Are Sleeves Necessary in Static Computer-Assisted Implant Surgery? A Comparative In Vitro Analysis.

OBJECTIVES: This study aims to examine differences in trueness and precision between surgical guides with (S) and without sleeves (SL). A secondary aim was to assess the impact of the sleeve-to-bone distance. MATERIALS AND METHODS: Mandible replicas (n = 120) were printed from an STL file obtained from a clinical CBCT. The mandibles were divided into sleeved (S, n = 60) and sleeveless (SL, n = 60) groups, each further divided into three categories (n = 20 each) with different heights from the guide to the implant platform: 2 mm (H2), 4 mm (H4), or 6 mm (H6). Digital planning and surgical guide design were done for a 4.1 × 10 mm implant for site #30. Post-op positions were captured using a scan body and lab scanner. Angular deviation was the primary outcome, with 3D and 2D deviations as secondary parameters. Statistical analysis included two-sample t-tests, and one-way and two-way ANOVA. RESULTS: Group S (2.41 ± 1.41°) had significantly greater angular deviation than Group SL (1.65 ± 0.93°; p = 0.0001). Angular deviation increased with sleeve-to-bone distance. H2 deviations were 1.48 ± 0.80° (S) vs. 1.02 ± 0.45° (SL; p < 0.05), H4: 2.36 ± 1.04° (S) vs. 1.48 ± 0.79° (SL; p < 0.05), H6: 3.37 ± 0.67° (S) vs. 2.46 ± 0.89° (SL; p < 0.05). 3D deviation at the implant platform was 0.36 ± 0.17 mm (S) vs. 0.30 ± 0.15 mm (SL; p < 0.05) and at the apex 0.74 ± 0.34 mm (S) vs. 0.53 ± 0.31 mm (SL; p < 0.01). Group SL at H2 had the smallest inter-implant distance (0.53 ± 0.37°), while Group S at H4 had the largest (1.20 ± 0.84°; p < 0.05). CONCLUSIONS: Sleeveless guides are more accurate than sleeved guides, and angular deviation is influenced by the distance from the guide to the implant platform.

Influence of dental implant clinical experience on the accuracy of robot-assisted immediate implant placement: an in vitro study.

OBJECTIVES: To assess the accuracy and effectiveness among operators with different levels of experience in a robot-assisted immediate implant surgery. MATERIALS AND METHODS: The study included four participants who had received dental training at the same institution but have varying levels of clinical experience in implant dentistry, denoted as undergraduate student (UG), dental resident (DR), specialist with no robot experience (IS) and specialist with robot experience (RS). Following comprehensive theoretical training in robot-assisted implant operation, each operator participated in five robotic-assisted implant procedures at 21 sites, resulting in the implant surgery of a total of 20 implants. Subsequently, the accuracy of the implants was assessed by analyzing the preoperative planning and the postoperative CBCT scans, and the time required for each procedure was also recorded. RESULTS: Angular deviation in UG, DR, IS and RS group was 0.82 ± 0.27°, 0.55 ± 0.27°, 0.83 ± 0.27°, and 0.56 ± 0.36°, respectively. The total deviation of the implant platform point was 0.28 ± 0.10 mm, 0.26 ± 0.16 mm, 0.34 ± 0.08 mm and 0.31 ± 0.06 mm, respectively. The total deviation of the apical point was 0.30 ± 0.08 mm, 0.25 ± 0.18 mm, 0.31 ± 0.09 mm, and 0.31 ± 0.05 mm, respectively. The time spent was 10.37 ± 0.57 min, 10.56 ± 1.77 min, 9.93 ± 0.78 min, and 11.76 ± 0.78 min for each operator. As the number of operations increased, the operation time decreased, but there was no significant difference in implant accuracy between the different groups. CONCLUSIONS: Within the scope of this study, robot-assisted implant surgery demonstrated high accuracy, with no significant differences in performance between operators with varying levels of clinical experience or implant robot-user experience. Furthermore, the learning curve for robotic implant surgery is steep and consistent. CLINICAL RELEVANCE: Robot-assisted implant surgery demonstrates consistent high accuracy across operators of varying clinical and robotic experience levels, highlighting its potential to standardize procedures and enhance predictability in clinical outcomes.

