Clinical accuracy of flapless computer-guided surgery for implant placement in edentulous arches.
OBJECTIVE
Although flapless computer-guided implant placement provides important benefits, deviations from the planned implant placement in the edentulous arch may pose significant risks. This study evaluated the reliability and accuracy of a flapless computer-guided surgical approach.


METHODS
Computer-generated preoperative implant planning was compared to actual placement by cone-beam computerized tomography (CBCT) scanning of patients before and after surgery. A well-fitting complete denture or optimized prosthetic tooth arrangement was used and converted to a radiographic template. Prior to scanning, esthetics and functional aspects were checked clinically. The implant positions were virtually determined by the implant planning software relative to the bone structure and prospective tooth position. After implant placement, new CBCT scans were obtained for each subject. Software was used to fuse the images of the planned and placed implants, and the locations and axes were compared. The normality of the data distribution was evaluated by the Kolmogorov-Smirnov test. Mean values were compared between groups based on the upper or lower jaws with the t test for independent samples. The level of significance was fixed at 5%.


RESULTS
Sixty-two implants were placed in edentulous arches with stereolithographic surgical guides in 14 patients. Damage due to implant placement was not observed in any critical anatomical structure. Compared to the planned implants, placed implants showed mean and standard deviation linear measurements at the cervical, middle, and apical implant portions of 2.17 (± 0.87), 2.32 (± 1.52), and 2.86 (± 2.17) mm, for the maxilla, and 1.42 (± 0.76), 1.42 (± 0.76), and 1.42 (± 0.76) mm, for the mandible, respectively. The angular deviations were 1.93 (± 0.17) and 1.85 (± 0.75) degrees for the maxilla and mandible, respectively. The linear deviation differed significantlybetween the upper and lower jaws, but the angular deviation did not.


CONCLUSIONS
Flapless computer-guided surgery may be a viable treatment option for rehabilitating the edentulous arch.
Dalton Marinho
DM
Vieira
Bruno Salles
BS
Sotto-Maior
Carlos Alberto Villaça de Souza
CA
Barros
Elson Simões
ES
Reis
Carlos Eduardo
CE
Francischone
D001863:Bone Screws; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008334:Mandible; D008437:Maxilla; D009066:Mouth, Edentulous / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012984:Software; D018709:Statistics, Nonparametric; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods* / Q000592:standards