Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study.
BACKGROUND
Stereolithographic surgical guides provide significant benefits during the simultaneous placement of multiple implants with regard to the final prosthetic plan. However, deviation from the planning poses a significant risk. Deviations of implants that were placed by bone-, tooth-, and mucosa-supported stereolithographic surgical guides were examined in this study.


METHODS
After enrolling 54 eligible patients, 294 implants were planned on cone-beam computerized tomography CB(CT)-derived images. Sixty guides, both single- and multiple-type, were produced using two commercial systems. Mucosa-supported guides were fixed with osteosynthesis screws. Implants were inserted, and at the end of osseointegration period, a new CB(CT) scan was performed. Preoperative planning was merged with the new CB(CT) data to identify the deviations between the planned and placed implants for each support type and manufacturer. The Kruskal-Wallis and Mann-Whitney U tests were used for comparison (P <0.05).


RESULTS
There were no damage-related complications in any critical anatomy. Implants that were placed by bone-supported guides had the highest mean deviations (5.0 degrees +/- 1.66 degrees angular, and 1.70 +/- 0.52 mm and 1.99 +/- 0.64 mm for implant shoulder and tip, respectively), whereas the lowest deviations were measured in implants that were placed by mucosa-supported guides (2.9 degrees +/- 0.39 degrees angular, and 0.7 +/- 0.13 mm and 0.76 +/- 0.15 mm for implant shoulder and tip, respectively).


CONCLUSIONS
Computer-aided planning and manufacturing surgical guides in accordance with CB(CT) images may help clinicians place implants. Rigid screw fixation of a single guide incorporating metal sleeves and a special drill kit further minimizes deviations.
Arisan
Volkan
V
Department of Oral Implantology, Faculty of Dentistry, Istanbul University, 34390 Capa, Istanbul, Turkey. varisan@istanbul.edu.tr
Karabuda
Z Cuneyt
ZC
Ozdemir
Tayfun
T
D000328:Adult; D000368:Aged; D017076:Computer-Aided Design / Q000295:instrumentation*; D054893:Cone-Beam Computed Tomography; D003758:Dental Implantation, Endosseous / Q000295:instrumentation* / Q000379:methods; D015921:Dental Implants; D017267:Dental Prosthesis Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007576:Jaw, Edentulous, Partially / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D003765:Models, Dental; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D010347:Patient Care Planning; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
D015921:Dental Implants