Accuracy of immediate anterior implantation using static and robotic computer-assisted implant surgery: A retrospective study.

OBJECTIVES: To investigate the accuracy of immediate anterior implantation using static computer-assisted implant surgery (s-CAIS) and robotic computer-assisted implant surgery (r-CAIS). MATERIALS AND METHODS: One hundred and six implants were immediately inserted in the anterior zone of 69 patients using a freehand technique, s-CAIS or r-CAIS. Postoperative cone-beam computed tomography scans were matched with preoperative plans to evaluate the deviations between the planned and placed implant positions. RESULTS: The global coronal deviations in the freehand, s-CAIS, and r-CAIS groups were 1.29 ± 0.52 mm, 1.01 ± 0.41 mm, and 0.62 ± 0.28 mm, respectively. Significant differences were observed in the r-CAIS group compared to both the s-CAIS group and the freehand group (p < 0.05). However, no significant differences were found between the s-CAIS group and the freehand group (p > 0.05). The global apical deviations in the freehand, s-CAIS and r-CAIS groups were 1.78 ± 0.59 mm, 1.24 ± 0.52 mm and 0.65 ± 0.27 mm, respectively, while the angular deviations in the freehand, s-CAIS and r-CAIS groups were 6.46 ± 2.21°, 2.94 ± 1.71° and 1.46 ± 0.57°, respectively. Significant differences were observed in both the global apical deviations and angular deviations among the three groups (p < 0.05). CONCLUSIONS: The accuracy of immediate anterior implantation with r-CAIS was better than that with s-CAIS. This difference is attributed to better control of the coronal, vertical and axial errors during r-CAIS. CLINICAL SIGNIFICANCE: This study provides significant evidence to support the use of r-CAIS as a potential alternative in immediate anterior implantation.

Cone-wedge anchored surgical templates for stackable metal guide: a novel technique.

OBJECTIVE: To address the instability in implant surgical guides, this technique proposes an alternative anchoring mechanism in the stackable metal surgical guides utilizing cone-wedge anchors for improved stability. METHODS: Postoperative implant position superimposed onto the preoperatively planned design using Mimics Medical 21.0 and Materialise Magics 24.0 to assess 3D coronal implant deviation, 3D apical implant deviation, and implant angular deviation. RESULTS: Postoperative cone-beam computed tomography (CBCT) revealed a high level of precision in the implant placement, with an average 0.97 mm deviation at implant coronal region, 1.56 mm at implant apexes, and 2.95° angular deviation. CONCLUSION: This technique introduces a novel cone-wedge anchoring mechanism to enhance the stability of stackable metal surgical guide templates, addressing inherent instability issues. The utilization of this approach significantly improves the accuracy of implant placement procedures.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series.

OBJECTIVES: This study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement. METHODS: Patients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial-distal, labial-palatal, and apico-coronal directions were recorded. RESULTS: Fifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively. CONCLUSIONS: High accuracy of immediate implant placement was achieved with the robotic system. CLINICAL SIGNIFICANCE: Our study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

How palatal vault morphology and screw length influence the accuracy of dynamic computer-guided orthodontic miniscrew insertion. A prospective clinical study.

