A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template.
OBJECTIVE
To assess the accuracy of guided surgery (mucosa and bone-supported) compared to mental navigation or the use of a surgical template, in fully edentulous jaws, in a randomized controlled study.


METHODS
Fifty-nine patients (72 jaws), requiring four to six implants (maxilla or mandible), were consecutively recruited and randomly assigned to one of the following treatment groups; guidance via Materialise Universal(®)/mucosa, Materialise Universal(®)/bone, Facilitate™/mucosa, Facilitate™/bone, or mental navigation or a pilot-drill template. The precision was assessed by matching the planning computed tomography (CT) with a post-operative cone beam CT.


RESULTS
A significant lower mean deviation at the entry point (1.4 mm, range: 0.3-3.7), at the apex (1.6 mm, range: 0.2-3.7) and angular deviation (3.0°, range: 0.2-16°) was observed for the guiding systems when compared to mental navigation (2.7 mm, range: 0.3-8.3; 2.9 mm, range: 0.5-7.4 and 9.9°, range: 1.5-27.8) and to the surgical template group (3.0 mm, range: 0.6-6.6; 3.4 mm, range: 0.3-7.5 and 8.4°, range: 0.6-21.3°). Differences between bone and mucosa support or type of guidance were negligible. Jaw and implant location (posterior-anterior, left-right), however, had a significant influence on the accuracy when guided.


CONCLUSIONS
Based on these findings, guided implant placement appears to offer clear accuracy benefits.
Department of Periodontology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
Marjolein
M
Vercruyssen
Catherine
C
Cox
Wim
W
Coucke
Ignace
I
Naert
Reinhilde
R
Jacobs
Marc
M
Quirynen
D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007575:Jaw, Edentulous / Q000601:surgery*; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D010347:Patient Care Planning; D016037:Single-Blind Method; D012907:Smoking; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery
D015921:Dental Implants
accuracy; dental implant; stereolitography; surgical template; three-dimensional imaging