Fig. 9. Scatter diagrams illustrating the distribution of angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 9. Scatter diagrams illustrating the distribution of angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 8. Box plot diagrams illustrating the distribution of maximum angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 8. Box plot diagrams illustrating the distribution of maximum angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 7. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 7. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 6. Box plot diagrams illustrating the distribution of maximum horizontal apex deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 6. Box plot diagrams illustrating the distribution of maximum horizontal apex deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 5. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 5. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 4. Box plot diagrams illustrating the distribution of maximum horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 4. Box plot diagrams illustrating the distribution of maximum horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 3. Box plot diagrams illustrating the distribution of vertical deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 3. Box plot diagrams illustrating the distribution of vertical deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 2. a Schematic diagram illustrating the measurement of vertical, horizontal neck, horizontal apex, and angle deviations. b Three forms of horizontal deviation were measured: maximum, mesiodistal, and buccolingual directions
Fig. 2. a Schematic diagram illustrating the measurement of vertical, horizontal neck, horizontal apex, and angle deviations. b Three forms of horizontal deviation we...
Fig. 1. Flowchart summarizing the different phases of the experiment
Fig. 1. Flowchart summarizing the different phases of the experiment
 Vertical implant deviation  Anterior implantPosterior implantp values between anterior and posterior implants FGPGFHFGPGFHMean (mm)0.210.530.300.340.640.49FG = 0.07SD (mm)0.120.520.240.230.370.22PG = 0.27Maximum (mm)0.391.650.810.801.130.80FH = 0.05Minimum (mm)0.090.050.070.040.200.07p valuesAll groups = 0.12All groups = 0.08  Maximum horizontal implant neck deviation Â...
Abduo, J., Lau, D. Accuracy of static computer-assisted implant placement in anterior and posterior sites by clinicians new to implant dentistry: in vitro comparison of fully guided, pilot-guided, and freehand protocols. Int J Implant Dent 6, 10 (2020). https://doi.org/10.1186/s40729-020-0205-3
Download citation
Received: 31 October 2019
Accepted: 21 January 2020
Published: 11 March 2020
DOI:...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This study was approved by the University of Melbourne Human Research Ethics Committee (1851406.1). The study complied with the Declaration of Helsinki. All participants were aware of the nature of the study and provided their consent prior to the commencement of the study.
Not applicable
Jaafar Abduo, and Douglas Lau declare that they have no competing interests.
Associate Professor in Prosthodontics, Convenor of Postgraduate Diploma in Clinical Dentistry (Implants), Melbourne Dental School, Melbourne University, 720 Swanston Street, Melbourne, VIC, 3010, Australia
Jaafar Abduo
Periodontist, Private Practice, Melbourne University, Melbourne, VIC, Australia
Douglas Lau
You can also search for this author in PubMed Google Scholar
You can also search fo...
The implants, surgical kits, and guide sleeves were provided by Straumann Australia. This study has been funded by the Kernot Early Career Researcher Award. No financial income for conducting the study was received by the authors.
The authors would also like to thank Mr. Attila Gergely for his technical support in developing the simulated case and the input of the team of Digital Dental Network in designing the guides.
Deeb GR, Allen RK, Hall VP, Whitley D 3rd, Laskin DM, Bencharit S. How accurate are implant surgical guides produced with desktop stereolithographic 3-dimentional printers? J Oral Maxillofac Surgery. 2017;75:2551–9.
Horwitz J, Zuabi O, Machtei EE. Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study. Clin Oral Implants Res. 2009;20:1156–62...
Rungcharassaeng K, Caruso JM, Kan JY, Schutyser F, Boumans T. Accuracy of computer-guided surgery: a comparison of operator experience. J Prosthet Dent. 2015;114:407–13.
Park SJ, Leesungbok R, Cui T, Lee SW, Ahn SJ. Reliability of a CAD/CAM surgical guide for implant placement: an in vitro comparison of surgeons' experience levels and implant sites. Int J Prosthodont. 2017;30:367–9.
