Accuracy of half-guided implant placement with machine-driven or manual insertion: a prospective, randomized clinical study

Abstract Objectives To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol. Materials and methods Implant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated. Results Forty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group. Conclusion No significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming. Clinical relevance Optimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion. Trial registration ID: NCT04854239

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Patient-Reported Outcome Measures (PROMs) for Two Implant Placement Techniques in Sinus Region (Bone Graft versus Computer-Aided Implant Surgery): A Randomized Prospective Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17092990 ◽

2020 ◽

Vol 17 (9) ◽

pp. 2990

Author(s):

Ghazwan Almahrous ◽

Sandra David-Tchouda ◽

Aboubacar Sissoko ◽

Nathalie Rancon ◽

Jean-Luc Bosson ◽

...

Keyword(s):

Bone Graft ◽

Clinical Success ◽

Implant Surgery ◽

Implant Placement ◽

Posterior Maxilla ◽

Significant Difference ◽

Patient Reported ◽

Computer Aided ◽

Bone Atrophy ◽

One Year

Purpose: To assess patient-reported outcomes measures (PROMs) for two implant placement techniques in cases of sinus bone atrophy (bone graft surgery (BGS) versus computer-aided implant surgery (CAIS)), after surgery and one year later, and to evaluate the clinical success of both treatments. Methods: Sixty patients with bone atrophy in the posterior maxilla and in need of implant placement were randomly assigned to two groups, and in accordance with the case report form (CRF), 30 were treated with BGS and 30 with CAIS. Immediately after treatment and one year later, PROMs were assessed, and the clinical success of both treatments was evaluated. Results: No significant differences were found between BGS and CAIS with regard to the following: loss of implants (p = 492); patient recommendation (p = 210); duration of surgery (p = 987); pain on the intervention day (p = 512); pain in the week after intervention (p = 299); and complications in the stage of surgery (p = 1.00). Similarly, at one year, no differences were found with regard to the following: pain around implant (p = 481); infection of implants (p = 491); abnormal radiographic imaging (p = 226); occurrence of undesirable events (p = 1.00); loss of one of the implants (p = 1.00); plaque detection (p = 1.00); bleeding on probing (p = 236); and presence of keratinized mucosa (p = 226). However, a significant difference was found among BGS and CAIS with regard to the number of consultations (p = 0001); number of implants placed (p = 033); and treatment difficulty (p = 0369). Significant differences were found for peri-implantitis (p = 0481) and radiology of craterization (p = 020) in clinical examination at the first year. Conclusion: Treatment difficulty and number of consultations were higher for BGS than for CAIS, as well as peri-implantitis and bone craterization at one year, indicating significant differences between the two treatments. However, there were no statistically significant differences between BGS and CAIS regarding the other PROMs, at placement and after one year.

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A Simplified Prosthetic Implant Loading Protocol: 1-Year Clinical Follow-Up Study

International Journal of Dentistry ◽

10.1155/2020/8832500 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Lorenzo Andreatta ◽

Malin Bjursten Brailsford ◽

Jakob Zwaan

Keyword(s):

Bone Remodeling ◽

Treatment Time ◽

Treatment Protocol ◽

Immediate Loading ◽

Insertion Torque ◽

Implant Stability ◽

Implant Placement ◽

Significant Difference ◽

One Year

Purpose. To retrospectively investigate the one-year clinical outcome following a standardized treatment protocol for immediate loading. The protocol mandates predefined requirements for implant stability. If fulfilled, immediate loading of the implants is performed with a simplified prosthetic protocol which includes one-time impression at the time of surgery and definitive restoration within eight weeks. Methods. Twenty-five patients were treated with 48 Neoss ProActive Tapered implants. Minimum primary stability was established before subjecting the implants to immediate nonfunctional load. Definitive prostheses were delivered six to eight weeks from implant placement. Insertion torque (IT), resonance frequency analysis (RFA), intraoral radiographs, and impressions of implant positions were registered at implant placement. During clinical follow-up, RFA was measured at two, four, and six to eight weeks and six months from implant placement to monitor continued implant stability. Marginal bone level measurements were performed at implant placement, six-month, and one-year follow-up visits. Results. IT was over 40 N·cm for 46 implants. Two implants with IT <30 N·cm were both splinted to another implant with IT >50 N·cm, tightening the retention screw with low forces. No implants were lost during the observation period. Mean RFA measurements remained stable without any decrease during the initial six-month healing phase. Mean marginal bone remodeling was −0.47 ± 0.38 mm from implant placement to 1 year. No significant difference was found for marginal bone remodeling between implants placed in the healed bone or fresh extraction sockets. Conclusion. Within the limits of this study, it is concluded that using a simplified immediate loading protocol can be predictably applied to reduce the overall treatment time and the number of clinical sessions.

