Accuracy of different types of computer-aided design/computer-aided manufacturing surgical guides for dental implant placement

Abstract

Purpose: To evaluate the clinical outcomes of implants placed using different types of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, including partially guided and totally guided templates, and determine the accuracy of these guides Materials and methods: In total, 111 implants were placed in 24 patients using CAD/CAM surgical guides. After implant insertion, the positions and angulations of the placed implants relative to those of the planned ones were determined using special software that matched pre- and postoperative computed tomography (CT) images, and deviations were calculated and compared between the different guides and templates.

Results: The mean angular deviations were 1.72 ± 1.67 and 2.71 ± 2.58, the mean deviations in position at the neck were 0.27 ± 0.24 and 0.69 ± 0.66 mm, the mean deviations in position at the apex were 0.37 ± 0.35 and 0.94 ± 0.75 mm, and the mean depth deviations were 0.32 ± 0.32 and 0.51 ± 0.48 mm with tooth- and mucosa-supported stereolithographic guides, respectively (P < .05 for all). The mean distance deviations when partially guided (29 implants) and totally guided templates (30 implants) were used were 0.54 ± 0.50 mm and 0.89 ± 0.78 mm, respectively, at the neck and 1.10 ± 0.85 mm and 0.81 ± 0.64 mm, respectively, at the apex, with corresponding mean angular deviations of 2.56 ± 2.23° and 2.90 ± 3.0° (P > .05 for all).

Conclusions: Tooth-supported surgical guides may be more accurate than mucosa-supported guides, while both partially and totally guided templates can simplify surgery and aid in optimal implant placement.

Keywords: Dental implant; computer-aided design/computer-aided manufacturing; mucosa-supported guide; osseointegration; surgical guide; tooth-supported guide.

Figures

Figure 1

Treatment planning and implant selection using a computer program (Simplant®) and cone beam computed tomography (CBCT) scans.

Figure 2

Computer-aided design of the surgical guide.

Figure 3

Surgery is completed using the computed-aided design/computer-aided manufacturing (CAD/CAM) surgical guide.

Figure 4

Matching procedure using Simplant® software. The planned implants are shown in red and the placed implants are shown in blue.

Figure 5

Matching procedure between planned (gray) and placed (blue) implants. α represents the angular deviation of the axis of the placed implant relative to the axis of the planned implant. a is the distance between the planned and placed implant at the neck; b is the distance between the planned and placed implant at the apex; and c is the deviation in depth of the placed implant relative to the depth of the planned implant.

Figure 6

The partially guided surgical template is often designed with a single pilot drill guide.

Figure 7

The totally guided surgical template is designed and used for osteotomy site preparation and implant delivery. Osteotomy sites are prepared using sequential, removable surgical drilling guides.

Figure 8

A tooth-supported surgical guide is seated and stabilized with the help of natural teeth.