Implant placement in the aesthetic zone: More efficiency in guided surgery

The aim of this case report is to describe the combining of a surgical guide with a temporary restoration to streamline the implant process. A 54-year-old male patient presenting partial edentulism underwent computer-aided template-guided implant placement for the replacement of the missing upper second right incisor. The presented technique was used during the surgical procedures; it introduced the integration of a surgical guide into the temporary fixed partial denture. Using computer-aided design, computer-aided manufacturing technology and virtual implant planning, a temporary-implantation fixed partial denture was constructed, and a guidance sleeve was implemented into it. The implant bed preparation was then performed using the bridge as a surgical guide. After osteotomy, the guidance sleeve within the bridge was sealed, and the bridge was temporarily incorporated for submerged healing of the implant. The usage of a temporary restoration as a surgical guide seems to make the digital workflow of guided implant placement more efficient, by achieving a representative clinical outcome.

Accuracy of Different Surgical Guide Designs for Static Computer-Assisted Implant Surgery: An in vitro Study

The aims of this study were to evaluate the effect of (i) the different surgical guide designs and (ii) implant placement location on the accuracy of fully guided implant placement in single edentulous sites using an in vitro study model. Forty-five partially edentulous models were scanned and divided into three groups: group 1, tooth-supported full-arch surgical guide; group 2, three different tooth-supported shortened surgical guides (SSGs); and group 3, tooth-supported full-arch surgical guide with a crossbar. All surgical guides were printed and used for fully guided implant placement. A total of 180 implants (60 per group) were placed, and scanbodies were positioned on all models, and postoperative surface scan files (STL) files were obtained. Superimposition of preoperative and postoperative STL files was performed, and the accuracy of implant position was evaluated. The interaction between group and implant location was statistically significant for angle, 3D offset at the base, and at the tip (p<0.001). The post-hoc tests showed a statistically significantly higher deviation for group 2 compared to group 3 for all outcomes for implants #4 (p<0.05) and #7 (p<0.05). There was also a statistically significant difference in all outcomes between groups 1 and 3 for implant #7 (p<0.05). All surgical guide designs presented satisfactory performance with clinically acceptable levels of deviation. However, SSGs presented higher accuracy for guided implant placement in a single-edentulous site, whereas a full-arch surgical guide with a crossbar presented superior outcomes when two or more guided implants were placed simultaneously.

Determination of the Accuracy of Linear Height Bone for Implant Placement in Panoramic Radiography Relative to CBCT in the Posterior Areas of the Jaws

Purpose: In the levels of implant treatment in the posterior region, determining the height of the bone has particular importance. The aim of the study was to compare the accuracy of linear bone height measurement for implant placement on panoramic view compared to CBCT in posterior jaw area. Materials and Methods: The study was performed on 20 patients. In each of the posterior edentulous areas, a surgical guide for each patient was marked with gutta-percha (a total of 70 points). Panoramic radiographs and CBCTs were obtained from the patients and then the distance between the marked points in the maxilla to the maxillary sinus and in the mandible to the upper border of the alveolar canal was measured by Romaxis software and analyzed by Statistical software Stata 14. The obtained measurements of panoramic view were compared to CBCTs using t-test. P≤0.05 was considered significant. Results: The mean difference between the sizes obtained from panoramic radiography and CBCT radiography in the maxilla was 0.34 mm (P = 0.57) and the mean difference between the sizes obtained from panoramic radiography and CBCT radiography in the mandible was 0.86 mm (P = 0.004). Conclusion: According to the results of study, it is logical panoramic radiography just used to pre-assessment of implant procedures in posterior area of mandible were as it could be more reliable in maxilla.

Computer-Guided Bone Biopsy: A Technical Note with the Description of a Clinical Case

Aim: The aim of this technical note is to present a computer-aided design–computer-aided manufacturing (CAD–CAM) surgical guide to perform a computer-guided bone biopsy. Traditionally, to diagnose abnormal conditions affecting jawbone, a bone biopsy is performed with the use of a trephine bur. The positioning of the bur, during the biopsy, is based on the skill of the surgeon; therefore, an inaccurate placement of a trephine bur may occur. The use of a guide, however, can minimize this risk and achieve a better result. Materials and Methods: To determine the site and the extension of bone sampling, the stereolithography file (STL) file of cone–beam computed tomography (CBCT) images is acquired using a specific planning software and superimposed with the STL file of a dental cast; a virtual surgical guide is designed, using the same software that allows a 3D (three-dimensional) view of the guide from different perspectives and planes. The number and site of guide tubes are determined on the basis of the width and the extension of the sampling; thanks to a 3D printer, the surgical guide is manufactured. Results: The use of a customized surgical guide realized with CAD–CAM technology allows a precise and minimally invasive approach, with an accurate three-dimensional localization of the biopsy site. Conclusions: The high precision, great predictability, time-effectiveness and versatility of the present guide should encourage the clinician to use this minimally invasive surgical approach, but controlled clinical trials should be conducted to evaluate the advantages as well as any possible complications.

Guided Insertion of Temporary Anchorage Device in Form of Orthodontic Titanium Miniscrews with Customized 3D Templates—A Systematic Review with Meta-Analysis of Clinical Studies

(1) Background: Miniscrew insertion, using a surgical guide, aims to avoid possible adverse effects or complications. With the higher availability of both 3D imaging and printing, 3D surgical guides have been used more frequently in orthodontics. The aim of the present systematic review was to find scientific clinical evidence concerning the precision of the 3D guided insertion of miniscrews for temporary orthodontic anchorage. (2) Methods: Literature searches were performed in the following five search engines: Pubmed (Medline), Pubmed Central, Scopus, Web of Science and Embase on 10 September 2021 (articles from 1950 to 10 September 2021). A meta-analysis was performed using the random-effect model, with Standardized Mean Differences (SMD) and 95% confidence intervals (95% CI) calculated as effect estimates. The heterogeneity was assessed quantitatively. (3) Results: The search strategy identified 671 potential articles. After the removal of duplicates, 530 articles were analyzed. Subsequently, 487 papers were excluded, because they were not associated with the subject of the study. Of the remaining 43 papers, 34 were excluded because they did not meet the methodological criteria. Finally, only nine papers were subjected to a qualitative analysis. (4) Conclusions: The current literature concerning guided miniscrew insertion reveals, for the most part, a low methodological level. High-quality clinical trials are in the minority. The use of surgical guides increases insertion accuracy, stability and reduces the failure rate of orthodontic miniscrews. Tooth-borne insertion guides supported on the edges of the teeth ensure a higher insertion precision compared to mucosa-borne ones. The study protocol was registered in PROSPERO under the number CRD42021267248.

From Denture to the Final Implant-Supported Prosthesis Using a Full-Digital Protocol: A Dental Technique

Proper maxillomandibular relationship registration can be clinically challenging during a digital workflow in full-arch rehabilitations. This dental technique requires the manufacturing and use of a hybrid surgical guide custom scanning device, indicated to be used during implant placement surgery, in addition to being used to simultaneously register the maxillomandibular relationship and transfer the implants’ 3D positioning, ensuring a fully digital workflow in full-arch implant-supported prosthesis rehabilitation. The sequence of steps presented here will allow dentists and dental technicians to conduct rehabilitations from denture to the final implant-supported prosthesis using a full-digital protocol, using a minimal quantity of intraoral devices and digital tools.