Marheine...
Belser UC, Mericske-Stern R, Bernard JP, Taylor TD. Prosthetic management of the partially dentate patient with fixed implant restorations. Clin Oral Implants Res. 2000;11:126–45.
Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19:43–61.
Ramaglia L, Toti P, Sbordone...
Three-dimensional
Computer-aided design/computer-aided manufacturing
Cone beam computed tomography
Digital Imaging and Communications in Medicine
Fully guided
Freehand
Pilot-guided
Static computer-assisted implant placement
Surface tessellation language
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Within the limitations of the present study, it can be hypothesized that apart from vertical deviation, the FG protocol is more accurate than the PG and FH protocols for all the evaluated variables in the hands of inexperienced clinicians. The PG and FH protocols were generally similar. The FG protocol did not seem to be influenced by the position of the placed implants, while the PG and FH protoc...
For the majority of the evaluated variables, there was a tendency for the posterior implants to suffer from more deviation than anterior implants. This is in accordance with several published reports [5, 21, 22]. Interestingly, implants placed by the FG protocol seemed to be less vulnerable to inaccuracy by changing the implant sites, while the PG and FH protocols showed more horizontal and angle ...
The superior accuracy and the less variation of the FG protocol is most likely related to the control of all the drilling steps and the implant placement via sequential use of precision sleeves. This eliminated the manual orientation and handling of the drills at any stage of drilling or implant placement. In accordance with these observations, Noharet et al. reported a better accuracy of the FG p...
The overall outcome of this study indicates the superiority of the FG protocol in comparison to PG and FH protocols for placing single implants. With the exception of vertical deviation, this was obvious for horizontal neck, horizontal apex, and angle deviations that were closer to the planned implant for the FG protocol than the other protocols. In addition, this superiority was shown for anterio...
In relation to the maximum angle deviation (Fig. 8), the FG protocol had less deviation than the other protocols for anterior (2.42 ± 0.98°) and posterior (2.61 ± 1.23°) implants. The PG (4.65 ± 1.78°) and FH (4.79 ± 2.08°) protocols were similar for anterior implant placement, while the FH protocol seemed more accurate for posterior implants (4.77 ± 2.09°) than the ...
In general, for all the variables, there was a tendency for the FG protocol to yield more accurate implant placement than other protocols (Table 1). In relation to vertical deviation, the PG protocol seemed to be associated with more errors. However, there was no significant difference in vertical deviation among all the protocols. Figure 3 indicates that the PG protocol was associated with deep...
The vertical deviation was measured by calculating the discrepancy along the long axis of the planned implant at the center of the platform (Fig. 2a). In addition to the magnitude of the deviation, the direction of the error was determined. The horizontal deviations were measured at the neck and the apex of the planned implant. The angle deviation was computed by measuring the angle of the long a...
For all the protocols, straight bone level Straumann dummy implants were planned. The anterior implants were 4.1 × 10 mm, while the posterior implants were 4.8 × 10 mm. The anterior implants were planned to be placed 2 mm subcrestal, while the posterior implants were planned to be placed 1 mm subcrestal.
For the conventional protocols, the clinicians had access to physical intact Ni...
The soft tissue silicone former was removed from the Nissin model to simulate bone anatomy. Subsequently, this model was duplicated with clear resin material mixed with barium sulfate and scanned by a cone beam computed tomography (CBCT) machine to generate cross-sectional DICOM images.
The DICOM images were imported to the implant planning software programs. For the FH protocol, the 2D DICOM ima...
A total of 10 qualified clinicians with a minimum of 3Â years of general practice experience were invited to participate in the study. The number of participants was similar to previously published studies [12, 19], and was confirmed by sample size calculation. A mean horizontal deviation of 1Â mm and an expected standard deviation of 0.75Â mm that were reported from earlier studies [13, 19] were ...
