A randomized controlled trial on the efficiency of free‐handed, pilot‐drill guided and fully guided implant surgery in partially edentulous patients

Abstract

Objectives To compare the effectiveness of free‐handed (FH), pilot‐drill guided (PG) and fully guided (FG) implant surgery by means of the apical global deviation (AGD) in relation to the additional financial cost and time spent. Materials and methods Thirty‐three partially edentulous patients in need of ≥2 implants in the posterior maxilla were randomly allocated to one of the following treatment groups: FH, PG and FG. Eleven patients (mean age 57; eight females; altogether 26 implants) were treated by FH surgery, 11 (mean age 53; seven females; altogether 24 implants) by PG surgery and 10 (mean age 60; six females; altogether 21 implants) by FG surgery. The accuracy in implant positioning was assessed by comparing the actual implant position to its planned position with the AGD as the main measure of effectiveness. Cost analysis included data on time investment (pre‐ and per‐operative) and operational cost. The efficiency of PG and FG surgery was assessed by means of the incremental cost‐effectiveness ratio (ICER), defined as the extra investment that is needed per unit reduction in AGD when compared to FH surgery. Results FG surgery was most effective (mean AGD: 0.97 mm) and FH surgery was least effective (mean AGD: 2.11 mm) in terms of surgical accuracy. As a result, 5/26 implants had to be restored with a cement‐retained restoration following FH surgery, although screw‐retention was planned for all implants in every group. The total time investment did not differ significantly between the 3 groups (p = 0.811). A significant additional cost per implant was found for PG and FG as compared to FH surgery pointing to 8.29% (€176.54) and 10.45% (€222.52), respectively (p < 0.001). The ICER revealed an additional cost of €5.48 and €4.12 per per cent reduction in AGD for PG and FG surgery, respectively. Conclusion The extra operational cost for guided implant surgery is acceptable and clinically justified since cementation can be avoided. FG surgery is the most efficient surgical approach, even though the absolute operational cost is higher when compared to PG and FH surgery.

Accuracy of static computer-assisted implant placement in anterior and posterior sites by clinicians new to implant dentistry: in vitro comparison of fully guided, pilot-guided, and freehand protocols

“…In addition, this superiority was shown for anterior and posterior implants. Such observations confirm the advantage of the FG protocol in controlling all the steps of osteotomy and implant placement [7,9,15,16]. On the contrary, the inaccuracies of the PG and FH protocols were generally similar and tended to be approximately double the inaccuracies of the FG protocol.…”

“…Likewise, Vermeulen found the FG protocol to be more accurate than the FH protocol [19]. Further, several clinical studies reported that the PG protocol is associated with approximately double the errors of the FG protocol [16,20,21]. On the contrary, the PG protocol inaccuracy seemed comparable to the FH protocol, which could be due to the execution of most of the drilling steps and implant placement without the use of guides, leading to inevitable deviation of the drills and implant placement.…”

“…Currently, there are two protocols for sCAIP: fully guided (FG) and pilot-guided (PG) protocols [15,16]. The FG protocol is related to implant manufacturers and has the advantage of controlling all the drilling, tapping, and implant placement through the surgical guide.…”

A 10‐year prospective study on single immediate implants

“…The fact that all of the implants with a buccal shoulder position ( n = 3) presented ≥1 mm mid‐facial recession shows benefit of these recent innovations. Given that guided implant surgery is most accurate (Younes et al., 2018) and has a favourable cost–benefit ratio (Younes, Eghbali, De Bruyckere, Cleymaet, & Cosyn, 2019), clinicians should at the very least consider guided implant surgery for IIP in order to avoid mid‐facial recession. Besides a buccal shoulder position, descriptive statistics also identified the lack of a CTG as putative risk factor for ≥1 mm mid‐facial recession.…”

Guidance means accuracy: A randomized clinical trial on freehand versus guided dental implantation

“…Most studies have focused on the accuracy of the full protocol, and their results indicate that full guidance yields higher accuracy than lower levels of guidance (Tahmaseb et al, 2014(Tahmaseb et al, , 2018Van Assche et al, 2012), though the difference is not always significant (Kühl et al, 2013). Less attention has been paid to the pilot and partial protocols and freehand surgery (Di Giacomo, Cury, Araujo, Sendyk, & Sendyk, 2005;Vercruyssen et al, 2015Vercruyssen et al, , 2014Younes, Eghbali, Bruyckere, Cleymaet, & Cosyn, 2019), even though the former are widespread, and the latter is still considered to be the standard by many. The accuracy of tooth-supported guides for partial edentulous cases (Arisan, Karabuda, & Ozdemir, 2010) is another under-discussed aspect, while it is safe to assume that partial edentulousness is a frequent reason for dental implantation.…”