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Correct implant placement is necessary for satisfactory implant restoration. Therefore, the use of surgical guide is recommended. This study evaluated the accuracy of implant placement in posterior edentulous areas with different levels of tooth-support by novice clinicians according to fully-guided (FG), pilot-guided (PG), and freehand (FH) placement protocols. A mandibular model with missing first molars was designed. On one side, the model had a bound edentulous area (BEA), and on the other side, a free end edentulous area (FEA). Fourteen clinicians new to implant dentistry participated in the study, and each clinician inserted an implant in the BEA and FEA sites for every placement protocol. Angle, vertical and maximum horizontal platform and apex deviations were measured. The FG placement was more accurate than the PG and FH placements. This was significant for BEA angle deviation, BEA and FEA maximum horizontal platform deviations, and BEA maximum horizontal apex deviation. The PG placement was significantly more accurate than the FH placement for BEA and FEA maximum horizontal platform deviations. FG shows significantly greater angle, maximum horizontal platform and maximum horizontal apex deviations at FEA than BEA. This can be attributed to reduced guide support and the possibility of guide displacement during surgery., (Copyright© 2023 Dennis Barber Ltd.)

Purpose: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates., Materials and Methods: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test., Results: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048)., Conclusions: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome., Clinical Relevance: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits., Trial Registration: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019)., (© 2023. The Author(s).)

Background: Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting 'conventional' and limiting 'guided' surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels., Methods: Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer's instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene's test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05., Results: The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036)., Conclusion: Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range., (© 2023. The Author(s).)

Purpose: Manufacturing-related inaccuracies of surgical guides for static computer-aided implant surgery may contribute to the overall potential error in the obtained implant position. Measuring such inaccuracies before surgery may provide quality control assessment and improve the safety and outcomes of guided implant surgery. This technical report demonstrates a workflow to measure the accuracy of a surgical guide (at the intaglio surface and sleeve housing) using a freeware metrology software program., Methods: The scan of a milled surgical guide was aligned to and compared with its reference computer-aided design model using a freeware metrology software program (GOM Inspect suite; GOM GmbH). The trueness of the internal surface of the surgical guide was measured as an indicator of adaptation to the supporting tissues. Additionally, some features were constructed to extract the plane at the sleeve entrance and sleeve axis and to set a local coordinate system on them. Linear and angular deviations between the planned and obtained sleeve axes were measured using this system. Such measurements, together with additional known data (sleeve offset and the planned implant length), allowed the estimation of linear errors in implant position at both the implant platform and apex by applying common geometric formulas, based on the assumption that all other sources of error in implant position could be effectively controlled during the surgical procedure., Conclusions: The proposed digital technique is a cost-effective approach for quality control of the inaccuracies of a surgical guide and predicts the related potential error in implant position.

Objectives: The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used., Methods: Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol (Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative CT scan (with the final position of the achieved implants) with the pre-operative CT scan (with the planned implants)., Results: The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71°, p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm, p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm, p<0.001) and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm, p<0.001)., Conclusions: The proposed guided surgery system exhibited a higher accuracy for all the investigated variables, when compared to the free hand technique., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: To ensure accurate implant placement, surgical guides are used to control the steps of implant placement surgery., Purpose: Evaluation of the accuracy of implant placement in long span edentulous area by novice implant clinicians according to fully-guided (FG), pilot-guided (PG), and freehand (FH) placement protocols., Materials and Methods: Maxillary surgical models with four missing teeth from the right first canine to the first molar were produced by 3-dimensional printing. Fourteen clinicians new to implant dentistry participated in the study, and each one of them inserted one canine and one molar implant for every implant placement protocol. All implant placement steps were completed in phantom heads to simulate the clinical situation. To evaluate the accuracy, the implant vertical, horizontal platform, horizontal apex, angle, and interimplant distance deviations from the planned positions were calculated., Results: With the exception of vertical deviation, the FG placement was clearly more accurate than the PG and FH placements for all the variables for canine and molar implants. The PG placement was significantly more accurate than the FH placement for the horizontal platform and apex deviations, and interimplant distance deviation. The FG placement did not show a significant impact of the location of the implant, or the horizontal deviations of the platform or the apex. The PG and FH placements showed increased deviation at the canine implant than the molar implant, and at the apex of the implants than the platform of the implants., Conclusions: Within the limitations of this in vitro study, novice clinicians achieved a significantly more accurate implant position with FG placement, followed by PG and FH placements respectively. Therefore, a form of guided surgery is beneficial for novice clinicians., (© 2021 Wiley Periodicals LLC.)