Despite all the advantages of sCAIP protocols, several studies reported that they are still prone to errors and complications [7,8,9, 17, 18]. The FG and PG protocols still require thorough planning and surgical understanding and skills [11]. For multiple implants and long-span edentulous ridges, guided surgery has the advantages of being more reliable, more comfortable for the patient, and more r...
Implant treatment is a growing field in dentistry, and many clinicians aim to increase their scope of practice by including such treatment. One of the main challenges encountered by clinicians new to implant dentistry is the determination and controlling of implant location. It is the consensus that implant placement must be planned to achieve an acceptable position for an ideal restorative outcom...
One of the challenges encountered by clinicians new to implant dentistry is the determination and controlling of implant location. This study compared the accuracy of fully guided (FG) and pilot-guided (PG) static computer-assisted implant placement (sCAIP) protocols against the conventional freehand (FH) protocol for placing single anterior and posterior implants by recently introduced clinicians...
Fig. 9. Scatter diagrams illustrating the distribution of angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 9. Scatter diagrams illustrating the distribution of angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 8. Box plot diagrams illustrating the distribution of maximum angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 8. Box plot diagrams illustrating the distribution of maximum angle deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 7. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 7. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 6. Box plot diagrams illustrating the distribution of maximum horizontal apex deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 6. Box plot diagrams illustrating the distribution of maximum horizontal apex deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 5. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 5. Scatter diagrams illustrating the distribution of horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 4. Box plot diagrams illustrating the distribution of maximum horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 4. Box plot diagrams illustrating the distribution of maximum horizontal neck deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 3. Box plot diagrams illustrating the distribution of vertical deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 3. Box plot diagrams illustrating the distribution of vertical deviation of each protocol. a Anterior implants. b Posterior implants
Fig. 2. a Schematic diagram illustrating the measurement of vertical, horizontal neck, horizontal apex, and angle deviations. b Three forms of horizontal deviation were measured: maximum, mesiodistal, and buccolingual directions
Fig. 2. a Schematic diagram illustrating the measurement of vertical, horizontal neck, horizontal apex, and angle deviations. b Three forms of horizontal deviation we...
Fig. 1. Flowchart summarizing the different phases of the experiment
Fig. 1. Flowchart summarizing the different phases of the experiment
 Vertical implant deviation  Anterior implantPosterior implantp values between anterior and posterior implants FGPGFHFGPGFHMean (mm)0.210.530.300.340.640.49FG = 0.07SD (mm)0.120.520.240.230.370.22PG = 0.27Maximum (mm)0.391.650.810.801.130.80FH = 0.05Minimum (mm)0.090.050.070.040.200.07p valuesAll groups = 0.12All groups = 0.08  Maximum horizontal implant neck deviation Â...
Abduo, J., Lau, D. Accuracy of static computer-assisted implant placement in anterior and posterior sites by clinicians new to implant dentistry: in vitro comparison of fully guided, pilot-guided, and freehand protocols. Int J Implant Dent 6, 10 (2020). https://doi.org/10.1186/s40729-020-0205-3
Download citation
Received: 31 October 2019
Accepted: 21 January 2020
Published: 11 March 2020
DOI:...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This study was approved by the University of Melbourne Human Research Ethics Committee (1851406.1). The study complied with the Declaration of Helsinki. All participants were aware of the nature of the study and provided their consent prior to the commencement of the study.
Not applicable
Jaafar Abduo, and Douglas Lau declare that they have no competing interests.
Associate Professor in Prosthodontics, Convenor of Postgraduate Diploma in Clinical Dentistry (Implants), Melbourne Dental School, Melbourne University, 720 Swanston Street, Melbourne, VIC, 3010, Australia
Jaafar Abduo
Periodontist, Private Practice, Melbourne University, Melbourne, VIC, Australia
Douglas Lau
You can also search for this author in PubMed Google Scholar
You can also search fo...
The implants, surgical kits, and guide sleeves were provided by Straumann Australia. This study has been funded by the Kernot Early Career Researcher Award. No financial income for conducting the study was received by the authors.