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The Influence of Surgical Experience and Bone Density on the Accuracy of Static Computer-Assisted Implant Surgery in Edentulous Jaws Using a Mucosa-Supported Surgical Template with a Half-Guided Implant Placement Protocol—A Randomized Clinical Study

Materials ◽

10.3390/ma13245759 ◽

2020 ◽

Vol 13 (24) ◽

pp. 5759

Author(s):

Márton Kivovics ◽

Dorottya Pénzes ◽

Orsolya Németh ◽

Eitan Mijiritsky

Keyword(s):

Clinical Study ◽

Bone Density ◽

Computer Assisted ◽

Angular Deviation ◽

Grey Level ◽

Surgical Experience ◽

Implant Placement ◽

Randomized Clinical Study ◽

R Value ◽

Edentulous Jaws

The aim of our randomized clinical study was to analyze the influence of surgical experience and bone density on the accuracy of static computer-assisted implant surgery (CAIS) in edentulous jaws using a mucosa-supported surgical template with a half-guided implant placement protocol. Altogether, 40 dental implants were placed in the edentulous jaws of 13 patients (novice surgeons: 18 implants, 6 patients (4 male), age 71 ± 10.1 years; experienced surgeons: 22 implants, 7 patients (4 male), age 69.2 ± 4.55 years). Angular deviation, coronal and apical global deviation and grey level measurements were calculated for all implants by a blinded investigator using coDiagnostiX software. 3DSlicer software was applied to calculate the bone volume fraction (BV/TV) for each site of implant placement. There were no statistically significant differences between the two study groups in either of the primary outcome variables. There was a statistically significant negative correlation between angular deviation and both grey level measurements (R-value: −0.331, p < 0.05) and BV/TV (R-value: −0.377, p < 0.05). The results of the study suggest that surgical experience did not influence the accuracy of implant placement. The higher the bone density at the sites of implant placement, the higher the accuracy of static CAIS.

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Assessment of the Simultaneous Use of Biomaterials in Transalveolar Sinus Floor Elevation: Prospective Randomized Clinical Trial in Humans

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061888 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1888 ◽

Cited By ~ 1

Author(s):

Adrián Maximiano Millán ◽

Rocío Bravo Álvarez ◽

Miguel Plana Montori ◽

María Guerrero González ◽

David Saura García-Martín ◽

...

Keyword(s):

Test Group ◽

Control Group ◽

Simultaneous Application ◽

Sinus Floor Elevation ◽

Implant Placement ◽

Randomized Clinical Study ◽

Additional Surgery ◽

Posterior Maxilla ◽

Sinus Floor ◽

Bone Gain

Implants inserted in the posterior maxilla frequently need additional surgery for successful bone augmentation. One of the most common procedures for this is transalveolar sinus floor elevation. There are different protocols for this procedure, and there is controversy over the simultaneous application of grafting material upon elevating. In this prospective randomized clinical study in humans, a total of 49 transalveolar sinus floor elevations were performed in 49 different patients, divided into a control group (without graft, 25 patients) and a test group (with graft, 24 patients). The analyzed variables were obtained through digital orthopantomography on day 0 (day of surgery) and 18 months after surgery. These measurements showed a tendency towards greater vertical bone gain in the test group, but this was not statistically significant. Therefore, considering that sinus elevation and implant placement without the application of grafts is a successful treatment with fewer complications, a critical assessment of the need for these biomaterials is necessary.

