title: Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation.
abstract: BACKGROUND
  Computer-aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation.
  
  
  METHODS
  Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented.
  
  
  RESULTS
  The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively.
  
  
  CONCLUSIONS
  The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer-aided dental implant surgery still requires improvement and should be considered as in the developmental stage.
authors.affiliation: Department of Diagnostic Imaging, School of Medicine, Federal University of São Paulo, São Paulo, Brazil. giovannidi@uol.com.br
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Di Giacomo
authors.forename: Jorge V
authors.initials: JV
authors.lastname: da Silva
authors.forename: Airton M
authors.initials: AM
authors.lastname: da Silva
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Paschoal
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Cury
authors.forename: Gilberto
authors.initials: G
authors.lastname: Szarf
mesh_terms: D000328:Adult; D000368:Aged; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003724:Dental Arch / Q000473:pathology; D003758:Dental Implantation, Endosseous / Q000295:instrumentation*; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D005891:Gingivitis / Q000209:etiology; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000379:methods*; D007574:Jaw Relation Record / Q000295:instrumentation; D007834:Lasers; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D010149:Postoperative Pain / Q000209:etiology; D010347:Patient Care Planning; D011183:Postoperative Complications; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface
chemical_list: D015921:Dental Implants