ABSTRACT
@#The standardized workflow of computer-aided static guided implant surgery includes preoperative examination, data acquisition, guide design, guide fabrication and surgery. Errors may occur at each step, leading to irreversible cumulative effects and thus impacting the accuracy of implant placement. However, clinicians tend to focus on factors causing errors in surgical operations, ignoring the possibility of irreversible errors in nonstandard guided surgery. Based on the clinical practice of domestic experts and research progress at home and abroad, this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection, data collection, guide designing and manufacturing and describes strategies to resolve errors so as to gain expert consensus. Consensus recommendation: 1. Preoperative considerations: the appropriate implant guide type should be selected according to the patient's oral condition before surgery, and a retaining screw-assisted support guide should be selected if necessary. 2. Data acquisition should be standardized as much as possible, including beam CT and extraoral scanning. CBCT performed with the patient’s head fixed and with a small field of view is recommended. For patients with metal prostheses inside the mouth, a registration marker guide should be used, and the ambient temperature and light of the external oral scanner should be reasonably controlled. 3. Optimization of computer-aided design: it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers. Properly designing the retaining screws, extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors. 4. Improving computer-aided production: it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postprocessing procedures.
ABSTRACT
A 63-year-old male patient, who had a severely resorbed edentulous maxillary arch and partially edentulous mandibular arch decided on the implant-supported fixed treatment option to replace the edentulous maxillary arch. The fully guided implant placement that utilizes the computer-generated guide is more accurate than traditional surgical guides and free-hand placements. The researchers have correlated possible implant failure risk factors with age, sex, smoking, type of edentulism, bone quality and volume, implant location, angulation, diameter, length, and various systemic factors. This case report demonstrated the failure cause of virtually planned anterior implants in All-on-4 and how to manage it by free-hand surgery without surgical guides.
ABSTRACT
PURPOSE: The image registration of radiographic image and digital surface data is essential in the computer-guided implant guide system. The purpose of this study was to examine the effects of using micro-screw on the working time and convenience of operators in the process of image matching for guided implant surgery. MATERIALS AND METHODS: A mandibular dental model was prepared in partial edentulism for Kennedy class I classification. Two micro-screws were placed on the each side of retromolar area. Radiographic and scan images were taken using computed-tomography and digital scanning. The images were superimposed by 12 operators in software in two different conditions: using remaining teeth image alone and using teeth and micro-screws images. Working time, operator convenience and satisfaction were obtained, and analyzed using the Mann-Whitney U test (α=.05). RESULTS: The working time was not statistically different between image registration conditions (P>.05); however, operator convenience and satisfaction were higher in the teeth and micro-screw assisted condition than in the teeth-alone assisted condition (P<.001). CONCLUSION: The use of microscrew for the image registration has no effect in working time reduction, but improves operator convenience and satisfaction.
Subject(s)
Classification , Models, Dental , ToothABSTRACT
Computer aided design and manufacturing and implant surgery using a guide template improve restoration-driven implant treatment procedures. This case utilized those digital technologies to make definitive prostheses for a patient. According to the work flow of digital dentistry, cone beam computed tomography established the treatment plan, which was followed to make the guide template for implant placement. The template guided the implants to be installed as planned. The customized abutments and surveyed fixed restorations were digitally designed and made. The metal framework of the removable partial denture was cast from resin pattern using an additive manufacturing technique, and the artificial resin teeth were replaced with the zirconia onlays for occlusal stability. These full mouth rehabilitation procedures provided functionally and aesthetically satisfactory results for the patient.