Comparison of the accuracy of implant placement using different drilling systems for static computer‐assisted implant surgery: A simulation‐based experimental study

Abstract

Background Different designs of surgical drilling systems have been developed for the purpose of static Computer‐Assisted Implant Surgery (sCAIS), but there is at present little understanding of how design principles affect the accuracy of implant placement. Purpose The aim of this in vitro study was to compare the accuracy of implant placement among five drilling systems of sCAIS in a controlled experimental setting. Materials and Methods Twenty‐five 3D printed models with two edentulous bilateral premolar spaces were allocated to five different drilling systems: group A: sleeve‐in‐sleeve, group B: sleeve‐in‐sleeve with self‐locking, group C: mounted sleeve‐on‐drill, group D: integrated sleeve‐on‐drill with metal sleeve in the guide, group E: integrated sleeve‐on‐drill without metal sleeve. Models were scanned with CBCT and optical scanner. All implants were digitally planned and 10 implants placed with sCAIS in each group. Postoperative 3D deviation of placed vs planned position was measured by means of platform, apex and angular deviation. Data was analyzed using Kruskal‐Wallis test (P ≤ .05). Pairwise comparisons were tested with Dunn's test with adjusted P values. Results The overall platform deviation ranged from 0.42 ± 0.12 mm (group B) to 1.18 ± 0.19 mm (group C). The overall apex deviation ranged from 0.76 ± 0.22 mm (group B) to 1.95 ± 0.48 mm (group D). The overall angular deviation ranged from 2.50 ± 0.89 degree (group B) to 5.30 ± 1.04 degree (group E). Group A and B showed significantly less angular deviation than groups D and E (P < .05). There was no statistically significant differences in all parameters between group A and B, as well as between group D and E (P > .05). Conclusions Significant differences were found with regards to accuracy among the five sCAIS systems tested, suggesting that the drilling protocol, the devices used and the design principles of the guides could influence the accuracy of implant placement.

Accuracy of keyless vs drill-key implant systems for static computer-assisted implant surgery using two guide-hole designs compared to freehand implant placement: an in vitro study

“…Therefore, these findings should be taken into consideration when immediate or early implant placement using sCAIS is planned after tooth extraction. The findings observed in this study agree with previous studies evaluating different implant systems, where differences in implant positional accuracy were found between and within manufacturers [ 17 , 18 ]. The differences between systems could be explained by drilling system design and protocol since the implant macro-design is similar between both investigated implants.…”

“…These differences may be related to the macro-design of the implants, and the variations in design or tolerances of components, such as surgical drills, drill keys, and guide-hole sleeves used for guided implant site osteotomy and placement. To enhance the accuracy of sCAIS, alternative implant systems or surgical guide design options focusing on the reduction of components, such as keyless compared to drill-key systems or sleeveless (SL) versus manufacturer’s sleeve [ 19 ] guide-hole designs have been introduced to the market [ 18 ]. Interestingly, recent studies have reported higher accuracy of final 3D implant position when SL guide-hole designs were used [ 19 , 20 ].…”

Digital vs. conventional workflow for one-abutment one-time immediate restoration in the esthetic zone: a randomized controlled trial

“…Several designs of drilling systems are available for s-CAIS, including sleeve-in-sleeve system, sleeve-in-sleeve with self-locking, the mounted sleeve-on-drill, the integrated sleeve-on-drill, and the integrated sleeve-on-drill without a metal sleeve. The sleeve-in-sleeve system, used in the present study, was shown to lead to significantly less angular deviation compared to other systems listed above [ 40 ]. Regarding the IOS, the accuracy of IOS for single implant was widely demonstrated [ 41 , 42 ] and should, therefore, be considered as a valid research tool complying with (ALADA) principles for patient radiation safety [ 43 – 46 ].…”

A critical analysis of research methods and experimental models to study working length determination and the performance of apex locators – A narrative review with recommendations for the future

“…Yet, these simple mounting devices are rarely used in published studies. Clinically, instead of stoppers, the use of spacers resembling implant key heights (El Kholy et al, 2019;Sittikornpaiboon et al, 2021) eliminate errors of adjustment, reading and movement of stoppers, and spare clinicians the continuous monitoring of the position of stoppers. Recommendations:…”