References
CAD CAM drilling guides for transferring CT-based digital planning to flapless placement of oral implants in complex cases. Valente F, Sbrenna A, Buoni C dott@valente.com The medical field is experiencing a robust trend toward minimally invasive surgical procedures. This is made possible by the improvement of both diagnostic and operating equipment. In oral implantology this trend is now mainstream thanks to the integration of CT scans, digital treatment planning software and smart oral appliances that exactly transfer the computerized planning to the surgical field. The present prospective clinical study shows how this approach may be useful also in complex, multi-implant cases. 56 Brånemark System MKIV TiuniteTM implants have been inserted 14 patients with Minimally Invasive Computer-Aided Implant Surgery and followed for 1 year. The implant success rate was 98,3% demonstrating that this approach is a predictable procedure. At the same time intraoperative and postoperative morbidity proved to be minimal leading to a greater patient satisfaction. Publication Types:
State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Guerrero ME, Jacobs R, Loubele M, Schutyser F, Suetens P, van Steenberghe D. Oral Imaging Center, School for Dentistry, Oral Pathology and Maxillofacial Surgery, Katholieke Universiteit Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium. Orofacial diagnostic imaging has grown dramatically in recent years. As the use of endosseous implants has revolutionized oral rehabilitation, a specialized technique has become available for the preoperative planning of oral implant placement: cone beam computed tomography (CT). This imaging technology provides 3D and cross-sectional views of the jaws. It is obvious that this hardware is not in the same class as CT machines in cost, size, weight, complexity, and radiation dose. It is thus considered to be the examination of choice when making a risk-benefit assessment. The present review deals with imaging modalities available for preoperative planning purposes with a specific focus on the use of the cone beam CT and software for planning of oral implant surgery. It is apparent that cone beam CT is the medium of the future, thus, many changes will be performed to improve these. Any adaptation of the future systems should go hand in hand with a further dose optimalization.
Comparison of static and dynamic computer-assisted guidance methods in
implantology.
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| 5: Int J Oral Maxillofac Implants. 2006 Mar-Apr;21(2):298-304. |
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Effect of flapless surgery on pain experienced in implant placement using an image-guided system.
Fortin T, Bosson JL, Isidori M, Blanchet E.
Department of Oral Surgery, Dental University of Lyon, France. Thomas.fortin@rockefeller.univ-lyon1.fr
PURPOSE: The aim of this study was to compare the pain experienced after implant placement with 2 different surgical procedures: a flapless surgical procedure using an image-guided system based on a template and an open-flap procedure. MATERIALS AND METHODS: The study population consisted of 60 patients who were referred for implant placement. One group consisted of 30 patients who were referred for the placement of 80 implants and treated with a flapless procedure. The other group consisted of 30 patients who were referred for the placement of 72 implants with a conventional procedure. Patients were selected randomly. They were requested to fill out a questionnaire using a visual analog scale (VAS) to assess the pain experienced and to indicate the number of analgesic tablets taken every postoperative day from the day of the surgery (DO) to 6 days after surgery (D6). RESULTS: The results showed a significant difference in pain measurements, with higher scores on the VAS with open-flap surgery (P < .01). Pain decreased faster with the flapless procedure (P = .05). The number of patients who felt no pain (VAS = 0) was higher with the flapless procedure (43% at DO versus 20%). With the flapless procedure, patients took fewer pain tablets (P = .03) and the number of tablets taken decreased faster (P = .04). DISCUSSION: Minimally invasive procedures may be requested by patients to reduce their anxiety and the pain experienced and thus increase the treatment acceptance rate. CONCLUSION: With the flapless procedure, patients experienced pain less intensely and for shorter periods of time.
Publication Types:
- Randomized Controlled Trial
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6: Eur J Impl Prosth. 2006 Jan-Apr;1(2):15-25 |
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Precision of
CAD-CAM stereolithographic mucosa-supported drilling guides in flapless
implant placement.
[Article in English, Italian; dott@valente.com]
Valente F, Buoni C, Scarfò B, Mascolo A,
Parducci F.
AIM:
CAD-CAM technology has made interactive Ctbased planning software possible,
which virtually reproduces the ideal position of fixtures by means of
stereolithographic drilling guides. The aim of this study was to assess the
precision of this method for the rehabilitation of edentulous mandibles
using mucosa supported guides without osteosynthesis screws. MATERIALS AND
METHODS: CAT scan of an edentulous epoxy mandible with rubber gum surface
was taken, on which ten implant sites had previously been created with a
parallelometer filled with a mixture of coloured resin and barium sulphate
powder. A software was used to select the single implant sites and
superimpose on them ten virtual implants. Three stereolithographic
mucosa-supported surgical guides were used to make ten new closed
osteotomies. Subsequently a new CT was taken and a software comparative
analysis and a clinical one between the first osteotomies and the second
ones were carried out. RESULTS: A good correspondence at the implant head
between the centre of the first osteotomy and the second one was detected as
well as differences between their inclinations. CONCLUSIONS: The differences
between the osteotomies made with the parallelometer and the second ones
show the lobate shape of the osteotomies and that the distance between the
two centres is more marked at the implant apex than at the implant head. The
use of only one surgical guide fixed by means of osteosynthesis screws can
be a more effective option for a more precise implant osteotomy.
| 1: Clin Implant Dent Relat Res. 2005;7 Suppl 1:S111-20. |
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A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study.
van Steenberghe D, Glauser R, Blomback U, Andersson M, Schutyser F, Pettersson A, Wendelhag I.
