Three-Dimensional Evaluation of the Accuracy of Zygomatic Implant Placement Through an In-House Fully Guided Approach.

Purpose: To validate guided surgery for zygomatic implants (ZIs) by analyzing the final position of the implants relative to the preoperatively planned position. Material and Methods: Five patients with fully edentulous atrophic maxillae treated with four ZIs through a fully guided implant surgical approach were evaluated. The preoperative phase included digital planning, through which the surgical guide was designed and created. Analysis of the guided surgery accuracy was carried out by superimposing the digital planning over the final position of the implants using preoperative and postoperative CBCT. The radiologic evaluation included implant angular deviation, entrance deviation, exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. Results: All five patients (two men and three women; mean age: 61.8 ± 3 years) were each treated with four ZIs using a fully guided approach with an extrasinusal path, obtaining ideal emergence of the implants. Superimposition comparison found a mean axial angular implant deviation of 0.79 ± 0.41 degrees and a mean implant entrance deviation of 0.95 ± 0.26 degrees. The platform deviation was 0.62 ± 0.19 mm buccopalatally and 0.76 ± 0.14 mm mesiodistally, while the apical deviation was 0.42 ± 0.13 mm buccopalatally and 1.06 ± 0.37 mm mesiodistally. Conclusions: Guided surgery in zygomatic implants appears to be sufficiently accurate to make it a safe and predictable technique.

Accuracy of static fully guided implant placement in the posterior area of partially edentulous jaws: a cohort prospective study.

OBJECTIVE: A cohort prospective study was conducted to assess the three-dimensional positioning accuracy of the implant between pre-surgical and the final implant position using a static fully guided approach in the posterior area of the jaws. MATERIALS AND METHODS: A total of 60 implants (30 patients) were digitally analyzed after superimposing the Digital Imaging and Communications in Medicine (DICOM) files obtained from the Cone Beam Computed Tomography (CBCT) pre- and post-implant placement. The software calculations included deviations at the implant shoulder and at the implant apex, global deviation (3D offset), and angle deviation. Statistical analysis was performed with α = 0.05. RESULTS: Considering the total number of implants, mesiodistal, buccolingual, and apicocoronal mean deviations at the shoulder and implant apex were equal or below 0.21 ± 0.69 mm, and only the buccolingual mean deviation at the apex reached up to 0.67 ± 1.06 mm. The mesiodistal and apicocoronal deviations were not statistically significant at both the shoulder and apex levels of the implant. The mean total angular deviation was 5.62° ± 4.09. The main limitation of this surgical approach was the requirement for a wide mouth opening. CONCLUSIONS: Static fully guided surgery for dental implant placement exhibits minimum deviations respect to presurgical planning. The main limitation in the posterior areas is the requirement for a wide mouth opening. CLINICAL RELEVANCE: Even with minimum deviations clinically acceptable, precautions and safety margins must be respected when using static full-guided surgery to place dental implants.