was made at a "trial level" applying the Cochrane Collaboration Tool and the Newcastle-Ottawa Assessment Scale, respectively. RESULTS: The systematic search identified 112 titles. Seventy abstracts were screened, and 14 full texts were included for analysis. A total of 484 patients were treated with s-CAIS for placement of 2,510 implants. Due to the heterogeneity of the included studies, meta-analyses could not be performed. CONCLUSIONS: The number of identified studies investigating s-CAIS for PROMs was low. Scientifically proven recommendations for clinical routine cannot be given at this time; however, the number of clinical complications with s-CAIS seems to be negligible and comparable to conventional implant surgery. s-CAIS may offer a beneficial treatment option in edentulous cases if a flapless approach is applicable. Nevertheless, the economic effects in terms of time efficiency and treatment costs are unclear. Clinical investigations with well-designed RCTs investigating PROMs with standardized parameters are compellingly necessary for the field of s-CAIS.

Outcomes Assessment of Treating Completely Edentulous Patients with a Fixed Implant-Supported Profile Prosthesis Utilizing a Graftless Approach. Part 2: Patient-Related Outcomes.

PURPOSE: To assess outcomes of treating completely edentulous patients with a fixed implant-supported profile prosthesis, utilizing a graftless approach, for the maxilla and for the mandible, with an emphasis on patient-related outcomes, specifically maximum occlusal force, patient satisfaction, and impact on quality of life. MATERIALS AND METHODS: This was a cross-sectional study with the following inclusion criteria: completely edentulous patients rehabilitated with a fixed implant-supported profile denture, utilizing a graftless approach. Patients fulfilling the inclusion criteria were asked to participate in the study during their follow-up visits; hence, a consecutive sampling strategy was used. To measure maximum occlusal force, a digital occlusal force gauge was used. Subjects were asked to answer a paper survey distributed in the clinic. The survey contained general demographic questions, visual analog scale (VAS) categories, and Oral Health Impact Profile-14 (OHIP-14). RESULTS: The mean VAS score was 8.9 out of a possible 10. The mean OHIP-14 score was 7.5 out of a possible 56. The mean maximum occlusal force recorded in the anterior region was 108 Ncm. The mean maximum occlusal force recorded in the posterior region was 205 Ncm. CONCLUSION: Results indicated that patients treated with a graftless approach reported high satisfaction and impact on quality of life. Regarding maximum occlusal force values, significant differences between men and women were reported. The impact on quality of life seemed to improve when patients presented completely edentulous at the time of treatment as opposed to terminal dentition. Finally, significant positive correlations were detected between satisfaction and impact on quality of life, impact on quality of life and posterior maximum occlusal force, anterior and posterior maximum occlusal force, and complications and anterior maximum occlusal force.

Assessment of Long-Term Survival of Immediately Loaded Tilted Implants Supporting a Maxillary Full-Arch Fixed Prosthesis.

PURPOSE: To analyze the long-term outcome of fixed prostheses supported by six implants, two of which were tilted, placed in the maxilla and immediately loaded more than 10 years earlier. MATERIALS AND METHODS: A retrospective review of implants placed between May 29, 2003 and February 12, 2005 and used to support immediately loaded fixed dental prostheses in the maxilla was conducted. The features of failed implants were analyzed. In the most recent follow-up visits, survival of individual implants and prostheses was verified, and modified Plaque Index as well as modified Sulcular Bleeding Index were assessed. Patients also filled out a questionnaire requiring graded responses from 0 (poor) to 10 (excellent) that was designed to assess their quality of life. RESULTS: A total of 162 implants were placed between May 29, 2003 and February 12, 2005 to support immediately loaded maxillary fixed prostheses of 27 totally edentulous patients (19 female, 8 male). Three patients (1 male, 2 female) dropped out, so 144 implants were followed up. Seven of the 144 original implants failed, corresponding to a survival rate of 95.1% over 10 years. All the failures occurred within 2 years after surgery. Patients' responses to the questionnaire produced an average score of 8.4 to 8.8, showing a relevant degree of satisfaction. CONCLUSION: Based upon this study of 27 patients who received immediately loaded maxillary full-arch fixed implant-supported prostheses supported by two tilted and four axial implants, it appears that this is a reliable procedure with a high long-term survival rate and a high level of patient satisfaction.

Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial.

PURPOSE: To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading. MATERIALS AND METHODS: Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading. RESULTS: Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients. CONCLUSIONS: When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

[Significance of dental implants for health care]. / Stellenwert oraler Implantate im Rahmen der Gesundheitsversorgung.

Nowadays, endosseous titanium implants must be considered as an evidence-based treatment concept for the replacement of missing teeth. The economic evaluation of scientific evidence suggests that patient satisfaction and oral health-related quality of life may be improved by mandibular implant-retained overdentures over conventional dentures. However, despite promising survival rates reported for dental implants, an increase in the prevalence of peri-implant diseases is emerging. Accordingly, concepts for quality management in education, research, and practice are essential to further improve medical care in implant dentistry.