Department of Periodontology, Catholic University of Leuven, Leuven, Belgium. Daniel.vanSteenberghe@uz.kuleuven.ac.be
BACKGROUND: Based on three-dimensional implant planning software for computed tomographic (CT) scan data, customized surgical templates and final dental prostheses could be designed to ensure high precision transfer of the implant treatment planning to the operative field and an immediate rigid splinting of the installed implants, respectively. PURPOSE: The aim of the present study was to (1) evaluate a concept including a treatment planning procedure based on CT scan images and a prefabricated fixed prosthetic reconstruction for immediate function in upper jaws using a flapless surgical technique and (2) validate the universality of this concept in a prospective multicenter clinical study. MATERIALS AND METHODS: Twenty-seven consecutive patients with edentulous maxillae were included. Treatments were performed according to the Teeth-in-an-Hour concept (Nobel Biocare AB, Goteborg, Sweden), which includes a CT scan-derived customized surgical template for flapless surgery and a prefabricated prosthetic suprastructure. RESULTS: All patients received their final prosthetic restoration immediately after implant placement, that is, both the surgery and the prosthesis insertion were completed within approximately 1 hour. In the 24 patients followed for 1 year, all prostheses and individual implants were recorded as stable. CONCLUSION: The present prospective multicenter study indicates that the prefabrication, on the basis of models derived from three-dimensional oral implant planning software, of both surgical templates for flapless surgery and dental prostheses for immediate loading is a very reliable treatment option. It is evident that the same approach could be used for staged surgery and in partial edentulism.
Publication Types:
- Clinical Trial
- Multicenter Study
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2: J Periodontol. 2005 Apr;76(4):503-7. |
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Clinical application of stereolithographic surgical guides for implant
placement: preliminary results.
Di Giacomo GA, Cury PR, de Araujo NS, Sendyk WR,
Sendyk CL.
Department of Periodontics and Implantology, School of Dentistry, University
of Santo Amaro, Sao Paulo, Brazil.
BACKGROUND: The success of implant-supported restorations requires detailed
treatment planning, which includes the construction of a surgical guide.
Recently, computer-aided rapid prototyping has been developed to construct
surgical guides in an attempt to improve the precision of implant placement.
The aim of the present study was to evaluate the match between the positions
and axes of the planned and placed implants when a stereolithographic
surgical guide is employed. METHODS: Six surgical guides used in four
patients (three women, one man; age from 23 to 65 years old) were included
in the study and 21 implants were placed. A radiographic template was
fabricated and computer-assisted tomography (CT) was performed. The virtual
implants were placed in the resulting 3-dimensional image. Using a
stereolithographic machine, liquid polymer was injected and laser-cured
according to the CT image data with the planned implants, generating three
surgical guides, with increasing tube diameters corresponding to each twist
drill diameter (2.2, 3.2, and 4.0 mm), for each surgical area. During the
implant operation, the surgical guide was placed on the jawbone and/or the
teeth. After surgery, a new CT scan was taken. Software was used to fuse the
images of planned and placed implants, and the locations and axes were
compared. RESULTS: On average, the match between the planned and the placed
implant axes was within 7.25 degrees +/- 2.67 degrees ; the differences in
distance between the planned and placed positions at the implant shoulder
were 1.45 +/- 1.42 mm, and 2.99 +/- 1.77 mm at the implant apex. In all
patients, a greater distance was found between the planned and placed
positions at the implant apex than at the implant head. CONCLUSIONS:
Clinical data suggest that computer-aided rapid prototyping of surgical
guides may be useful in implant placement. However, the technique requires
improvement to provide better stability of the guide during the surgery, in
cases of unilateral bone-supported and non-tooth-supported guides. Further
clinical studies, using greater number of patients, are necessary to
evaluate the real impact of the stereolithographic surgical guide on implant
therapy.
Publication Types:
-
Clinical Trial
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3: Int J Oral Maxillofac Implants. 2005 Mar-Apr;20(2):253-60. |
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Assessment of correlation between computerized tomography values of the
bone and cutting torque values at implant placement: a clinical study.
Ikumi N, Tsutsumi S.
Department of Medical Simulation Engineering, Institute for Frontier Medical
Sciences, Kyoto University, Kyoto, Japan. noriharu@cic-implant.jp
PURPOSE: The relationship between computerized tomography (CT) values of
bone surrounding endosseous implants and the cutting torque values required
for self-tapping during implant placement was examined for the purpose of
predicting the initial stability (bone quality) during implant placement by
presurgical CT scan examinations and determining whether it can be
quantified. MATERIALS AND METHODS: The study sample consisted of 13 subjects
with 56 implants. Sites for implant placement were determined based on CT
data using implant planning software. The average CT values of the bone
surrounding the simulated implants were calculated by the software. Using a
stereolithographic drill guide, implants were placed at the locations
indicated by the protocol. The cutting torque values required for
self-tapping were measured during implant placement. The resulting CT values
and cutting torque values were analyzed statistically for correlation.
RESULTS: The correlation was considered significant at a level of .01 or
less, and the correlation coefficient was 0.77. DISCUSSION: There was a
strong correlation between CT values and cutting torque values in the
clinical cases evaluated. These results indicate that it may be possible to
predict and quantify initial implant stability and bone quality from
presurgical CT diagnosis and implant simulation. CONCLUSION: Presurgical CT
examination may be an effective technique for predicting initial stability
of the implant and bone quality.
| 4: J Oral Maxillofac Surg. 2005 Sep;63(9 Suppl 2):59-71. |
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Presurgical planning with CT-derived fabrication of surgical guides.