OBJECTIVES: The aim of this study was to evaluate the influence of palatal vault morphology and screw length on the accuracy of miniscrew insertion in dynamic computer-assisted surgery (d-CAS). METHODS: Twenty-four subjects were allocated into three groups, according to their palatal vault morphology (Group A: medium; Group B: steep/high; Group C: low/flat) and the length of miniscrew used. For each subject, two miniscrews were inserted using a dynamic navigation system. To assess the accuracy of insertion, a postoperative CBCT was performed, and the pre- and post-operative scans were superimposed. Five variables were evaluated: Entry-3D, Entry-2D, Apex-3D, Apex-vertical and angular deviation. Descriptive statistics, Shapiro-wilk, Kruskal-Wallis and Dunn's tests were used for the statistical analysis. The level of significance was P ≤ 0.05. RESULTS: The mean angular deviation values revealed strong discrepancies amongst the groups (Group A:7.11°±5.70°; Group B:13.30°±7.76°; Group C:4.92°±3.15°) and significant differences were found regarding the Apex-3D (P = 0.036) and angular deviations (P = 0.008). A Dunn's test revealed differences in angular deviation between the medium and high/steep palate group (P = 0.004), and between low/flat and high/steep palate group (P = 0.01) but did not confirm any significant difference in the Apex-3D parameter (Group A-B P = 0.10; Group B-C, P = 0.053; Group A-C, P = 1.00). No significant differences were found regarding the length of the miniscrews. CONCLUSIONS: Palatal vault morphology is a factor that influences the accuracy of miniscrew insertion in d-CAS. In subjects with steep and high palatal vaults, insertion accuracy is lower when considering the angular deviation value. Miniscrew length does not influence accuracy. CLINICAL SIGNIFICANCE: Although computer-guided surgery assists the clinician in preventing damage to nearby anatomical structures, individual anatomical variability is a crucial variable. In subjects with a high/steep palate, greater attention should be paid during the planning phase in order to allow for a wide margin from adjacent anatomical structures to achieve better outcomes.

Impact of digital technologies on implant surgery in fully edentulous patients: A scoping review.

BACKGROUND: For over three decades, digital technologies have been used in Implant Dentistry, beginning with the introduction of planning software for Static Computer-Assisted Implant Surgery (S-CAIS). During this time, this field has witnessed the emergence of diverse methodologies and a proliferation of technological advancements. Today, S-CAIS is a widely adopted procedure for the placement of dental implants in both partially and fully edentulous patients, with Dynamic Computer-Assisted Surgery (D-CAIS) and Robotic-Assisted Implant Surgery (RAIS) rapidly gaining attention among dental professionals. The continuous advancements in this arena are not merely indicative of technological progress; they represent a steadfast dedication to refining precision, enhancing efficiency, and fostering innovation with the goal of optimizing patient outcomes in dental implantology. AIMS: The purpose of the following review is to meticulously examine the spectrum of digital technologies available and to describe their protocols, advantages, and shortcomings as well as to evaluate their accuracy in implant surgery in patients with complete edentulism. MATERIALS AND METHODS: A scoping review was performed following the Joanna Briggs Institute (JBI) protocols, leveraging the population, concept, and context (PCC) framework to construct the research question and determine the inclusion and exclusion criteria. RESULTS: Two hundred and sixty-seven records were identified for screening. After applying all the screening criteria, 41 articles were included for review and qualitative data analysis. DISCUSSION: S-CAIS, D-CAIS, and RAIS were identified as the main technologies for computer assisted implant surgery. Their applications, characteristics, protocols and levels of accuracy were compared and described. CONCLUSION: Taking into consideration the limitations of this study, S-CAIS appears to be the most applied and validated technology in implant surgery for fully edentulous patients followed by D-CAIS and RAIS being these last two promising initiatives in the field. Despite having similar levels of accuracy, the overall comparison showed a slightly higher values in RAIS followed by D-CAIS and S-CAIS.

Navigating the future of guided dental implantology: A scoping review.

BACKGROUND: The aim of this scoping review was to understand the development of robotics and its accuracy in placing dental implants when compared to other forms of guided surgery. METHODS: An electronic search was conducted on the electronic databases of PubMed, Cochrane, and Science direct with the following queries: ((robotics) AND (dental implant)) AND (accuracy). The search timeline was between 2017 and 2022. RESULTS: A total of 54 articles were screened for title and abstract, of which 16 were deemed eligible for inclusion. Thirty-one articles were excluded mainly because they were out of topic (not relevant) or not in English. In total, 16 articles were included for analysis. CONCLUSIONS: This review thoroughly analyses 5 years of literature concerning the evolution of robotics in dental implant surgery, underscoring the necessity for additional research on nascent technologies reported and a comparative study with static and dynamic systems for clinical efficacy evaluation.

Clinical evaluation of autonomous robotic-assisted full-arch implant surgery: A 1-year prospective clinical study.

