Guided surgery with tooth-supported templates for single missing teeth: A critical review.
To systematically scrutinise the scientific literature to evaluate the accuracy of computer-guided implant placement for single missing teeth, as well as to analyse the eventual clinical advantages and treatment outcomes.



The electronic and manual literature search of clinical studies published from January 2002 up to November 2015 was carried out using specified indexing terms. Outcomes were accuracy; implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); plaque score (PS); pink esthetic score [PES]; aesthetic and clinical outcomes.



The search yielded 1027 relevant titles and abstracts, found during the electronic (n = 1020) and manual (n = 7) searches. After data extraction, and screening of titles, abstracts, and full-texts, 32 studies fulfilled inclusion criteria and were included in the critical review: two randomised controlled clinical trials, six prospective observational single cohort studies, one retrospective observational study, three in vitro comparative studies, 10 case reports and 10 systematic reviews. A total of 209 patients (18 to 67 years old) were treated with 342 implants using computer-guided implant surgery. The follow-up ranged from 12 to 52 months. The cumulative survival rate ranged from 96.5% to 100%. Eleven implant planning softwares and guided surgery systems were used and evaluated.



Computer-guided surgery for single missing teeth provides comprehensive treatment planning, reliable implant positioning, favourable clinical outcomes and aesthetics. A tooth-supported template for the treatment of single missing teeth results in greater accuracy of implant positioning than with mucosa-supported or bone-supported templates. The limited scientific evidence available suggests that guided surgery leads to implant survival rates as good as conventional freehand protocols. Computer-guided surgery implies additional costs, that should be analysed in terms of cost-effectiveness, considering the reduction of surgery time, postoperative pain and swelling, as well as, the potential increased accuracy. Long-term randomised clinical trials are eagerly needed to investigate the clinical performance of guided surgery in partially edentate patients.
Alessandro
A
Pozzi
Giovanni
G
Polizzi
Peter K
PK
Moy
D016301:Alveolar Bone Loss / Q000145:classification; D003758:Dental Implantation, Endosseous / Q000295:instrumentation*; D019250:Dental Implants, Single-Tooth; D003774:Dental Plaque Index; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D006801:Humans; D010512:Periodontal Index; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016019:Survival Analysis; D016388:Tooth Loss / Q000601:surgery; D016896:Treatment Outcome