Accuracy, Labor-Time and Patient-Reported Outcomes with Partially versus Fully Digital Workflow for Flapless Guided Dental Implants Insertion—A Randomized Clinical Trial with One-Year Follow-Up

Abstract

(1) Background: Prosthetically-driven implant positioning is a prerequisite for long-term successful treatment. Transferring the planned implant position information to the clinical setting could be done using either static or dynamic guided techniques. The 3D model of the bone and surrounding structures is obtained via cone beam computed tomography (CBCT) and the patient’s oral condition can be acquired conventionally and then digitalized using a desktop scanner, partially digital workflow (PDW) or digitally with the aid of an intraoral scanner (FDW). The aim of the present randomized clinical trial (RCT) was to compare the accuracy of flapless dental implants insertion in partially edentulous patients with a static surgical template obtained through PDW and FDW. Patient outcome and time spent from data collection to template manufacturing were also compared. (2) Methods: 66 partially edentulous sites (at 49 patients) were randomly assigned to a PDW or FDW for guided implant insertion. Planned and placed implants position were compared by assessing four deviation parameters: 3D error at the entry point, 3D error at the apex, angular deviation, and vertical deviation at entry point. (3) Results: A total of 111 implants were inserted. No implant loss during osseointegration or mechanical and technical complications occurred during the first-year post-implants loading. The mean error at the entry point was 0.44 mm (FDW) and 0.85 (PDW), p ≤ 0.00; at implant apex, 1.03 (FDW) and 1.48 (PDW), p ≤ 0.00; the mean angular deviation, 2.12° (FDW) and 2.48° (PDW), p = 0.03 and the mean depth deviation, 0.45 mm (FDW) and 0.68 mm (PDW), p ≤ 0.00; (4) Conclusions: Despite the statistically significant differences between the groups, and in the limits of the present study, full digital workflow as well as partially digital workflow are predictable methods for accurate prosthetically driven guided implants insertion.

Can computer‐assisted implant surgery improve clinical outcomes and reduce the frequency and intensity of complications in implant dentistry? A critical review

“…Apart from the few comparative studies, 17 studies reported survival rates of implants placed with different static or d‐CAIS protocols. Fourteen of these studies had a follow‐up of at least 1 year, one was 3 months, 30 while in the other two, 28,31 the observation period was not reported. Among these, eight studies reported 100% survival of the implants without complications 15,25,30–35 .…”

“…Five studies reported implants without osseointegration after completion of the healing period, all of which concerned s‐CAIS placement 13 , 15 , 18 , 23 , 28 (Table 4 ). