Performance of novice versus experienced surgeons for dental implant placement with freehand, static guided and dynamic navigation approaches.

Lack of evidence exists related to the investigation of the accuracy and efficacy of novice versus experienced practitioners for dental implant placement. Hence, the following in vitro study was conducted to assess the accuracy of implant positioning and self-efficacy of novice compared to experienced surgeons for placing implant using freehand (FH), pilot drill-based partial guidance (PPG) and dynamic navigation (DN) approaches. The findings revealed that DN significantly improved the angular accuracy of implant placement compared with FH (P < 0.001) and PPG approaches (P < 0.001). The time required with DN was significantly longer than FH and PPG (P < 0.001), however, it was similar for both novice and experienced practitioners. The surgeon's self-confidence questionnaire suggested that novice practitioners scored higher with both guided approaches, whereas experienced practitioners achieved higher scoring with PPG and FH compared to DN. In conclusion, implant placement executed under the guidance of DN showed high accuracy irrespective of the practitioner's experience. The application of DN could be regarded as a beneficial tool for novices who offered high confidence of using the navigation system with the same level of accuracy and surgical time as that of experienced practitioners.

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches.

PURPOSE: This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches. METHODS: A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. Each practitioner inserted 4 implants per approach randomly with a 1-week gap to avoid memory bias (4 insertion sites × 3 approaches × 6 practitioners = 72 implants). The performance of practitioners was assessed by comparing actual implant deviation to the planned position, time required for implant placement and questionnaire-based self-confidence evaluation of practitioners on a scale of 1-30. RESULTS: The navigation approach significantly improved angular deviation compared with freehand (P < 0.001) and surgical guide (P < 0.001) irrespective of the experience. Surgical time with navigation was significantly longer compared to the freehand approach (P < 0.001), where experienced practitioners performed significantly faster compared to novice practitioners (P < 0.001). Overall, self-confidence was higher in favor of novice practitioners with both guided approaches. In addition, the confidence of novice practitioners (median score = 26) was comparable to that of experienced practitioners (median score = 27) for placing implants with the navigation approach. CONCLUSIONS: Dynamic navigation system could act as a viable tool for dental implant placement. Unlike freehand and static-guided approaches, novice practitioners showed comparable accuracy and self-confidence to that of experienced practitioners with the navigation approach.

Conservative management of large mandibular dentigerous cysts with a novel approach for follow up: Two case reports.

BACKGROUND: Dentigerous cysts are odontogenic cysts of the jaws accounting for approximately 24% of all epithelium-lined jaw cysts. Rarely, these cysts can become extremely large causing additional symptoms, while challenging treatment. This article represents a novel approach for radiological treatment follow up of large dentigerous cysts. MATERIAL AND METHODS: Dentigerous cysts were treated by marsupialization, using dedicated obturators and enucleation of the cyst afterwards. Teeth vitality in the lesion was regularly assessed by laser doppler flowmetry, follow-up of lesion regression was accomplished using semi-automatic radiographic analysis of bone healing quantification. RESULTS: Cystic marsupialization by means of the obturator resulted in a number of advantages compared to a conventional approach: lower risk of spontaneous fracture of the mandible, anatomical structure preservation, mandibular canal identification and preservation of tooth vitality as measured by intraoral laser doppler flowmetry. Notwithstanding that a 1-year follow-up panoramic image could not visualize a remnant bone defect nor cystic lesion recurrence, 3D-CBCT based semi-automated bone quantification could only demonstrate an increase of 46% of mineralized bone volume one year after surgery. Bone healing typically occurred starting from the periphery of the original lesion towards the inner core. CONCLUSIONS: The presently reported cystic marsupialization was useful as a preliminary treatment for subsequent enucleation. 3-D CBCT based objective quantification of the bone volume and healing can provide new insights in lesion healing in general and more particular in the outcome of specific diagnostic and therapeutic challenges.

Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study.

OBJECTIVES: The aim of this study was to validate a standardized pragmatic approach to manage new oral anticoagulants (NOACs) in patients who undergo dental extractions. MATERIALS AND METHODS: This prospective case-control study in patients undergoing dental extraction included 26 patients (mean age 76 years, 57% male) treated with dabigatran, rivaroxaban, or apixaban and 26 matched controls. Regardless of timing of extraction, drug regimen, or renal function, patients were instructed to skip only the dose on the morning of the procedure. A procedural bleeding score was recorded and early and delayed bleeding was assessed at day 1 and day 7. Bleeding events were compared with a prospectively matched control group not taking any antithrombotic drug. RESULTS: There was no difference in the procedural bleeding score or in early bleeding events (5 in both groups). However, delayed bleeding occurred more frequently in anticoagulated compared to non-anticoagulated patients (7 versus none, p = 0.01). CONCLUSIONS: Skipping the morning dose of NOACs avoids excess bleeding during and early after the procedure. However, anticoagulated patients had an increased risk of delayed bleedings. Further study is needed to determine the optimal post-procedural management. CLINICAL RELEVANCE: This is the first prospective study for the management of patients on NOACs undergoing dental extraction. Our pragmatic approach, omitting only a single morning dose, can guide clinical practice. Both patients and physicians should be aware of the increased delayed bleeding risk.

Intraoperative Computed Tomography in Bilateral Sagittal Split Osteotomy.

OBJECTIVES: The objective of the study was to show the importance of intraoperative computed tomography as an aid for ensuring inferior alveolar nerve safety during bilateral sagittal split osteotomy. MATERIALS AND METHODS: This study included ten patients who underwent bilateral sagittal split osteotomy procedure. All patients were treated for orthognathic reasons. The unerupted lower third molars, if present, were removed at least 6 months prior to Sagittal Split Osteotomy. The Sagittal Split Osteotomy surgical technique was previously described in detail. Each patient underwent computed tomography with an Artis Zeego multi-axis system (Siemens AG, Healthcare Sector, Henkestrasse 127 D-91052 Erlangen, Germany) at the beginning of the operation and immediately after placement of the osteosynthesis plates and screws. The neurosensory tests consisted of a light touch test using the 5.07/10-g Semmes Weinstein monofilament (Stoelting Co, Wood Dale, IL), and patient self-reporting. RESULTS: Eight (80 %) patients presented with hypoesthesia of lower lip at 6 weeks follow up. At 6 month follow up only two patients (20 %) presented with diminished sensation in the lower lip. Labial sensibility was normal in all patients at the last follow-up visit. CONCLUSION: Intraoperative computed tomography enables immediate assessment of treatment and the option to modify the treatment if necessary. Our results indicate that intra-operative computed tomography would be a helpful procedure during orthognathic surgery to improve the postoperative health of the inferior alveolar nerve.

Accuracy of a Dedicated Bone-Supported Surgical Template for Dental Implant Placement with Direct Visual Control.

The aim of this study is to evaluate feasibility and accuracy of dental implant placement utilizing a dedicated bone-supported surgical template. Thirty-eight implants (sixteen in maxilla, twenty-two in mandible) were placed in seven fully edentulous jaws (three maxillae, four mandibles) guided by the designed bone-supported surgical template. A voxel-based registration technique was applied to match pre- and post-operative CBCT scans. The mean angular deviation and mean linear deviation at the implant hex and apex were 6.4 ± 3.7° (0.7°-14.8°), 1.47 ± 0.64 mm (0.5-2.56 mm) and 1.70 ± 1.01 mm (0.71-4.39 mm), respectively. The presented bone-supported surgical template showed acceptable accuracy for clinical use. In return for reduced accuracy, clinicians gain accessibility when using this type of surgical template for both the maxilla and the mandible. This is particularly important in patients with reduced mouth opening.