Alloplastic replacement of the temporomandibular joint (TMJ) is the treatment of choice in cases of TMJ end-stage disease. Improvements in computer-aided design/computer-aided manufacturing (CAD/CAM) translated into the possibility ongf designi very precise TMJ prostheses based on the anatomy of each single patient. Custom-made TMJ prostheses are described in the most recent literature and provide facilitations in terms of ease of placement and accuracy. Although before the era of custom-made surgical guides, they did not play a prominent role in the field of TMJ surgery, their use has become mandatory when custom-made prostheses are used. Surgical guides, generally known also as cutting guides, allow the subcondylar bone cut to be performed according to the exact shape and size of the planned prostheses. Additionally, they allow the predrilling of fixation holes in the mandible to minimize errors in prostheses positioning. However, the design of surgical guides did not evolve over time as much as prostheses did. In this paper the authors critically analysed literature on this topic and described the improvements of surgical guides over time. Moreover, based on the findings of literature research, a new cutting guide system was developed and is proposed in this article., (Copyright © 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Computer aided implantology is the safest way to perform dental implants. The research of high accuracy represents a daily effort. The validated method to assess the accuracy of placed dental implants is the superimposition of a pre-operative and a post-operative cone beam computed tomography (CBCT) with planned and placed implants. This procedure is accountable for a biologic cost for the patient. To investigate alternative procedure for accuracy assessment, fifteen resin casts were printed. For each model, six implants were digitally planned and then placed following three different approaches: (a) template guided free hand, (b) static computer aided implantology (SCAI), and (c) dynamic computer aided implantology (DCAI). The placement accuracy of each implant was performed via two methods: the CBCT comparison described above and a matching between implant positions recovered from the original surgical plan with those obtained with a post-operative intraoral scan (IOS). Statistically significant mean differences between guided groups (SCAI and DCAI) and the free hand group were found at all considered deviations, while no differences resulted between the SCAI and DCAI approaches. Moreover, no mean statistically significant differences were found between CBCT and IOS assessment, confirming the validity of this new method.

Purpose: To compare the 2D and 3D positional accuracy of four guided surgical protocols using an analysis of linear and angular deviations., Methods: DICOM and .STLs files obtained from a CBCT and a digital impression were superimposed with software to plan implant position. Fifty-six patients were subdivided into 4 groups: FGA group (template support [Ts]: teeth [T]; bed preparation [Bp]: fully guided [FG]; implant insertion [Ii]: 3D template [3Dt]; device [D]: manual adapter [MA], FGM group (Ts: T; Bp: FG; Ii: 3Dt; D: fully guided mounter [FGM]), PG group (Ts: T; Bp: FG; Ii: manual; D: none) and MS group (Ts: mucosa; Bp: FG; Ii: 3Dt; D: FGM). The position of 120 implants was assessed by superimposing the planned and final position recorded with a digital impression., Results: In FGA group, 3D deviations were 0.92 ± 0.52 mm at the implant head and 1.14 ± 0.54 mm at the apex, and the angular deviation (ang. dev.) was 2.45 ± 1.24°. In FGM group, were 0.911 ± 0.44 mm (head) and 1.11 ± 0.54 mm (apex), and the ang. dev. was 2.73 ± 1.96°. In PG group, were 0.95 ± 0.47 mm (head) and 1.17 ± 0.488 mm (apex), and the ang. dev. was 3.71 ± 1.67°. In MS group, were 1.15 ± 0.45 mm (head) and 1.42 ± 0.45 mm (apex), and the ang. dev. was 4.19 ± 2.62°. Ang. dev. of MS group was different from the other groups (P < 0.05)., Conclusions: Guided surgery showed a sufficient accuracy., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: The aim of this cadaveric study was to measure the transfer accuracy of orthodontic mini-implant placement at the anterior palate depending on tooth-borne or gingiva-borne guide support., Materials and Methods: Forty orthodontic mini-implants were placed paramedian in the anterior palate of 20 cadaver heads using tooth-borne (TBG) or gingiva-borne guides (GBG). Placement was planned after superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, digital impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using automatic surface registration based on an iterative closest point algorithm., Results: Statistical differences between TBG and GBG were detected for lateral deviations 0.88 mm (SD 0.46) versus 1.65 mm (SD 1.03) (p = .004) and sagittal angular deviations 3.67° (SD 2.25) versus 6.46° (SD 5.5) (p = .043). No differences were found for vertical deviations 2.34 mm (SD 0.74) versus 2.14 mm (SD 0.73) (p = .40) and transverse angular deviations 3.60° (SD 2.89) versus 4.06° (SD 3.04) (p = .62)., Conclusions: The use of surgical guides based on silicone provides sufficient control of orthodontic mini-implant placement and is comparable to CAD/CAM templates. However, when compared with guided dental implantology, the planned mini-implant position is more inaccurate. However, accuracy can be significantly increased by guide extension involving the teeth. Clinical investigations have to prove if the accuracy is sufficient for receiving an orthodontic appliance., Clinical Relevance: The use of lateral cephalograms and plaster models for silicone guide construction leads to lower radiation exposure and provides sufficient accuracy for palatal orthodontic mini-implant placement.

The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To systematically review the current dental literature regarding clinical accuracy of guided implant surgery and to analyze the involved clinical factors., Material and Methods: PubMed and Cochrane Central Register of Controlled Trials were searched. Meta-analysis and meta-regression analysis were performed. Clinical studies with the following outcome measurements were included: (1) angle deviation, (2) deviation at the entry point, and (3) deviation at the apex. The involved clinical factors were further evaluated., Results: Fourteen clinical studies from 1951 articles initially identified met the inclusion criteria. Meta-regression analysis revealed a mean deviation at the entry point of 1.25 mm (95% confidence interval [CI]: 1.22-1.29), 1.57 mm (95% CI: 1.53-1.62) at the apex, and 4.1° in angle (95% CI: 3.97-4.23). A statistically significant difference (P < .001) was observed in angular deviations between the maxilla and mandible. Partially guided surgery showed a statistically significant greater deviation in angle (P < .001), at the entry point (P < .001), and at the apex (P < .001) compared with totally guided surgery. The outcome of guided surgery with flapless approach indicated significantly more accuracy in angle (P < .001), at the entry point (P < .001), and at apex (P < .001). Significant differences were observed in angular deviation based on the use of fixation screw (P < .001)., Conclusions: The position of guide, guide fixation, type of guide, and flap approach could influence the accuracy of computer-aided implant surgery. A totally guided system using fixation screws with a flapless protocol demonstrated the greatest accuracy. Future clinical research should use a standardized measurement technique for improved accuracy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Dental implants have been a routine part of dental practice for many years and are performed by a variety of practitioners with different backgrounds and training. This paper will outline the principles and practical surgical aspects of 'simple' implant placement against a background of our current understanding of the literature that informs our surgical procedures. Implants need to be placed in a restoratively suitable position surrounded by sufficient bone, draped in adequate keratinised soft tissue and sufficiently separated from one another and the adjacent teeth. Practically, while the above principles apply, there are nuances based on the local situation, adjacent teeth and restorative needs which will be considered in this paper. Surgery for the placement of implants needs a practitioner with adequate surgical training and experience and who understands the biological aspects and restorative needs of each clinical situation., (© 2018 Australian Dental Association.)

