title: An Accuracy Study of Computer-Planned Implant Placement in the Augmented Maxilla Using Mucosa-Supported Surgical Templates.
abstract: OBJECTIVE
  The purpose of this study was to determine the clinically relevant accuracy of implant placement in the augmented maxilla using computer planning and a mucosa-supported surgical template.
  
  
  METHODS
  Twenty-five consecutive edentulous patients with an extreme maxillar alveolar ridge resorption were treated with a bone augmentation procedure. In a second stage, six Brånemark MkIII Groovy (Nobel Biocare®, Zürich, Switzerland) implants were installed. Preoperatively, a cone beam computer tomography (CBCT) scan was acquired, followed by virtual implant planning and flapless implant placement using a surgical template. A postoperative CBCT scan was acquired and registered to the preoperative scan. The Implant Position Orthogonal Projection validation method was applied to measure implant deviations in both the buccolingual and mesio-distal plane. The influence of fixation pins and the position on the dental arch were investigated with regard to implant deviations, and rotations and translations of the surgical template.
  
  
  RESULTS
  One hundred fifty implants were installed. In mesio-distal direction, a mean implant deviation of 1.50 mm was scored at the implant tip, 1.27 mm at the shoulder, -0.60 mm in depth, as well as a mean deviation of angulation of 2.50°. In buccolingual direction, a mean implant deviation of 0.99 mm was found at the implant tip, 0.76 mm at the implant shoulder, -0.57 mm in depth, and a deviation of angulation of 2.48°. Of all implants, 53% was placed too superficial compared with the planning. The use of fixation pins and implant deviations in both buccal and mesial directions as also for rotations and translation of the surgical template showed statistically significant differences.
  
  
  CONCLUSIONS
  Computer-aided implant planning showed to be a clinically relevant tool. However, this study emphasizes that the surgeon should take into account that deviations are larger compared with implant placement without augmentation procedure. Deviations are mainly caused by angulations and translations of the surgical template.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Luc M
authors.initials: LM
authors.lastname: Verhamme
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|Department of Implantology and Periodontology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Meijer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Stefaan J
authors.initials: SJ
authors.lastname: Bergé
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Rik A
authors.initials: RA
authors.lastname: Soehardi
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Tong
authors.initials: T
authors.lastname: Xi
authors.affiliation: Department for Health Evidence, Biostatistics group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Anton F J
authors.initials: AF
authors.lastname: de Haan
authors.affiliation: Nobel Biocare c/o Medicim NV, Mechelen, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Schutyser
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Thomas J J
authors.initials: TJ
authors.lastname: Maal
mesh_terms: D000368:Aged; D000540:Alveolar Ridge Augmentation; D016025:Bone Transplantation / Q000379:methods; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography; D003758:Dental Implantation, Endosseous / Q000379:methods*; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007575:Jaw, Edentulous / Q000534:rehabilitation; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
keywords: CAD/CAM technology; accuracy; atrophic maxilla; bone augmentation; computer-assisted; cone beam CT; edentulous maxilla; flapless implant surgery; sinus floor elevation; surgical guides