The authors would also like to thank Mr. Attila Gergely for his technical support in developing the simulated case and the input of the team of Digital Dental Network in designing the guides.
Deeb GR, Allen RK, Hall VP, Whitley D 3rd, Laskin DM, Bencharit S. How accurate are implant surgical guides produced with desktop stereolithographic 3-dimentional printers? J Oral Maxillofac Surgery. 2017;75:2551–9.
Horwitz J, Zuabi O, Machtei EE. Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study. Clin Oral Implants Res. 2009;20:1156–62...
Rungcharassaeng K, Caruso JM, Kan JY, Schutyser F, Boumans T. Accuracy of computer-guided surgery: a comparison of operator experience. J Prosthet Dent. 2015;114:407–13.
Park SJ, Leesungbok R, Cui T, Lee SW, Ahn SJ. Reliability of a CAD/CAM surgical guide for implant placement: an in vitro comparison of surgeons' experience levels and implant sites. Int J Prosthodont. 2017;30:367–9.
Marheine...
Belser UC, Mericske-Stern R, Bernard JP, Taylor TD. Prosthetic management of the partially dentate patient with fixed implant restorations. Clin Oral Implants Res. 2000;11:126–45.
Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19:43–61.
Ramaglia L, Toti P, Sbordone...
Three-dimensional
Computer-aided design/computer-aided manufacturing
Cone beam computed tomography
Digital Imaging and Communications in Medicine
Fully guided
Freehand
Pilot-guided
Static computer-assisted implant placement
Surface tessellation language
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Within the limitations of the present study, it can be hypothesized that apart from vertical deviation, the FG protocol is more accurate than the PG and FH protocols for all the evaluated variables in the hands of inexperienced clinicians. The PG and FH protocols were generally similar. The FG protocol did not seem to be influenced by the position of the placed implants, while the PG and FH protoc...
For the majority of the evaluated variables, there was a tendency for the posterior implants to suffer from more deviation than anterior implants. This is in accordance with several published reports [5, 21, 22]. Interestingly, implants placed by the FG protocol seemed to be less vulnerable to inaccuracy by changing the implant sites, while the PG and FH protocols showed more horizontal and angle ...
The superior accuracy and the less variation of the FG protocol is most likely related to the control of all the drilling steps and the implant placement via sequential use of precision sleeves. This eliminated the manual orientation and handling of the drills at any stage of drilling or implant placement. In accordance with these observations, Noharet et al. reported a better accuracy of the FG p...
The overall outcome of this study indicates the superiority of the FG protocol in comparison to PG and FH protocols for placing single implants. With the exception of vertical deviation, this was obvious for horizontal neck, horizontal apex, and angle deviations that were closer to the planned implant for the FG protocol than the other protocols. In addition, this superiority was shown for anterio...
In relation to the maximum angle deviation (Fig. 8), the FG protocol had less deviation than the other protocols for anterior (2.42 ± 0.98°) and posterior (2.61 ± 1.23°) implants. The PG (4.65 ± 1.78°) and FH (4.79 ± 2.08°) protocols were similar for anterior implant placement, while the FH protocol seemed more accurate for posterior implants (4.77 ± 2.09°) than the ...
In general, for all the variables, there was a tendency for the FG protocol to yield more accurate implant placement than other protocols (Table 1). In relation to vertical deviation, the PG protocol seemed to be associated with more errors. However, there was no significant difference in vertical deviation among all the protocols. Figure 3 indicates that the PG protocol was associated with deep...
The vertical deviation was measured by calculating the discrepancy along the long axis of the planned implant at the center of the platform (Fig. 2a). In addition to the magnitude of the deviation, the direction of the error was determined. The horizontal deviations were measured at the neck and the apex of the planned implant. The angle deviation was computed by measuring the angle of the long a...
For all the protocols, straight bone level Straumann dummy implants were planned. The anterior implants were 4.1 × 10 mm, while the posterior implants were 4.8 × 10 mm. The anterior implants were planned to be placed 2 mm subcrestal, while the posterior implants were planned to be placed 1 mm subcrestal.