Previous research on the accuracy of flapless implant placement of virtually planned implants in the augmented maxilla revealed unfavourable discrepancies between implant planning and placement. By using the osteosynthesis screws placed during the augmentation procedure, the surgical template could be optimally stabilized. The purpose of this study was to validate this method by evaluating its clinically relevant accuracy. Twelve consecutive fully edentulous patients with extreme resorption of the maxilla were treated with a bone augmentation procedure. Virtual implant planning was performed and a surgical template was manufactured. Subsequently, six implants were installed using the surgical template, which was only supported by the osteosynthesis screws. Implant deviations between planning and placement were calculated. A total of 72 implants were installed. Mean deviations found in the mesiodistal direction were 0.817mm at the implant tip and 0.528mm at the implant shoulder. The angular deviation was 2.924°. In the buccolingual direction, a deviation of 1.038mm was registered at the implant tip and 0.633mm at the implant shoulder. The angular deviation was 3.440°. This study showed that implant placement in the augmented maxilla using a surgical template supported by osteosynthesis screws is accurate., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Immediate occlusal and non-occlusal loading protocols have been discussed and, despite varying success rates, are considered viable in selected cases. Preoperative implant planning and intraoperative transfer are essential to the success of implant-supported reconstructions in partially or completely edentulous jaws., Purpose: This study was performed to compare clinical outcomes of immediate occlusal versus non-occlusal loading of posterior implants., Materials and Methods: Of 19 patients with 52 screw-type implants replacing mandibular molars or premolars, nine patients with 21 implants were randomized to a study group that received immediate restorations with occlusal loading, whereas 10 patients with 31 implants were randomized to a control group that received provisional restorations without occlusal loading. Occlusal loading was defined as full loading in maximum intercuspidation. Single-tooth or splinted multiunit restorations were incorporated by screw retention or cementation. Marginal bone defects (MBD), implant survival, and implant success were evaluated 12 months after insertion., Results: Both groups revealed similar MBD levels consistent with previous reports. No implants were lost (overall survival: 100%) or found to fail (overall success: 100%). No significant intergroup differences were noted for any of the evaluated parameters., Conclusions: Immediate restorations in partially edentulous mandibles demonstrated successful clinical and radiographic 12-month results. Larger long-term prospective studies are needed to confirm the final evidence and predictability of immediate functional loading as a standard treatment concept for partially edentulous jaws., (© 2013 Wiley Periodicals, Inc.)

Purpose: The study aims to evaluate the accuracy of the NobelGuide™ (Medicim/Nobel Biocare, Göteborg, Sweden) concept maximally reducing the influence of clinical and surgical parameters. Moreover, the study was to compare and validate two validation procedures versus a reference method., Material and Methods: Overall, 60 implants were placed in 10 artificial edentulous mandibles according to the NobelGuide™ protocol. For merging the pre- and postoperative DICOM data sets, three different fusion methods (Triple Scan Technique, NobelGuide™ Validation software, and AMIRA® software [VSG - Visualization Sciences Group, Burlington, MA, USA] as reference) were applied. Discrepancies between the virtual and the actual implant positions were measured., Results: The mean deviations measured with AMIRA® were 0.49 mm (implant shoulder), 0.69 mm (implant apex), and 1.98°mm (implant axis). The Triple Scan Technique as well as the NobelGuide™ Validation software revealed similar deviations compared with the reference method. A significant correlation between angular and apical deviations was seen (r = 0.53; p < .001). A greater implant diameter was associated with greater deviations (p = .03)., Conclusion: The Triple Scan Technique as a system-independent validation procedure as well as the NobelGuide™ Validation software are in accordance with the AMIRA® software. The NobelGuide™ system showed similar or less spatial and angular deviations compared with others., (© 2013 Wiley Periodicals, Inc.)

Background: In the maxillary anterior region, differences in bone density along the drilling path can impact the accuracy of implant placement despite the use of a surgical guide. Hence, the aim of this in vitro study was to investigate the accuracy of implant placement using the over-preparation technique in different drilling environments in the maxillary anterior region. Methods: Three experimental models (a, b, and c) were designed and fabricated to simulate the following drilling environments (n = 60 each): unhealed bone, less dense bone, and dense bone after tooth extraction. The models were subjected to implant cavity preparation and placement using the over-preparation technique (group OPT) and conventional surgical guide technique (group CGT). Differences between the actual positions and the planned positions of the implants were calculated. Results: The deviations of the implants in the group OPT in Model a and Model b were significantly smaller than those in the group CGT (P < 0.05). Among the group OPT, Model c presented with the smallest deviation, followed by Model b and Model a (P < 0.05), and the CGT group showed the same trend. Conclusions: In the maxillary anterior region, differences in bone density along the drilling path can adversely affect the accuracy of implant placement. These discrepancies can be significantly minimized using the over-preparation technique. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Materials and Methods Results Conclusion Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA).Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements.A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation.Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA. [ABSTRACT FROM AUTHOR]

