COMPARISONS BETWEEN DIGITAL-GUIDED AND NONDIGITAL PROTOCOL IN IMPLANT PLANNING, PLACEMENT, AND RESTORATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

ABSTRACT

OBJECTIVES: The present study aimed to systematically review the current randomized clinical trials (RCTs) with respect to computer-aided design/computer-aided manufactured (CAD/CAM) techniques in the process of implant planning, placement, and rehabilitation. MATERIALS AND METHODS: Four independent reviewers conducted an electronic and manual literature search using several databases, including the National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE. Articles were included if they were RCTs involving the interventions regarding the computer-guided impression, placement, and manufacturing process. The outcomes of interest include clinical and patient-reported outcomes and time efficiency. A meta-analysis was conducted to evaluate the time efficiency, pain severity, accuracy of implant placement, and postsurgery marginal bone level. RESULTS: A total of 39 and 25 articles were included in the qualitative and quantitative analysis, respectively. The results of the meta-analysis showed that significantly less time was spent performing the digital impression procedure than the conventional impression (P = .002). In addition, the average adjustment time of the final prosthesis was significantly less than the nondigital fabricated prosthesis (P = .0005). Computer-guided groups reported significantly lower painkiller consumption compared to control groups (P = .03). CONCLUSIONS: Digital impressions and CAD/CAM procedures are time-saving and provide stable and predictable outcomes. Moreover, computer-guided surgery can effectuate an accurate implant placement and less postsurgery discomfort.