OBJECTIVES: This prospective clinical study aimed to evaluate the accuracy and 1-year clinical follow-up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full-arch implant surgery. MATERIALS AND METHODS: Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP-FC) were recorded. RESULTS: Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance (p > .05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations (p > .05). The periodontal parameters, the BBT, and IP-FC remained stable during 1-year follow-up. CONCLUSION: The ADIR system showed excellent positional accuracy. The 1-year follow-up after full-arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full-arch implant surgery.

Effect of implant shape and length on the accuracy of robot-assisted immediate implant surgery: An in vitro study.

OBJECTIVES: To compare the accuracy of immediate implant placement of cylindrical implants (CI) and tapered implants (TI) of different lengths using a robotic dental implant system. MATERIALS AND METHODS: CI and TI of three lengths (8, 10, and 12 mm) each were digitally planned and placed in a three-dimensional printed extraction socket model under robotic guidance. There were six groups with three samples in each group, resulting in a total of 18 samples. Implant angular deviation, platform point deviation (total, lateral, depth), and implant apical point deviation (total, lateral, depth) were recorded and compared between the different groups. RESULTS: The angular deviations for CI 8 mm, CI 10 mm, CI 12 mm, TI 8 mm, TI 10 mm, and TI 12 mm were 1.32° ± 0.19°, 1.03° ± 0.56°, 1.31° ± 0.38°, 1.27° ± 0.64°, 1.10° ± 0.43° and 1.05° ± 0.45°, respectively. The total deviations of platform and apical points for CI 8 mm, CI 10 mm, CI 12 mm, TI 8 mm, TI 10 mm, and TI 12 mm were 0.79 ± 0.18 mm, 0.77 ± 0.33 mm; 0.64 ± 0.21 mm, 0.55 ± 0.17 mm; 0.64 ± 0.37 mm, 0.65 ± 0.34 mm; 0.68 ± 0.26 mm, 0.71 ± 0.20 mm; 0.70 ± 0.12 mm, 0.66 ± 0.23 mm; and 0.71 ± 0.15 mm, 0.77 ± 0.29 mm, respectively, and had no significant differences. CONCLUSIONS: Within the limitation of this study, acceptable accuracy can be achieved for both TI and CI using robotic systems. Our study demonstrated that the implant shape and length did not affect the accuracy of immediate implant placement under robotic guidance in vitro. However, further trials are required to confirm their efficacy in clinical practice.

In vitro and in vivo accuracy of autonomous robotic vs. fully guided static computer-assisted implant surgery.

OBJECTIVES: To assess the accuracy of autonomous robotic and fully guided static computer-assisted implant surgery (sCAIS) performed on models and patients. MATERIALS AND METHODS: This study was divided into in vitro and in vivo sections. In vitro, 80 operators were assigned to two groups randomly. Forty operators performed forty autonomous robotic implant (ARI group) surgeries and the remaining forty operators carried out forty fully guided sCAIS (FGI group) surgeries on maxillary models, respectively. Each operator placed an implant in one maxillary model. In vivo, 60 patients with 113 implants from 2019 to 2023 (ARI group: 32 patients, 58 implants; FGI group: 28 patients, 55 implants) receiving implant surgeries were incorporated in this retrospective research. The preoperative and postoperative cone beam computer tomographs (CBCTs) were utilized to estimate the linear deviations and angular deviations in two-dimensional (2D) and three-dimensional (3D) space. The Pearson's chi-square test, Shapiro-Wilk test, Student's t test, Mann-Whitney U test and mixed models were applied, and p <0.05 was considered statistically significant. RESULTS: In vitro, a total of 80 implants were enrolled and significant differences were found between the two groups (p < 0.001): The 3D deviation at the platform of ARI and FGI group was 0.58 ± 0.60 mm and 1.50 ± 1.46 mm, respectively, at the apex was 0.58 ± 0.60 mm and 1.78 ± 1.35 mm, respectively, and angle was 1.01 ± 0.87° and 2.93 ± 1.59°, respectively. Also, except for mesiodistal deviation at the implant platform, the rest linear and angular deviations in the ARI group were significantly lower than those in the FGI group in 2D space (p < 0.001). In vivo, a significantly lower mean of angular deviation (0.95 ± 0.50°, p < 0.001) and the linear deviation at both platform (0.45 ± 0.28 mm, p < 0.001) and apex (0.47 ± 0.28 mm, p < 0.001) were observed in ARI group when compared to the FGI group (4.31 ± 2.60°; 1.45 ± 1.27 mm; 1.77 ± 1.14 mm). CONCLUSIONS: The use of autonomous robotic technology showed significantly higher accuracy than the fully guided sCAIS.