Introduction: Surgical guides are commonly used to assist with dental implant placement. This study investigated the effects of five sterilization and disinfection methods on the accuracy of implant guides. Methods: Thirty surgical guides (five in each group) were designed and printed (with digital light processing technology) using different sterilization or disinfection methods categorized into six groups: hydrogen peroxide sterilization (group one); glutaraldehyde sterilization (group two); autoclaving (group three); plasma sterilization (group four); iodophor disinfection (group five); and blank group (group six). Verification was determined using three methods: distance and angle between the cross‐shaped marks, deformation after superimposing the guides, and displacement and axial changes in the virtual implant. Results: After disinfection and sterilization, the guides in the autoclaving and iodophor groups showed a more pronounced color change and the guide in the autoclaving group had visible cracks. More significant changes were observed in the H2O2, glutaraldehyde, autoclaving, and iodophor groups regarding deformation after superimposing the guides and the distance and angle between the cross‐shaped marks. The average labial deformation values (mm) of the first through fifth groups of guides were 0.283, 0.172, 0.289, 0.153, and 0.188, respectively. All groups were statistically different from the blank group for displacement and axial changes of the virtual implant (p < 0.05). Conclusion: The sizes of almost all surgical guides changed after sterilization and disinfection treatments, with between‐group differences. Plasma sterilization was more suitable for surgical guide sterilization because of the smaller deformations after treatment. [ABSTRACT FROM AUTHOR]

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians. [ABSTRACT FROM AUTHOR]

Purpose: This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves). Methods: A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018–2022) were included and assessed by Newcastle–Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions. Results: Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°). Conclusions: Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) technologies can enable the direct fabrication of customized physical objects with complex shapes, based on computer-aided design models. This technology is changing the digital manufacturing industry and has become a subject of considerable interest in digital implant dentistry. Personalized dentistry implant treatments for individual patients can be achieved through Additive manufacturing. Herein, we review the applications of Additive manufacturing technologies in oral implantology, including implant surgery, and implant and restoration products, such as surgical guides for implantation, custom titanium meshes for bone augmentation, personalized or non-personalized dental implants, custom trays, implant casts, and implant-support frameworks, among others. In addition, this review also focuses on Additive manufacturing technologies commonly used in oral implantology. Stereolithography, digital light processing, and fused deposition modeling are often used to construct surgical guides and implant casts, whereas direct metal laser sintering, selective laser melting, and electron beam melting can be applied to fabricate dental implants, personalized titanium meshes, and denture frameworks. Moreover, it is sometimes required to combine Additive manufacturing technology with milling and other cutting and finishing techniques to ensure that the product is suitable for its final application.

The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was -0.31 ± 0.11 mm (mesial) and -0.28 ± 0.09 mm (distal); and in the test group was -0.35 ± 0.11 mm (mesial) and -0.33 ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. [ABSTRACT FROM AUTHOR]

Purpose: Cone beam computed tomography (CBCT) is increasingly overtaking multislice computed tomography (MSCT) for implant planning and computer-aided design/computer-assisted manufacturing (CAD/CAM) surgical guide fabrication. The purpose of this study was to evaluate whether the image modality has a significant influence on the accuracy of image-fusion stereolithographic guides. Materials and Methods: A total of 240 implants were placed in 30 polymer models using surgical guides fabricated using CBCT or MSCT and optical scanning of dental casts and diagnostic wax-up. Postsurgical image data were fused with the planning data for evaluation of the following errors: total error (Euclidean error), mesiodistal and buccolingual error, depth error, and angular error. The CBCT and MSCT results were statistically compared using a t test (P = .05). Results: CBCT showed a statistically significantly higher total error with mean (± SD) of 0.36 ± 0.13 mm vs 0.27 ± 0.13 mm (P = .000), mesiodistal error with 0.20 ± 0.14 mm vs 0.16 ± 0.11 mm (P = .018), and depth error with 0.17 ± 0.12 mm vs 0.07 ± 0.07 mm (P = .000). Buccolingual and angular errors did not statistically significantly differ with 0.16 ± 0.11 mm vs 0.15 ± 0.12 mm (P = .613), and 0.96 ± 0.47 degrees vs 0.85 ± 0.59 degrees (P = .111). Conclusion: Using CBCT for image-fusion stereolithographic guides may provide lower accuracy than MSCT. The results should be confirmed on alternative CBCT scanners. Due to the total volume of tissues, image artifacts, and patient movements, the advantages seen using MSCT on models could be nonexistent or exacerbated on patients. Patient studies are required to demonstrate clinical relevance. [ABSTRACT FROM AUTHOR]

This article explores the significance of 3D-printed surgical guides in dental implant surgery and their impact on treatment outcomes. Through a comprehensive literature review, the benefits and advancements of utilizing 3D-printed surgical guides are analyzed, highlighting their role in enhancing precision, efficiency, and success rates in dental implant procedures. [ABSTRACT FROM AUTHOR]

In patients with gingival exposure on smiling due to altered passive eruption, esthetic crown lengthening is often indicated. Meticulous planning and surgical precision are key for successful outcomes. Surgical guides are helpful tools that are seldomly reported on in the literature related to esthetic crown lengthening procedures. The authors searched the literature for articles that described the planning, tools, and execution related to esthetic crown lengthening procedures. Several techniques have been reported to guide the esthetic crown lengthening procedure, ranging from direct bone level measurement to 3-dimensional printed surgical guides. This review serves the clinician as an aid in the decision-making process for esthetic crown lengthening procedures and available surgical guide options, including computer-based guides. [ABSTRACT FROM AUTHOR]

Background: In dental implant treatment, the placement position of the implant body is important. The hypothesis is that there are factors that have a greater impact than the factors that have been studied so far. Material and Methods: The deviation between planned and actually placed implants was measured three-dimensionally by modified treatment evaluation method in 110 patients who underwent implant placement with guided surgery for partial edentulism. Ten factors that seemed to affect errors in placement were selected: the type of tooth, type of edentulism, distance from the remaining teeth, the type of implant, implant length, number of implants, method of guidance, the number of teeth supporting the surgical guide, number of anchor pins, and presence or absence of a reinforcement structure. The effect of each factor that corrected each confounding was calculated using multivariate analysis. Results: In this study, 188 implant bodies were set to target, and the errors measurement data of the implant position were as follows: average Angle, 2.5 ± 1.6° (95% CI 2.25–2.69); Base, 0.67 ± 0.37 mm (95% CI 0.62–0.72); and Apex, 0.92 ± 0.47 mm (95% CI 0.86–0.98). As the result of multivariate analysis, larger errors were present in the partially guided group than the fully guided group. The number of teeth supporting the surgical guide significantly influenced the error in placement position. The error caused by the number of anchor pins was significantly different for the Angle. Similarly, the presence of the reinforcement structure influenced the error significantly for the Angle. Conclusions: It was suggested that the smaller errors could be present by performing guided surgery with full guidance and devising the design of the guide such as the number of teeth supporting the surgical guide, the setting of the anchor pin, and the reinforcement structure. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was twofold: (1) to estimate the level of microbial contamination found on commercial guides (CG) and in-house laboratory guides (LG) prior to use, and (2) to evaluate the antimicrobial potential of disinfectants commonly used in dentistry to decontaminate heat-sensitive surgical guides. Ethylene oxide gas was used as the positive control; sterile water served as a negative control. Materials and Methods: Evaluation of CGs and LGs for bacterial contamination occurred soon after their arrival in the laboratory. Some guides went directly into tubes of trypticase soy broth solution, vortexed and equally divided into two tubes. One tube went into an 80°C bath for 19 minutes, while the other stayed at room temperature. After plating, half of the samples underwent anaerobic incubation. All incubation was for 48 hours at 37°C. Other guides underwent water rinsing or disinfection by various methods for 5 or 15 minutes or ethylene oxide gas sterilization prior to sampling. Results: Untreated CG specimens showed modest levels of bacterial contamination, with most colonies coming from liquid specimens not exposed to 80°C. LG specimens had more bacteria from both heat-treated and non-heat-treated aliquots. Chlorhexidine gluconate, diluted bleach, and water rinsing were not able to completely eliminate microorganisms on the specimens, but no viable microorganisms were present on specimenstreated with gas sterilization or 70% ethanol for 15 minutes. Conclusion: CGs and LGs, on average, had different levels of bacterial contamination prior to disinfection. Water, chlorhexidine gluconate, and diluted bleach were not totally successful in decontaminating the surgical guides, but no growth was found after 15 minutes of immersion in 70% ethanol. Preferably, surgical guides should be submerged in 70% alcohol for a minimum of 15 minutes or undergo sterilization using ethylene oxide gas. [ABSTRACT FROM AUTHOR]