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment.

PURPOSE: The aim of this randomized clinical trial was to compare the relative efficacy of mandibular overdentures retained by only two implants and a bar attachment with conventional dentures. MATERIALS AND METHODS: Edentulous adults, aged 35 to 65 years, were randomly assigned to two groups that received either a mandibular conventional denture (n = 48) or an overdenture supported by two endosseous implants with a connecting bar (n = 54). All subjects rated their general satisfaction and other features of their original dentures and their new prostheses (comfort, stability, ability to chew, speech, esthetics, and cleaning ability) on 100-mm visual analogue scales prior to treatment and 2 months postdelivery. Oral health-related quality of life was also evaluated pre- and posttreatment. RESULTS: Multiple regression analysis revealed that the mean general satisfaction was significantly higher in the overdenture group than in the conventional denture group (P = .0001). Age, gender, marital status, and income were not significantly associated with ratings of general satisfaction. Furthermore, the implant group gave significantly higher ratings on three additional measures of the prostheses (comfort, stability, and ease of chewing; P < .05). CONCLUSION: A mandibular two-implant overdenture opposed by a maxillary conventional denture is a more satisfactory treatment than conventional dentures for edentulous middle-aged adults.

Optimized therapy for the edentulous predicament: cost-effectiveness considerations.

After proof of the clinical effectiveness of prosthodontic interventions, comparative economic analyses (cost-effectiveness, cost benefit, cost utility) should be undertaken to establish the relative value of each intervention in terms of its costs and consequences. Over time, these analyses must consider the balance between each intervention's initial and maintenance costs versus a broad array of clinician and patient-based multidimensional benefits or outcomes. The findings of current research will enhance increased economic analysis in prosthodontics, which, in turn, may help both dentists' and patients' decision-making. Even implant-supported prostheses that are clinically effective have yet to be proven societally effective because they are inaccessible economically to some who need them. Long-term, multidimensional comparative economic analyses of overdenture and conventional denture use may lead to the expansion of implant-supported dentures to selected patients who, to date, have not had access to this treatment modality.

Future therapeutic directions for management of the edentulous predicament.

The 1982 Toronto Conference on Tissue-Integrated Prostheses introduced the technique of osseointegration to the academic dental community. Subsequently, prosthodontists have played a leading role in the educational and clinical development of implant-supported fixed and removable prostheses for the treatment of the edentulous jaw. The success rates of treatment in the mandible have been replicated in many parts of the world and results are rewarding when compared with conventional complete denture therapy. Unfortunately, treatment results in the maxilla do not parallel those in the mandible and the shortfall requires the development of alternative strategies in diagnosis, treatment planning, surgery, and prosthetic management. As these treatment concepts become an everyday practice reality, osseointegrated implants have predictably found their way into the curriculum of all dental specialties. However, in many localities, the role of the prosthodontist in continuing education and research and development has become diluted as other areas of dentistry realize the enormous potential for treatment with osseointegrated implants. Accordingly, prosthodontists need to reevaluate their clinical mind-set if the specialty is to provide a lead role in future therapeutic endeavors.

[Mandibular fractures due to implant management--incidence, mechanism of injury and therapeutic characteristics]. / Unterkieferfrakturen infolge Implantatversorgung--Inzidenz, Verletzungsmechanismen und therapeutische Besonderheiten.

We report of 5 of 337 patients (1.48%), in whom a fracture of the edentulous atrophied mandible occurred after dental implants had been inserted. In 79 patients a sandwich osteotomy (anterior and/or lateral mandible) had been carried out together with the insertion of implants. The reason for a fracture was infection in 3 patients and weakening of the atrophied mandible by the additional osteotomies in 2 patients. One of the latter two was seen intraoperatively and fixed immediately using miniplates. The other occurred about 4 weeks postoperatively and was not discovered until callus had been developed. Consequently only 4 of the 5 patients were treated by osteosynthesis. In two patients no implants were lost. The application of bone morphogenetic protein (BMP) helped to avoid the loss of implants because it accelerated ossification of the fracture and the integration of the implants.

Influences of some background factors on the subjective need for dental implants in a Swedish population.

On the basis of a questionnaire sent to 3000 randomly sampled individuals aged 45-69 years and living in an average Swedish county (response rate, 79.4%), the influences of some demographic socioeconomic, and attitude variables on the subjective need for treatment with dental implants were studied in stepwise logistic regression models. The overall influence of these background factors was rather limited. Instead, the most important single factor seemed to be dental status. For the subjects wearing removable partial dentures, low education was significantly related to a low subjective need for implant treatment. For the totally edentulous group of subjects, low income was most significantly associated with a low subjective need for implant therapy.