An in vitro analysis of the accuracy of static and robot-assisted implant surgery.

OBJECTIVES: Robot-assisted implant surgery (RAIS) is purported to improve the accuracy of implant placement. The objective of this study was to compare RAIS with static computer-assisted implant surgery (sCAIS) in a controlled environment. MATERIALS AND METHODS: A total of n = 102 implants were placed in the same modified typodont (n = 17 repeated simulated implant surgeries with each n = 3 implants per group) using robot-assisted or static computer-assisted implant surgery. The final implant positions were digitized utilizing cone-beam tomography and compared with the planned position. The angular deviation was the primary outcome parameter. 3D deviations at the implant platform level and the apex were secondary outcome parameters. Accuracy in terms of trueness and precision were assessed. Means, standard deviation, and 95%-confidence intervals were analyzed statistically. RESULTS: The overall angular deviation was 2.66 ± 1.83° for the robotic system and 0.68 ± 0.38° for guided surgery using static guides (p < .001), the 3D-deviation of the implant platform at crest level was for sCAIS 0.79 ± 0.28 mm and RAIS 1.51 ± 0.53 mm (p < .001) and at the apex for sCAIS 0.82 ± 0.26 mm and for RAIS 1.97 ± 0.79 mm (p < .001), respectively. CONCLUSIONS: Robotically guided implant surgery was less accurate in terms of trueness (planned vs. actual position) and precision (deviations among implants) than traditional static computer-assisted implant surgery in this in vitro study.

Comparing the accuracies of freehand, static computer-assisted and robot-assisted dental implant placements: an in vitro study.

OBJECTIVE: To compare the accuracies among three oral implant surgical techniques: freehand (FH), static computer-assisted implant surgery (sCAIS), and robotic computer-assisted implant surgery (rCAIS). METHODS: The polyurethane and bovine femur implant models were fabricated, and 126 and 96 implant sites were designed on them. The implant sites were divided into three groups: FH, sCAIS, and rCAIS, according to the implantation method. The deviation between the actual implant position and the planned position was analyzed and compared by cone beam computed tomography. RESULTS: In the polyurethane model test, the entry deviation, entry-level deviation, apical deviation, apical level deviation, and angle deviation in sCAIS and rCAIS groups were significantly reduced compared with those in the FH group (P<0.05). No significant differences were observed in all kinds of deviations between the sCAIS and rCAIS groups (P>0.05). In the bovine femur model test, the entry deviation, entry-level deviation, apical deviation, apical level deviation, and angle deviation in both sCAIS and rCAIS groups were significantly reduced compared with those in the FH group (P<0.05). No significant differences were observed in all kinds of deviations between the sCAIS and rCAIS groups (P>0.05). CONCLUSION: This in vitro study shows that the rCAIS technique is superior to the freehand, but has the same accuracy as the sCAIS.

Accuracy and patient-centered results of marker-based and marker-free registrations for dynamic computer-assisted implant surgery: A randomized controlled trial.