Objective: To test if using a CAD/CAM system might reduce the necessity of bone augmentation in patients with atrophic maxillary arches before implant therapy. Method and Materials: Twenty male and female patients consecutively scheduled for bone augmentation of the jaw before implant surgery were included in this study, with a total of 29 jaws (maxillary and mandibular) to analyze for the implant-supported fixed prosthesis group and 19 maxillary arches for the implant-supported removable prosthesis group. NobelGuide System (Nobel Biocare), Autocad System (Autodesk), and routine manual CT measurements of available bone were used in this study. Results: The total results of the mean values of the fixed prosthesis group plus the mean values of the removable prosthesis group showed a statistically significant difference between the NobelGuide intervention score and both manual (P = .004) and Autocad (P = .001) measurements. Conclusions: The NobelGuide System represents a viable diagnostic device to reduce the entity or avoid bone reconstructive surgery before implant placements in the atrophic maxilla and mandible. [ABSTRACT FROM AUTHOR]

Highlights • The part printing orientation and position influence its accuracy and flexural properties. • Inaccuracies up to 10% may occur along the Z-axis. • Part polymerization with different curing units is unlikely to affect its properties. Abstract Objective To evaluate the influence of printing parameters on flexural properties and accuracy of SLA-printed standard objects. Methods Thirty specimens were printed in 0°, 45° and 90° orientation. Fourth nine more specimens were printed evenly on the build platform. forty more specimens were printed and polymerized with three curing unit. Length, height and width was measured three times for each specimen and compared to the original dimensions. Afterwards all specimens underwent a three-point-bending test to assess their flexural properties. One way ANOVA and the Post-Hoc all pairs Tukey–Kramer HSD test were used for data evaluation. Results The print orientation influences the printing accuracy. The parameters printed along the Z-axis are particularly prone to inaccuracies. Specimens with 45° orientation were found to be the most accurate. Object printed on the borders of build platform a rather prone to inaccuracies than those in the center. The 90° specimens with layer orientation parallel to the axial load showed the superior flexural strength and flexural modulus. The use of different curing unit is unlikely to affect the objects printing accuracy and flexural properties. Significance The anisotropical behavior of printed specimens with regards to build orientation and positioning was revealed. The understanding of how the adjustable printing parameter influence the printing outcome is important for a precise fabrication of surgical guides. Inaccuracies up to 10% along the Z-axis, as revealed in the present study,may restrict an accurate implant placement. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to determine the clinically relevant accuracy of implant placement in the augmented maxilla using computer planning and a mucosa-supported surgical template. Materials and Methods Twenty-five consecutive edentulous patients with an extreme maxillar alveolar ridge resorption were treated with a bone augmentation procedure. In a second stage, six Brånemark MkIII Groovy ( Nobel Biocare®, Zürich, Switzerland) implants were installed. Preoperatively, a cone beam computer tomography ( CBCT) scan was acquired, followed by virtual implant planning and flapless implant placement using a surgical template. A postoperative CBCT scan was acquired and registered to the preoperative scan. The Implant Position Orthogonal Projection validation method was applied to measure implant deviations in both the buccolingual and mesio-distal plane. The influence of fixation pins and the position on the dental arch were investigated with regard to implant deviations, and rotations and translations of the surgical template. Results One hundred fifty implants were installed. In mesio-distal direction, a mean implant deviation of 1.50 mm was scored at the implant tip, 1.27 mm at the shoulder, −0.60 mm in depth, as well as a mean deviation of angulation of 2.50°. In buccolingual direction, a mean implant deviation of 0.99 mm was found at the implant tip, 0.76 mm at the implant shoulder, −0.57 mm in depth, and a deviation of angulation of 2.48°. Of all implants, 53% was placed too superficial compared with the planning. The use of fixation pins and implant deviations in both buccal and mesial directions as also for rotations and translation of the surgical template showed statistically significant differences. Conclusions Computer-aided implant planning showed to be a clinically relevant tool. However, this study emphasizes that the surgeon should take into account that deviations are larger compared with implant placement without augmentation procedure. Deviations are mainly caused by angulations and translations of the surgical template. [ABSTRACT FROM AUTHOR]