For the conventional protocols, the clinicians had access to physical intact Ni...
The soft tissue silicone former was removed from the Nissin model to simulate bone anatomy. Subsequently, this model was duplicated with clear resin material mixed with barium sulfate and scanned by a cone beam computed tomography (CBCT) machine to generate cross-sectional DICOM images.
The DICOM images were imported to the implant planning software programs. For the FH protocol, the 2D DICOM ima...
A total of 10 qualified clinicians with a minimum of 3Â years of general practice experience were invited to participate in the study. The number of participants was similar to previously published studies [12, 19], and was confirmed by sample size calculation. A mean horizontal deviation of 1Â mm and an expected standard deviation of 0.75Â mm that were reported from earlier studies [13, 19] were ...
Despite all the advantages of sCAIP protocols, several studies reported that they are still prone to errors and complications [7,8,9, 17, 18]. The FG and PG protocols still require thorough planning and surgical understanding and skills [11]. For multiple implants and long-span edentulous ridges, guided surgery has the advantages of being more reliable, more comfortable for the patient, and more r...
Implant treatment is a growing field in dentistry, and many clinicians aim to increase their scope of practice by including such treatment. One of the main challenges encountered by clinicians new to implant dentistry is the determination and controlling of implant location. It is the consensus that implant placement must be planned to achieve an acceptable position for an ideal restorative outcom...
One of the challenges encountered by clinicians new to implant dentistry is the determination and controlling of implant location. This study compared the accuracy of fully guided (FG) and pilot-guided (PG) static computer-assisted implant placement (sCAIP) protocols against the conventional freehand (FH) protocol for placing single anterior and posterior implants by recently introduced clinicians...
Â
author (y)
material used for fabrication of the template
radiographic marker used
imaging system used
conversion process
indication/ advantages
Engelman et al9
auto polymerizing acrylic resin
metal bearings
panoramic radiography
remove lingual surface, leaving only facial surface of the teeth in the proposed implant site
inexpensive, easy, improved visibility, external irr...
Conclusion
Although the completely limiting design is considered a far superior design concept, most clinicians still adopt the partially limiting design due to its cost-effectiveness and credibility in the field. In addition, it has been observed that most clinicians use surgical guide templates that are based on cross-sectional imaging to facilitate accurate planning and guidance during the sur...
CAD/CAM-based Surgical Guide
CAD/CAM technology uses data from computerized tomography scan (CT)33 to plan implant rehabilitation. The CT images are converted into data that are recognized by a CT imaging and planning software. This software then transfers this presurgical plan to the surgery site using stereolithographic drill guides.34Â CAD/CAM-based surgical guides offer many advantages. For e...
Completely Limiting Design
Completely limiting design restricts all of the instruments used for the osteotomy in a buccolingual and mesiodistal plane. Moreover, the addition of drill stops limits the depth of the preparation, and thus, the positioning of the prosthetic table of the implant. As the surgical guides become more restrictive, less of the decision-making and subsequent surgical executi...
In such designs, the first drill used for the osteotomy is directed using the surgical guide, and the remainder of the osteotomy and implant placement is then finished freehand by the surgeon.6Â Techniques based on this design concept involve fabrication of a radiographic template, which is then converted into a surgical guide template following radiographic evaluation. Various authors have propos...
Nonlimiting Design
Nonlimiting designs only provide an indication to the surgeon as to where the proposed prosthesis is in relation to the selected implant site.6Â This design indicates the ideal location of the implants without any emphasis on the angulation of the drill, thus allowing too much flexibility in the final positioning of the implant.
Blustein et al7Â Â and Engelman et al8 described...
Various techniques have been proposed for the fabrication of surgical guide templates in implant dentistry. The objective of this paper is to review the associated literature and recent advancements in this field, based on design concept. An electronic and hand search of the literature revealed 3 categories, namely, nonlimiting, partially limiting, and completely limiting design. Most clinicians s...