OBJECTIVES: To compare implant placement accuracy and patient-centered results between the dynamic computer-assisted implant surgeries (d-CAISs) using marker-based and marker-free registration methods. MATERIALS AND METHODS: A double-armed, single-blinded randomized controlled trial was conducted, in which 34 patients requiring single implant placement at the esthetic zone were randomly assigned to the marker-based (n = 17) or marker-free (n = 17) groups. The marker-based registration was performed using a splint containing radiopaque markers, while the marker-free registration used natural teeth. The primary outcome assessed implant positioning accuracy via angular and linear deviations between preoperative and postoperative implant positions in CBCT. Patients were also surveyed about the intraoperative experience and oral health impact profile (OHIP). RESULTS: The global linear deviations at the implant platform (0.82 ± 0.28 and 0.85 ± 0.41 mm) and apex (1.28 ± 0.34 and 0.85 (IQR: 0.64-1.50) mm) for the marker-based and marker-free groups respectively showed no significant difference. However, the angular deviation of the marker-free group (2.77 ± 0.92 ° ) was significantly lower than the marker-based group (4.28 ± 1.58 ° ). There was no significant difference in the mean postoperative OHIP scores between the two groups (p = .758), with scores of 2.74 ± 1.21 for marker-based and 2.93 ± 2.18 for marker-free groups, indicating mild oral health-related impairment in both. Notably, patients in the marker-free group showed significantly higher satisfaction (p = .031) with the treatment procedures. CONCLUSIONS: D-CAIS with a marker-free registration method for single implantation in the anterior maxilla has advantages in improving implant placement accuracy and patients' satisfaction, without generating a significant increase in clinical time and expenses.

Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency.

OBJECTIVE: Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW: This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION: The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE: Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.

Accuracy in static guided implant surgery: Results from a multicenter retrospective clinical study on 21 patients treated in three private practices.

PURPOSE: To evaluate the accuracy of a static computer-assisted implant surgery (s-CAIS) system across different private practices. METHODS: This retrospective clinical study was based on data retrieved from 21 patients who received 61 implants between 2018 and 2020 in 3 private practices run by surgeons with extensive experience with s-CAIS. All patients were treated using the same s-CAIS system, planning software, template manufacturing process, and surgical guides. The standard tessellation language (STL) file of the intraoral scan of the fixture taken immediately after implant placement was matched with that of the preoperative plan for comparisons of preoperative and planned implant positions with postoperative and actual implant positions. The study outcomes were linear and angular deviations between the planned and actual implant positions. RESULTS: No surgical or postsurgical complications occurred. The overlap of the two STL files resulted in a mean angular deviation of 2.94° The mean linear deviation at the implant shoulder was 0.73 mm, and that at the apex was 1.06 mm. The mean vertical deviations at the implant shoulder and the apex were 0.29 mm and 0.01 mm, respectively. CONCLUSION: All cases showed satisfactory accuracy within the limits of this study (small number of patients and retrospective design). These results might be related to the use of a standardized digital workflow by experienced operators. STATEMENT OF CLINICAL RELEVANCE: The study shows that careful control of each step, from data acquisition to final execution, is key for the accuracy of stent-guided systems.

Clinical evaluation of autonomous robot assisted implant surgery:A retrospective clinical study / 实用口腔医学杂志

Objective:To retrospectively evaluate the clinical outcomes of autonomous dental implant robot(ADIR)assisted implant surgery in 1-year follow-up.Methods:20 patients with tooth missing underwent implantation surgery by ADIR were incuded.The plat-form deviation,apex deviation and angular deviation of the implants were analyzed.The marginal bone height and peri-implant soft tis-sue health were measured and observed immediately,6 months and 12 months after the restoration.Results:The platform deviation,apex deviation and angular deviation of 20 implants at the 3 follow-up examinations were(0.34±0.11)mm,(0.34±0.15)mm and(0.82°±0.38°),respectively.There was no significant difference in the accuracy of different implant diameter and length(P＞0.05).During the follow-up period,all implants had successful osseointegration,stable marginal bone height,and acceptable peri-implant soft tissue condition.Conclusion:The 1-year follow-up indicates that ADIR can achieve promising clinical performance.Long-term follow-up studies are still necessary for verification.

Reliability of a chairside CAD-CAM surgical guide for dental implant surgery on the anterior maxilla: An in vitro study.

PURPOSE: This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience. MATERIALS AND METHODS: Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05). RESULTS: There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists' groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05). CONCLUSION: CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.

Computer-assisted and robotic implant surgery: Assessing the outcome measures of accuracy and educational implications.

OBJECTIVE: This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. METHODS: A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. RESULTS: Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta-analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. CONCLUSION: Meta-analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods.

OBJECTIVES: This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. DATA: In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. SOURCES: A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. RESULTS: A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. CONCLUSIONS: Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. CLINICAL SIGNIFICANCE: To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.