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Resonance Frequency Analysis of 208 Straumann Dental Implants During the Healing Period

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-11-00060 ◽

2013 ◽

Vol 39 (2) ◽

pp. 161-167 ◽

Cited By ~ 17

Author(s):

Ahmet Umut Guler ◽

Mahmut Sumer ◽

Ibrahim Duran ◽

Elif Ozen Sandikci ◽

Nazife Tuba Telcioglu

Keyword(s):

Dental Implant ◽

Implant Stability ◽

Anterior Maxilla ◽

Implant Placement ◽

Healing Period ◽

Posterior Maxilla ◽

Significant Difference ◽

Final Measurement ◽

Diagnostic Benefit ◽

Anterior Mandible

The most important prerequisite for the success of an osseointegrated dental implant is achievement and maintenance of implant stability. The aim of the study was to measure the 208 Straumann dental implant stability quotient (ISQ) values during the osseointegration period and determine the factors that affect implant stability. A total of 164 of the implants inserted were standard surface, and 44 of them were SLActive surface. To determine implant stability as ISQ values, measurements were performed at the stage of implant placement and healing periods by the Osstell mentor. The ISQ value ranges showed a significant increase during the healing period. Except for the initial measurement, the posterior maxilla had the lowest ISQ values, and there was no significant difference among anterior mandible, posterior mandible, and anterior maxilla (P < .05). Implant length did not have a significant influence on ISQ value (P > .05). The second measurement was significantly higher in men compared with women (P < .05). The second measurement was significantly higher than the others at 4.8 mm, and for the final measurement, there were no significant differences between 4.8 and 4.1 mm, which were higher than 3.3 mm (P < .05). When comparing sandblasted, large-grit, acid-etched (SLA) and SLActive surface implants, there were no significant differences for insertion measurements, but for second measurements, SLActive was significantly higher (P = 0), and for the final measurement, there was no significant difference. It appears that repeated ISQ measurements of a specific implant have some diagnostic benefit, and the factors that affect implant stability during the healing period are presented.

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Reverse torque values in indexed abutments

Journal of Research in Dentistry ◽

10.19177/jrd.v1e32013192-198 ◽

2013 ◽

Vol 1 (3) ◽

pp. 192

Author(s):

Daiane Cerutti-Kopplin ◽

Dimas João Rodrigues Neto ◽

Accácio Lins Do Valle ◽

Jefferson Ricardo Pereira ◽

Luis Gustavo Nunes Dias Pinho

Keyword(s):

Mechanical Stability ◽

Insertion Torque ◽

Average Percentage ◽

Reverse Torque ◽

Torque Wrench ◽

Significant Difference ◽

Implant Abutment ◽

Analysis Of Results ◽

Torque Values ◽

Biomechanical Instability

Mechanical stability of implant-abutment set is fundamentally important for the success in implant supported rehabilitation. For this, the knowledge about torque removal values is essential. In this way, the objective of this work was to evaluate the torque reverse values in indexed abutments of Morse Taper system. Five Morse taper implants with their respective abutments were tested (n=5). Each abutment received a sequence of two consecutive torques in insertion (15Ncm) with an interval of ten minutes, and one reverse torque, all measured by digital torque wrench. The t-student test with 5% significance was used to evaluate the data. The analysis of results showed there is statistical significant difference in reverse torque values between the insertion torque value and reverse torque value intra-group, the indexed abutments presented an average percentage of torque loosing of 15% (P=0.002). It is possible to conclude that the use of indexed abutments of Morse taper system presented statistical significant reduction of reverse torque values, which in turns increase the risk of no biomechanical instability.

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Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00229 ◽

2020 ◽

Vol 46 (4) ◽

pp. 415-422

Author(s):

Junho Jung ◽

Jung Soo Park ◽

Seoung-Jin Hong ◽

Gyu-Tae Kim ◽

Yong-Dae Kwon

Keyword(s):

Maxillary Sinus ◽

Surgical Techniques ◽

Lateral Sinus ◽

Sinus Floor Elevation ◽

Second Molar ◽

Sinus Wall ◽

Posterior Maxilla ◽

Significant Difference ◽

Sinus Floor ◽

Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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Socket preservation using xenograft does not impair implant primary stability in sheep: clinical, histological and histomorphometric study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00237 ◽

2020 ◽

Author(s):

