Accuracy of intraoral real-time navigation versus static, CAD/CAM-manufactured pilot drilling guides in dental implant surgery: an in vitro study

Abstract

Background Nowadays, 3D planning and static for dynamic aids play an increasing role in oral rehabilitation of the masticatory apparatus with dental implants. The aim of this study is to compare the accuracy of implant placement using a 3D-printed drilling guide and an intraoral real-time dynamic navigation system. Methods A total of 60 implants were placed on 12 partially edentulous lower jaw models. 30 were placed with pilot drilling guides, the other half with dynamic navigation (DENACAM®). In addition, implant placement in interdental gaps and free-end situations were investigated. Accuracy was assessed by cone-beam computed tomography (CBCT). Results Both systems achieved clinically acceptable results, yet more accurate results regarding the offset of implant base and tip in several spatial dimensions were achieved using drilling guides (each p < 0.05). With regard to angulation, real-time navigation was more precise (p = 0.0016). Its inaccuracy was 3°; the template-guided systems was 4.6°. Median horizontal deviation was 0.52 mm at base and 0.75 mm at tip using DENACAM®. When using the pilot drill guide, horizontal deviation was 0.34 mm in the median and at the tip by 0.59 mm. Regarding angulation, it was found that the closer the drill hole was to the system's marker, the better navigation performed. The template did not show this trend (p = 0.0043; and p = 0.0022). Conclusion Considering the limitations of an in vitro study, dynamic navigation can be used be a tool for reliable and accurate implantation. However, further clinical studies need to follow in order to provide an evidence-based recommendation for use in vivo.

Comparison of the accuracy of immediate implant placement using static and dynamic computer-assisted implant system in the esthetic zone of the maxilla: a prospective study

“…A possible explanation for this observation could be the restriction of the guide sleeve from the static template during the preparation of the borehole and implant placement, which may partially offset the resistance of the palatal bone wall of the extraction socket during immediate implant placement [ 22 ]. Robert Stünkel et al reported in their in vitro study that the dynamic CAIS system could achieve higher accuracy than the pilot drilling guide technique in posterior mandibular region of plastic models [ 23 ]. Zhaozhao Chen et al compared the deviation of the static CAIS and conventional freehand protocol in human head cadavers for immediate implant placement at the maxillary incisor site [ 4 ].…”

“…• An age of at least 18 years. • The maxillary esthetic single tooth sites (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) could not be retained due to trauma, endodontic failure, root fracture, root resorption. • Intact socket walls.…”

Does implant drill design influence the accuracy of dental implant placement using static computer-assisted implant surgery? An in vitro study

“…An in vitro study was designed to test our hypotheses. The sample size was determined based on the results of Stünkel et al [ 25 ] and Kivovics et al [ 26 ] using G*Power 3.1 software (v.3.1.9.3, 2017, Institut für Experimentelle Psychologie, Heinrich-Heine-Universität, Düsseldorf, Germany). According to the results of these studies, an angular deviation of 4.6 ± 1.50° may be expected from a pilot-guided implant placement protocol where implant beds were finalized using straight drills, whereas an angular deviation of 3.21 ± 1.52° may be expected from pilot-guided sCAIS where step drills were used to finalize osteotomies.…”

Experimental justification of the use of surgical templates

“…При этом виде навигации выполняют остеотомию и устанавливают дентальный имплантат под наблюдением КЛКТ в реальном времени при помощи специальных рентгеноконтрастных маркеров. Динамический ХНШ позволяет менять позицию дентального имплантата интраоперационно благодаря маркерам, упомянутым выше [8][9][10][11] .…”