Ganz SD.
Assistant Clinical Professor, Department of Prosthodontics and Restorative Dentistry, University of Medicine and Dentistry, Newark, NJ, USA. sdgimplant@aol.com
As implant dentistry is evolving toward accelerated treatment protocols, with immediate or delayed functional and nonfunctional loading, the importance of presurgical planning becomes paramount. The paradigm for restorative-driven implant placement works best when templates are used to transfer information from the desired plan to the surgical reality. The advent of computed tomography (CT) imaging, and CT-derived surgical templates allow for clinically significant improvements in accuracy, time efficiency, and reduction in surgical error, benefiting the patient, surgeon, restorative dentist, and the laboratory. Continued advances in the state-of-the-art software applications that enable enhanced planning give clinicians the vision necessary to deliver the desired results, while serving as an excellent communication tool between all members of the implant team. This article illustrates the advantages of using CT scan-based templates through various clinical presentations. Procedures were illustrated for single and multiple tooth applications in both mandibular and maxillary arches.
| 5: Clin Oral Implants Res. 2005 Feb;16(1):60-8. |
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Navigated vs. conventional implant insertion for maxillary single tooth replacement.
Kramer FJ, Baethge C, Swennen G, Rosahl S.
Department of Oral and Maxillofacial Surgery, Medical University of Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. Kramer.Franz@MH-Hannover.de
Abstract Introduction: Computer-guided navigation has proven a valuable tool in several surgical disciplines. During oral implant placement, its application is intended to accomplish optimal implant localization and to reduce the risk of damage to adjacent structures. The aim of this study was to compare the precision limits of conventional vs. navigated implant insertion in practice. Materials and methods: In cast models of the maxilla, implants were inserted to replace the left central incisor (n = 40) and the right canine (n = 40); each of those were inserted either conventionally (n = 20) or navigated (n = 20). Implant position, angulation and insertion depth were calculated from computer tomography scans of the implants that were connected to an index abutment of 40 cm length. Results: The variations of implant positions were reduced for implants that were inserted by navigation (P < 0.05). In both the axial and the transversal plane, the variations of implant angulations were reduced for implants that were inserted by a navigation protocol (P < 0.05). The variations of insertion depth were less (P < 0.05) when the implants were placed by navigation in comparison with conventional insertion procedures. Conclusions: Given the experimental conditions, although they tried to mimic a clinical situation, no final conclusions can be drawn. The in vitro application of a navigation system resulted in an improved precision of insertion surgery regarding the position, angulation and depth of an implant. Clinical studies will have to prove if routine image guidance will result in superior surgical outcome.
| 6: Clin Oral Implants Res. 2005 Oct;16(5):609-14. |
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Accuracy of navigation-guided socket drilling before implant installation compared to the conventional free-hand method in a synthetic edentulous lower jaw model.
Hoffmann J, Westendorff C, Gomez-Roman G, Reinert S.
Department of Oral and Maxillofacial Surgery, Tubingen University Hospital, Tubingen, Germany. juergen.hoffmann@uni-tuebingen.de
In this study, the three-dimensional (3D) accuracy of navigation-guided (NG) socket drilling before implant installation was compared to the conventional free-hand (CF) method in a synthetic edentulous lower jaw model. The drillings were performed by two surgeons with different years of working experience. The inter-individual outcome was assessed. NG drillings were performed using an optical computerized tomography (CT)-based navigation system. CF drillings were performed using a surgical template. The coordinates of the drilled sockets were determined on the basis of CT scans. A total of n=224 drillings was evaluated. Inter-individual differences in terms of the surgeons' years of work experience were without statistical significance. The mean deviation of the CF drilled sockets (n=112) on the vestibulo-oral and mesio-distal direction was 11.2+/-5.6 degrees (range: 4.1-25.3 degrees ). With respect to the NG drilled sockets (n=112), the mean deviation was 4.2+/-1.8 degrees (range: 2.3-11.5). The mean distance to the mandibular canal was 1.1+/-0.6 mm (range: 0.1-2.3 mm) for CF-drilled sockets and 0.7+/-0.5 mm (range: 0.1-1.8 mm) for NG drilled sockets. The differences between the two methods were highly significant (P<0.01). A potential benefit from image-data-based navigation in implant surgery is discussed against the background of cost-effectiveness.
| 7: Int J Oral Maxillofac Implants. 2005 May-Jun;20(3):382-6. |
Accuracy assessment of image-guided implant surgery: an experimental study.
Hoffmann J, Westendorff C, Schneider M, Reinert S.
Department of Oral and Maxillofacial Plastic Surgery, Tubingen University Hospital, Tubingen, Germany. juergen.hoffmann@uni-tuebingen.de
PURPOSE: To accurately accomplish the drilling of an implant socket, the use of image-guided navigation has become an option. The aim of this study was to evaluate the 3-dimensional (3D) accuracy of navigation-guided drilled holes. MATERIALS AND METHODS: Laboratory accuracy measurements were obtained on an acrylic resin model with standardized target holes drilled by a computerized numerical control machine. The model was scanned by a multislice computerized tomography scanner and registered with fiducial marker-based algorithms. Navigated drillings were performed using an optical navigation system based on passive marker technology. Coordinates of drilled holes were determined by a 3D-digitizer probe, and accuracy was assessed for all 5 degrees of freedom using a computer-aided design system (Pro/Engineer). RESULTS: A total of 240 drillings were evaluated. Mean registration error was 0.86 mm (SD 0.25 mm). Target point deviation between preplanned and actual drill starting point was 0.95 mm (SD 0.25 mm). The deviation in terms of full length was 0.97 mm (SD 0.34 mm), and mean angular deviation on the coronal and sagittal planes was 1.35 degrees (SD 0.42 degrees). DISCUSSION: The accuracy of image-guided navigation depends on imaging modalities, patient-to-image registration procedures, and instrument tracking. The technical accuracy and the navigation procedure, as evaluated in the study presented, seem to be of minor influence. CONCLUSION: The data obtained by this in vitro study demonstrate that the accuracy of navigation-based drilling may be sufficient for clinical practice, particularly in terms of the transferability of preplanned trajectories. However, in vivo clinical trials need to be performed to evaluate the clinical accuracy and treatment quality of navigation-guided interventions.
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1: Implant Dent. 2004 Jun;13(2):133-9. |
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Stereolithography in oral implantology: a comparison of surgical guides.
Sammartino G, Della Valle A, Marenzi G, Gerbino S,
Martorelli M, di Lauro AE, di Lauro F.
Department of Science of Dentistry and Maxillo-Facial, Faculty of Medicine,
University of Naples Federico II, Naples, Italy.
This article presents the use of stereolithography in oral implantology.
Stereolithography is a new technology that can produce physical models by
selectively solidifying an ultraviolet-sensitive liquid resin using a laser
beam, reproducing the true maxillary and mandibular anatomic dimensions.
With these models, it is possible to fabricate surgical guides that can
place the implants in vivo in the same places and same directions as those
in the planned computer simulation. A 70-year-old woman, in good health,
with severe mandibular bone atrophy was rehabilitated with an over-denture
supported by 2 Branemark implants. Two different surgical planning methods
were considered: 1) the construction of a surgical guide evaluating clinical
aspects, and 2) the surgical guide produced by stereolithographic study. The
accuracy of surgical planning can reduce the problems related to bone
density and dimensions. Furthermore, the stereolithographic study assured
the clinicians of a superior location of fixtures in bone. Surgical planning
based on stereolithographic technique is a safe procedure and has many
advantages. This technologic advance has biologic and therapeutic benefits
because it simplifies anatomic surgical management for improved implant
placement.
Publication Types:
-
Case Reports
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1: Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):599-604. |
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Computer-assisted implant placement. A case report: treatment of the
mandible.
Tardieu PB, Vrielinck L, Escolano E.
New York University, New York, New York, USA.
philippe-tardieu@mail.dotcom.fr
The authors present a case of immediate loading of mandibular implants using
a 5-step procedure. The first step consists of building a scannographic
template, the second step consists of taking a computerized tomographic (CT)
scan, and the third step consists of implant planning using SurgiCase
software. The final 2 steps consist of implant placement using a drill guide
created by stereolithography and placement of the prosthesis. Using a CT
scan-based planning system, the surgeon is able to select the optimal
locations for implant placement. By incorporating the prosthetic planning
using a scannographic template, the treatment is optimized from a prosthetic
point of view. Furthermore, the use of a stereolithographic drill guide
allows a physical transfer of the implant planning to the patient's mouth.
The scannographic template is designed so that it can be transformed into a
temporary fixed prosthesis for immediate loading, and the definitive
restoration is placed 3 months later.
Publication Types:
-
Case Reports
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2: Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):571-7. |
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Accuracy of implant placement with a stereolithographic surgical guide.
Sarment DP, Sukovic P, Clinthorne N.
Department of Periodontics/Prevention/Geriatrics, Center for Biorestoration
of Oral Health, University of Michigan, Ann Arbor, Michigan 48109-1078, USA.
sarment@umich.edu
PURPOSE: Placement of dental implants requires precise planning that
accounts for anatomic limitations and restorative goals. Diagnosis can be
made with the assistance of computerized tomographic (CT) scanning, but
transfer of planning to the surgical field is limited. Recently, novel
CAD/CAM techniques such as stereolithographic rapid prototyping have been
developed to build surgical guides in an attempt to improve precision of
implant placement. However, comparison of these advanced techniques to
traditional surgical guides has not been performed. The goal of this study
was to compare the accuracy of a conventional surgical guide to that of a
stereolithographic surgical guide. MATERIALS AND METHODS: CT scanning of
epoxy edentulous mandibles was performed using a cone beam CT scanner with
high isotropic spatial resolution, while planning for 5 implants on each
side of the jaw was performed using a commercially available software
package. Five surgeons performed osteotomies on a jaw identical to the
initial model; on the right side a conventional surgical guide (control
side) was used, and on the left side a stereolithographic guide was used
(test side). Each jaw was then CT scanned, and a registration method was
applied to match it to the initial planning. Measurements included distances
between planned implants and actual osteotomies. RESULTS: The average
distance between the planned implant and the actual osteotomy was 1.5 mm at
the entrance and 2.1 mm at the apex when the control guide was used. The
same measurements were significantly reduced to 0.9 mm and 1.0 mm when the
test guide was used. Variations were also reduced with the test guide,
within surgeons and between surgeons. DISCUSSION: Surgical guidance for
implant placement relieves the clinician from multiple perioperative
decisions. Precise implant placement is under investigation using
sophisticated guidance methods, including CAD/CAM templates. CONCLUSION:
Within the limits of this study, implant placement was improved by using a
stereolithographic surgical guide.
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1: Int J Adult Orthodon Orthognath Surg. 2002;17(4):264-6. |
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A stent fabricated on a selectively colored stereolithographic model for
placement of orthodontic mini-implants.
Kitai N, Yasuda Y, Takada K.
Department of Orthodontics and Dentofacial Orthopedics, Graduate School of
Dentistry, Osaka University, 1-8 Yamadaoka, Suita Osaka, 565-0871, Japan.
nkitai@dent.osaka-u.ac.jp
The purpose of this report is to present a new method for placing
orthodontic mini-implants using a stent fabricated on a selectively colored
stereolithographic model. A stent was fabricated that incorporated a guide
groove drilled in accordance with the planned direction of the mini-implant.
Tooth crowns, gingiva, tooth roots, and the maxillary sinuses were clearly
identified in the stereolithographic model. As a result, the stent could be
fabricated while taking into account the anatomic characteristics of both
the bone interior and the dental surface. A stent fabricated on the
selectively colored stereolithographic model is suggested to be a promising
device for guiding placement of orthodontic mini-implants adjacent to the
tooth roots and the maxillary sinuses.
| 2: Clin Oral Implants Res. 2002 Dec;13(6):651-6. |
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Precision of transfer of preoperative planning for oral implants based on cone-beam CT-scan images through a robotic drilling machine.
Fortin T, Champleboux G, Bianchi S, Buatois H, Coudert JL.
Department of Oral Surgery, Dental University of Lyon,Thomas Fortin, Guillaume Champleboux, TIMC-GMCAO, Medical University of Grenoble, France. Thomas.Fortin@rockefeller.univ-lyonI.fr
In this study, an image-guided system for oral implant placement was assessed. A specially designed mechanical tool has been elaborated to transfer the preoperative implant axis planned on 3-dimensional imagery into a surgical template by a numerically controlled drilling machine. The main drawback of image-guiding systems is the use of preoperative computed tomography, which is expensive and delivers high radiation doses. Therefore, in this study the image-guiding system was coupled with a cone-beam tomograph that significantly decreased both cost and radiation doses. Three edentulous models were used. To determine the accuracy of the system, the ability of a 1.8-mm diameter drill to enter a 2.0-mm diameter, 10-mm-long titanium tube inserted on the model with no contact was verified. Because the drill entered the tubes with no contact and went beyond the end of the tube, the transfer error was less than 0.2 mm for translation and less than 1.1 degrees for rotation. The method presented here is low cost and high precision compared to other technological solutions such as tracking. Further assessment in the surgical field should lead to daily use of this system for flapless surgery, to prepare a prosthesis prior to surgery for immediate loading, to reduce risk of injuring critical anatomical structures and to eliminate manual placement error.
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5: Clin Oral Implants Res. 2005 Aug;16(4):495-501. |
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Accuracy of image-guided implantology.
Brief J, Edinger D, Hassfeld S, Eggers G.
Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University
Hospital, Heidelberg, Germany.
OBJECTIVES: The accuracy of two commercially available systems for
image-guided dental implant insertion based on infrared tracking cameras was
compared with manual implantation. MATERIAL AND METHODS: Phantoms of
partially edentulous mandibles were used. In a master phantom, pilot
boreholes for dental implants were placed. These boreholes were reproduced
in slave phantoms using either of the two image-guided systems and manual
implantation. The resulting positions were determined using a coordinate
measurement machine and compared with the master model. RESULTS: In
comparison with manual implantation, the difference of borehole positions to
the master phantom was significantly lower using either of the systems for
image-guided implant insertion. CONCLUSION: Image-guided insertion of dental
implants is significantly more accurate than manual insertion. However, the
accuracy that can be achieved with manual implantation is sufficient for
most clinical situations.
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6: J Oral Maxillofac Surg. 2005 Jul;63(7):982-8. |
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Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.
Casap N, Wexler A, Tarazi E.
The Hebrew university-hadassah, Faculty of Dental medicine, Jerusalem, Israel. nard@md.huji.ac.il
PURPOSE: The study's purpose was to describe the application of a surgical navigation system for the treatment-planning and subsequent precise placement of dental implants in a patient, 2 years postexcision of a mandibular odontogenic myxoma. PATIENTS AND METHODS: A 25-year-old male patient presented for rehabilitation of a deficient edentulous ridge at the right mandible following excision of an odontogenic myxoma. The patient was imaged by dental computed tomography while wearing an individually fitted interfacing acrylic splint. Thereafter, computed tomography data were imported to the Image-Guided Implantology system (IGI; DenX Advanced Dental Systems Ltd, Moshav Ora, Israel), and a precise 3-dimensional implant treatment plan was contemplated considering the compromised anatomy and the anticipated prosthesis. RESULTS: Three dental implants were placed using a surgical navigation approach with precise coordination to the presurgical treatment plan and subsequently were restored with a screw-retained fixed prosthesis. At the 1-year follow-up, the implants were osseointegrated and the fixed prosthesis was fully functional. CONCLUSIONS: Computerized navigation is indicated for dental implant surgery in patients with deficient alveolar ridge where coordination of the positioning of the implants to the final prosthesis is difficult.
| 7: Int J Oral Maxillofac Surg. 2005 Jan;34(1):1-8. |
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Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.
Ewers R, Schicho K, Undt G, Wanschitz F, Truppe M, Seemann R, Wagner A.
University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical School, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.
Publication Types:
- Evaluation Studies
- Review
|
8: Refuat Hapeh Vehashinayim. 2005 Jan;22(1):60-4, 87. |
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[Image guided dental implantology]
[Article in Hebrew]
Shohat M, Tal C.
Dept. of Prosthodontics, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem.
Dental implants insertion is a predictable surgical procedure with very high success rates. An optimal implants placement requires excellent surgical skills and good prosthetic perception. Performing an inaccurate implantation can lead to irreversible surgical damage on the one hand or a prosthetic failure on the other hand. Planning software provide the surgeon with good planning tool; existing navigation systems allow for translating them into performance by semi-active or passive guidance. The later allows for flexibility in the implant location during the operation and real-time tracking of drill position. All of these tools are helpful in avoiding damage to anatomical structures by performing the implantation in close relation to the CT scan. But the solutions that provide most possible advantages requires CT with special markers, long and expansive preoperative preparations and most of all a very high initial cost. These, in addition to a very long learning curve are the reason for these systems not to become a popular working tool. The most important challenges of the next generation systems in dental implants navigation are lower price, smaller size, good performance and reliability and ease of use. This kind of image guided system should allow for preplanning of implants locations, and guided insertion by minimal invasive procedure.
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9: Int J Oral Maxillofac Implants. 2005 Jan-Feb;20(1):92-8. |
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Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible.
Casap N, Tarazi E, Wexler A, Sonnenfeld U, Lustmann J.
Department of Oral and Maxillofacial Surgery, Hadassah Faculty of Dental Medicine, The Hebrew University, PO Box 12272, Jerusalem 91120, Israel. nard@md.huji.ac.il
Computerized navigation surgery has evolved to facilitate minimally invasive procedures, the gold standard of surgery today. While flapless implant surgery may be clinically beneficial, it has generally been perceived as a blind procedure limited to straightforward cases that do not pose a risk of cortical plate perforation. The objective of this report is to describe a protocol for flapless implant placement in a completely edentulous mandible using computerized navigation surgery. The Image Guided Implantology system (IGI, DenX Advanced Dental Systems) is described. The IGI system provides real-time imaging of the dental drill and transforms flapless implant surgery into a fully monitored procedure. The highly accurate intraoperative navigation enables precise transfer of the detailed presurgical implant plan to the patient. This is particularly valuable in edentulous jaws lacking any indication of the dental arch. The accurate positioning of the implants, based on the presurgical digital plan, allows fabrication of a provisional fixed prosthesis before the implant surgery for immediate postoperative loading. This innovative protocol can enhance prosthodontic-driven placement of implants in a fully monitored flapless surgery.
| 10: Clin Implant Dent Relat Res. 2005;7 Suppl 1:S21-7. |
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Minimally invasive flapless implant surgery: a prospective multicenter study.
Becker W, Goldstein M, Becker BE, Sennerby L.
University of Southern California School of Dentistry, Los Angeles, CA, USA. branebill@comcast.net
BACKGROUND: Placement of implants with a minimally invasive flapless approach has the potential to minimize crestal bone loss, soft tissue inflammation, and probing depth adjacent to implants and to minimize surgical time. PURPOSE: The aim of this multicenter study was to evaluate implant placement using a minimally invasive one-stage flapless technique up to 2 years. MATERIALS AND METHODS: Fifty-seven patients ranging in age from 24 to 86 years were recruited from three clinical centers (Tucson, AZ, USA; Tel Aviv, Israel; Goteborg, Sweden). Seventy-nine implants were placed. A small, sharp-tipped guiding drill was used to create a precise, minimally invasive initial penetration through the mucosa and into bone (Nobel Biocare, Yorba, Linda, CA, USA). Implants were placed according to the manufacturer's instructions, with minimal countersinking. The parameters evaluated were total surgical time, implant survival, bone quality and quantity, implant position by tooth type, depth from mucosal margin to bone crest, implant length, probing depth, inflammation, and crestal bone changes. At 2 years, for 79 implants placed in 57 patients, the cumulative success rate using a minimally invasive flapless method was 98.7%, indicating the loss of 1 implant. Changes in crestal bone for 77 baseline and follow-up measurements were insignificant (radiograph 1: mean 0.7 mm, SD 0.5 mm, range 2.8 mm, minimum 0.2 mm, maximum 3.0 mm; radiograph 2: mean 0.8 mm, SD 0.5 mm, range 3.4 mm, minimum 0.12 mm, maximum 3.5 mm). Using descriptive statistics for 78 patients (one implant lost), mean changes for probing depth and inflammation were clinically insignificant. The average time for implant placement was 28 minutes (minimum 10 minutes, maximum 60 minutes, SD 13.1 minutes). Average depth from mucosal margin to bone was 3.3 mm ( SD 0.7 mm, minimum 2 mm, maximum 5 mm, range 3 mm). Thirty-two implants were placed in maxillae and 47 in mandibles. CONCLUSIONS: The results of this study demonstrate that following diagnostic treatment planning criteria, flapless surgery using a minimally invasive technique is a predictable procedure. The benefits of this procedure are lessened surgical time; minimal changes in crestal bone levels, probing depth, and inflammation; perceived minimized bleeding; and lessened postoperative discomfort.
Publication Types:
- Clinical Trial
| 11: Pract Proced Aesthet Dent. 2005 Mar;17(2):151-8; quiz 160. |
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Immediate restoration of implants utilizing a flapless approach to preserve interdental tissue contours.
Petrungaro PS.
Contemporary Periodontics, 12425 55th Street North, Lake Elmo, MN, 55042, USA. drpaul@petrungaro.com
Dental implants have become widely accepted for the replacement of missing teeth due to their high success rates. Conventional multistage approaches to implant reconstruction have contributed to professionals' acceptance of implant dentistry as a treatment option, yet innovative implant procedures often enable clinicians to achieve function and aesthetics in shorter treatment periods. This presentation describes recent advances in surgical procedures and provisionalization techniques that, when applied properly, provide soft tissue integration and long-term implant success.
Publication Types:
- Review
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1: Clin Implant Dent Relat Res. 2004;6(2):111-9. |
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An image-guided system-drilled surgical template and trephine guide pin to make treatment of completely edentulous patients easier: a clinical report on immediate loading.
Fortin T, Isidori M, Blanchet E, Perriat M, Bouchet H, Coudert JL.
Department of Oral Surgery, Dental University of Lyon, 69008 Lyon, France. Thomas.fortin@rockefeller.univ-lyon1.fr
PURPOSE: An image-guided system has been developed to drill a conventional surgical guide following a preoperative three-dimensional plan for accurate placement of implant on bone. The aim of this study is to illustrate how this system facilitates treatment of completely edentulous patients by modifying both surgical and prosthetic protocols, thereby making flapless surgery possible as well as the preparation of the transitional prosthesis before surgery. MATERIALS AND METHODS: This system was tested on 10 consecutive patients, placing all planned implants without raising the mucoperiosteal flap and with the connection of all implants to pre-angulated abutments. RESULTS: A 1-year follow-up demonstrated stable and properly functioning prostheses in all cases. CONCLUSIONS: This technique can be expected to flourish because implantology makes the highest demands on comfort, precision, and safety.
| 1: Pract Proced Aesthet Dent. 2003 Nov-Dec;15(10):763-71; quiz 772. |
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Use of stereolithographic models as diagnostic and restorative aids for predictable immediate loading of implants.
Ganz SD.
sdgimplant@aol.com
Implant dentistry has evolved into one of the most predictable treatment alternatives in all of medical science. Advances in the surgical and prosthetic components, implant designs and surface technologies, and imaging techniques have allowed for significant modifications to occur with respect to one- and two-stage surgical protocols, accelerating treatment times to the benefit of patient and clinician. This article presents a technique to improve surgical and restorative accuracy, allowing for predictable placement and immediate loading of implants through use of CT imaging, stereolithographic models, and CT-derived surgical templates.
Publication Types:
- Case Reports
| 2: Clin Implant Dent Relat Res. 2003;5 Suppl 1:29-36. |
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Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3-year clinical study.
Rocci A, Martignoni M, Gottlow J.
anrocci@tin.it
BACKGROUND: Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance during the whole treatment period. PURPOSE: The aim of the present study was to evaluate an immediate-loading treatment protocol, which included flapless surgery, implants placed in predetermined positions and connected to prefabricated provisional restorations, and the 3-year clinical results. MATERIALS AND METHODS: A total of 97 Branemark System Mk IV implants (Nobel Biocare AB, Gothenburg, Sweden) with a machined surface were inserted in the maxillas of 46 patients. A presurgical three-dimensional model of the patients' soft tissue and underlying alveolar bone anatomy was created, which allowed the clinician to place the implants in predetermined positions and connect them to prefabricated provisional restorations. A surgical template with drilling guides corresponding to each implant was used. The apical part of the master guide was equipped with a circular "mucotome," which punched out a 5 mm hole in the mucosa to eliminate the need for flap elevation. The patients received 25 fixed partial prostheses and 27 single-tooth restorations. Bone quality and quantity were assessed. Radiographic examinations were performed on the day of surgery/loading and at the 1-, 2-, and 3-year follow-up visits. RESULTS: All implant sites showed intact buccal and lingual bone walls during surgery, confirming the accuracy of the bone-mapping procedure. The prefabricated temporary restorations fitted, meaning that the implants were positioned clinically in the same way as on the cast. Nine implants in eight patients failed during the first 8 weeks of loading. This resulted in a cumulative survival rate of 91% after 3 years of prosthetic load. The survival rate of splinted implants was 94%. The number of failed implants was significantly higher in cases of single-tooth replacements and placement in soft bone sites and smokers. The failed implants were successfully replaced according to a two-stage protocol. All patients finally received the expected restoration. The marginal bone resorption was on average 1.0 mm during the first year of loading, 0.4 mm during the second year, and 0.1 mm during the third year. CONCLUSIONS: The study confirmed the feasibility of an immediate-loading treatment protocol in the maxilla, which included flapless surgery, implants and abutments placed in predetermined positions, and prefabricated provisional restorations. All failures occurred within the first 2 months of loading. The unchanged survival rate and the low average bone loss found during the following 34-month study period indicate a good long-term prognosis for the performed immediate-loading treatment.
Publication Types:
- Evaluation Studies
| 3: Implant Dent. 2003;12(2):123-31. |
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Immediate tooth extraction, placement of a Tapered Screw-Vent implant, and provisionalization in the esthetic zone: a case report.
Schiroli G.
schirol@tin.it
PURPOSE: This clinical report describes an immediate tooth extraction,
followed by placement and provisional restoration of a dental implant in the
prepared socket of a right maxillary central incisor. MATERIALS AND METHODS:
The tooth was extracted with minimal hard and soft tissue trauma and without
flap reflection. A flapless, transmucosal surgical approach was used to
prepare the socket and insert a tapered implant. The implant was immediately
restored with a provisional abutment and crown without occlusal contacts. An
impression was made 22 days after implant insertion, and a definitive,
all-ceramic restoration was placed 3 days later. RESULTS: During the period
of provisional progressive loading, no significant soft tissue contraction
was observed related to noninvasive operating techniques and the immediate
insertion of the provisional restoration. The patient exhibited no clinical
or radiologic complications through 8 months of clinical monitoring after
loading. CONCLUSION: The Tapered Screw-Vent implant and all-ceramic
restoration provided the patient with immediate esthetics, function, and
comfort without any complications during the postloading follow-up period.
Publication Types:
- Case Reports
- Review
| 4: Clin Implant Dent Relat Res. 2003;5(1):57-60. |
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Immediate/early loading of dental implants: a report from the Sociedad Espanola de Implantes World Congress consensus meeting in Barcelona, Spain, 2002.
Aparicio C, Rangert B, Sennerby L.
Clinica Aparicio, Barcelona, Spain.
BACKGROUND: Immediate/early loading protocols are becoming frequently used in implant dentistry, but the prerequisites for achieving good results and the limitations of such protocols are not fully known. Moreover, the terminology used in immediate/early loading is still confusing. PURPOSE: The purpose of this article is to present the outcome of a consensus meeting on immediate/early loading. MATERIALS AND METHODS: A consensus meeting was organized during the Sociedad Espanola de Implantes World Congress in Barcelona on May 23, 2002, with the objective to present and discuss the experiences from immediate/early loading protocols in dental implant treatment. The purpose was also to discuss definitions of the terminology used in immediate/early loading. The consensus meeting agenda included presentations from invited experts, followed by a consensus discussion. RESULTS: A consensus statement was agreed on. CONCLUSIONS: Multiple independent investigators have demonstrated that immediate/early loading of implants is possible in many clinical situations; however, additional documentation is required.
Publication Types:
- Consensus Development Conference
- Review
| 1: Int J Oral Maxillofac Implants. 2002 Mar-Apr;17(2):271-6. |
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Flapless implant surgery: a 10-year clinical retrospective analysis.
Campelo LD, Camara JR.
drluisdominguez@clinicadentaldrdominguez.com
PURPOSE: This article is a retrospective clinical analysis of implants placed with a flapless approach. MATERIALS AND METHODS: Seven hundred seventy implants were placed in 359 patients to restore both completely edentulous and partially edentulous arches with fixed prostheses or removable complete dentures. Each patient was examined after 3 months, 6 months, 1 year, and then once every year. Prostheses were removed, if possible, and implant mobility was assessed, periapical radiographs were obtained, and periodontal probing was performed. Implants were considered failed if they had mobility or pain, had to be removed, or if they showed more than 0.5 mm of bone loss per year and signs of active peri-implantitis. RESULTS: The cumulative success rate for implants placed using a flapless 1-stage surgical technique after a 10-year period varied from 74.1% for implants placed in 1990 to 100% at 2000. DISCUSSION: Since flapless implant placement is a generally "blind" surgical technique, care must be taken when placing implants. Angulation of the implants affected by drilling is critical to avoid perforation of the cortical plates, both lingual or buccal, especially on the lingual in the mandibular molar area and the anterior maxilla. There should be no problem if the patient has been appropriately selected and an appropriate width of bone is available for implant placement. There is a learning curve to every surgical procedure, after which it becomes routine. There are many advantages for the patient as well as for the surgeon, since the procedure is less time consuming, bleeding is minimal, implant placement is expedited, and there is no need to place and remove sutures. CONCLUSION: Flapless implant surgery is a predictable procedure if patient selection and surgical technique are appropriate.
Publication Types:
- Evaluation Studies
| 2: Clin Implant Dent Relat Res. 2002;4(2):88-92. |
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Precision surgical template for implant placement: a new systematic approach.
Wat PY, Chow TW, Luk HW, Comfort MB.
Honorary Clinical Assistant Professor, Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong.
The importance of a precise surgical template for implant placement cannot be overstated. The radiographic template carries both clinical and radiographic information for the planning of fixture angulation and location. This article describes a systematic approach to the fabrication of a dual-purpose radiographic surgical template. The simple steps result in the accurate transfer of radiographic information to the surgical template with no need for complex equipment or maneuvers. key words: dental implants, implant placement, radiographic template, surgical template
| 1: J Oral Implantol. 2000;26(4):300-3. |
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Precise dental implant placement in bone using surgical guides in conjunction with medical imaging techniques.
Fortin T, Champleboux G, Lormee J, Coudert JL.
Department of Oral Surgery at the Dental University of Lyon, France.
The use of medical imaging techniques to make a very precise surgical guide for implant placement is described. This template is the combination of a currently used template and a very simple mechanical system designed to transfer a preoperatively defined implant position onto the surgical site. With the planning software, the practitioner determines the implant position according both to the ideal position dictated by the final restorative prosthesis and the available volume of bone. The surgical template then communicates the actual implant position to the surgical site. The template can be used not only in critical anatomical situations but also in placing the implant in an ideal position on bone because it eliminates possible manual placement errors and matches planning to prosthetic requirements.
| 1: J Image Guid Surg. 1995;1(1):53-8. |
Computer-assisted dental implant surgery using computed tomography.
Fortin T, Coudert JL, Champleboux G, Sautot P, Lavallee S.
Faculte de Medecine de Grenoble, TIMC-IMAG, La Tronche, France.
Standard planning for dental implants consists of a prosthesis simulation on diagnostic casts and radiographic examination of anatomical structures. The clinician visually locates the planned trajectory on the surgical site in the patient's mouth without direct correlation between the radiographs and the anatomy. We have developed a computer assisted technique to define the optimal position of the bone implant using computed tomography to accurately place the implant in the planned position using a guide drilled into a resin splint.
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