The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis

Shengchi Fan, Gustavo Sáenz-Ravello, Leonardo Diaz, Yiqun Wu, Rubén Davó, Feng Wang, Marko Magic, Bilal Al-Nawas, Peer W Kämmerer, Shengchi Fan, Gustavo Sáenz-Ravello, Leonardo Diaz, Yiqun Wu, Rubén Davó, Feng Wang, Marko Magic, Bilal Al-Nawas, Peer W Kämmerer

Abstract

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla.

Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS.

Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34-2.29) at the entry point and 2.95 mm (95% CI: 1.66-4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04-4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83-1.54) at the entry point and 1.80 mm (95% CI: 1.10-2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43-2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69-2.39) at the entry point and 3.23 mm (95% CI: 2.34-4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86-5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements.

Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Keywords: computer-aided surgery; edentulous; guided surgery; navigation; zygomatic implant.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
Results of risk of bias [8,10,11,12,13,14,15,19,32,33,34,35,36,37].
Figure 3
Figure 3
Illustration of the parameters of 3D deviation.
Figure 4
Figure 4
Forest plot representing the pooled mean 3D entry deviation grouped by different ZI surgical protocol in (1) the navigation group, (2) the guide group, (3) and the free-hand group [10,11,12,13,14,19,19,32,35,36,37].
Figure 5
Figure 5
Forest plot representing the pooled mean 3D apex deviation grouped by different ZI surgical protocol in (1) the navigation group, (2) the guide group, (3) and the free-hand group [10,11,12,13,14,19,19,32,35,36,37].
Figure 6
Figure 6
Forest plot representing the pooled mean angular deviation grouped by different ZI surgical protocol in (1) the navigation group, (2) the guide group, (3) and the free-hand group [10,11,12,13,14,19,19,32,35,36,37].
Figure 7
Figure 7
The funnel plot was used for the visual inspection of asymmetry in the navigation and surgical guide groups for entry, apex and angular deviation. Entry deviation in blue. Apex deviation in green. Angular deviation in red.

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