Objectives To examine the accuracy of computer-guided implantation using a human cadaver model with reduced experimental variability. Materials and methods Twenty-eight (28) dental implants representing 12 clinical cases were placed in four cadaver heads using a static guided implantation template. All planning and surgeries were performed by one clinician. All radiographs and measurements were performed by two examiners. The distance of the implants from buccal and lingual bone and mesial implant or tooth was analyzed at the apical and coronal levels, and measurements were compared to the planned values. Results No significant differences were seen between planned and implanted measurements. Average deviation of an implant from its planning radiograph was 0.8 mm, which is within the range of variability expected from CT analysis. Conclusions Guided implantation can be used safely with a margin of error of 1 mm. [ABSTRACT FROM AUTHOR]

Background Computer-assisted implant surgery usually requires a radiographic scan template as the basis for prosthetic-driven implant planning and surgical guide fabrication. Purpose The study aims to evaluate the accuracy of image-fusion stereolithographic guides in which a computed tomography ( CT) scan is mapped with three-dimensional optical scans of cast and diagnostic wax-up. Materials and Methods Three-dimensional error at the base and tip of the implants, angular deviation of the implant-axis, and the inserting-depth error of 120 implants with a length of 10 mm and a caliber of 4.1 mm in 15 polymer-models were examined. A control CT was performed and fused with the planning data for accuracy evaluation. Results The mean three-dimensional error was 0.21 ± 0.10 mm (0.00-0.48 mm) at the implant base, 0.32 ± 0.17 mm (0.03-0.75 mm) at the implant tip, and the mean angular error was 0.85 ± 0.59° (0.00-2.50°). The mean depth error was 0.07 ± 0.07 mm (0.00-0.32 mm). Conclusions Within the limitations of an in vitro study, the novel technique showed excellent accuracy. Errors from fabrication and scanning of a radiographic scan template can be avoided, and the workflow and costs of computer-assisted implant surgery may be reduced. [ABSTRACT FROM AUTHOR]

Background Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. Purpose The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. Materials and Methods Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography ( CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score ( PES). Results Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 ( p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations ≥ 0.8 mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [ IQR]: 8-11) compared with more accurate implant positions (median PES: 13, IQR: 12-13, p = .039). Conclusion Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla. [ABSTRACT FROM AUTHOR]

Prosthetically driven implant prosthesis assures good aesthetics, function and more importantly hygiene maintenance enabling long time success. Accuracy in treatment planning and implementation of planned treatment is vital for this success. Following advancements that have occurred in treatment planning (virtual software) for implant prosthesis; an equal rise is to be expected in transferring the planned therapy to surgical fruition. In this regard, surgical templates have enabled clinician to deliver predictable surgical & prosthetic rehabilitation. Surgical guides have not only decreased the chances of iatrogenic damage of critical anatomic structures; they also increase the esthetic and functional advantages of prosthodontic-driven implant. Within the constraints of this article, the authors describes an over view of use of surgical guides in clinical situation. If clinician is considered a pilot, then surgical guide is his navigator. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement. Materials and methods: On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration. Results: The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 μm even at the apical end. Mean angle deviations of 1.18° were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations. Conclusion: Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning. [ABSTRACT FROM AUTHOR]