Yaniv Mayer ◽

Ofir Ginesin ◽

Hadar Zigdon-Giladi

Keyword(s):

Bone Biopsy ◽

Primary Stability ◽

Insertion Torque ◽

Socket Preservation ◽

Histomorphometric Study ◽

Implant Placement ◽

High Bone ◽

Delayed Implant Placement ◽

Natural Healing

Implant primary stability, which depends mainly on the amount and quality of bone, is important for implant survival. Socket preservation aims to reduce bone volumetric changes following tooth extraction. This animal study aims to examine whether preserving a ridge by using xenograft impairs the primary stability of the implant. Eighteen artificial bone defects were prepared in four sheep (5mmØ and 8mm length). Defects were randomly grafted with xenografts: Bio-Oss (BO), Bioactive Bone (BB), or left for natural healing (control). After 8 weeks, bone biopsy was harvested and dental implants installed. During installation, peak insertion torque (IT) was measured by hand ratchet, and primary stability by the Osstell method. Histomorphometric analysis showed a higher percentage of new bone formation in the naturally healed defects compared to sites with xenograft (control 68.66 ± 4.5%, BB 48.75 ± 4.34%, BO 50.33 ± 4.0%). Connective tissue portion was higher in the BO and BB groups compared to control (44.25 ± 2.98%, 41 ± 6%, and 31.33 ± 4.5, p<0.05, respectively). Residual grafting material was similar in BO and BB (7 ± 2.44%, 8.66 ± 2.1 %, respectively). Mean IT and ISQ values were not statistically different among the groups. A positive correlation was found between IT and ISQ (r=0.65, p=0.00). In conclusion, previously grafted defects with xenograft did not influence primary stability and implant insertion torque in delayed implant placement. These results may be attributed to a relatively high bone fill of the defect (~50%) two months after grafting.

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Simultaneous implant placement with autogenous onlay bone grafts: a systematic review and meta-analysis

International Journal of Implant Dentistry ◽

10.1186/s40729-021-00311-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Guoqiang Ma ◽

Chaoan Wu ◽

Miaoting Shao

Keyword(s):

Meta Analysis ◽

Survival Rates ◽

Bone Grafts ◽

Implant Survival ◽

Analysis Model ◽

Implant Placement ◽

Significant Difference ◽

Delayed Implant Placement ◽

Onlay Grafts

AbstractSeveral authors have suggested that implants can be placed simultaneously with onlay bone grafts without affecting outcomes. Therefore, the purpose of this study was to answer the following clinical questions: (1) What are the outcomes of implants placed simultaneously with autogenous onlay bone grafts? And (2) is there a difference in outcomes between simultaneous vs delayed placement of implants with autogenous onlay bone grafts? Databases of PubMed, Embase, and Google Scholar were searched up to 15 November 2020. Data on implant survival was extracted from all the included studies (single arm and comparative) to calculate point estimates with 95% confidence intervals (CI) and pooled using the DerSimonian–Laird meta-analysis model. We also compared implant survival rates between the simultaneous and delayed placement of implants with data from comparative studies. Nineteen studies were included. Five of them compared simultaneous and delayed placement of implants. Dividing the studies based on follow-up duration, the pooled survival of implant placed simultaneously with onlay grafts after <2.5 years of follow-up was 93.1% (95% CI 82.6 to 97.4%) and after 2.5–5 years was 86% (95% CI 78.6 to 91.1%). Implant survival was found to be 85.8% (95% CI 79.6 to 90.3%) with iliac crest grafts and 95.7% (95% CI 83.9 to 93.0%) with intra-oral grafts. Our results indicated no statistically significant difference in implant survival between simultaneous and delayed placement (OR 0.43, 95% 0.07, 2.49, I2=59.04%). Data on implant success and bone loss were limited. Data indicates that implants placed simultaneously with autogenous onlay grafts have a survival rate of 93.1% and 86% after a follow-up of <2.5 years and 2.5–5years respectively. A limited number of studies indicate no significant difference in implant survival between the simultaneous and delayed placement of implants with onlay bone grafts. There is a need for randomized controlled trials comparing simultaneous and delayed implant placement to provide robust evidence.

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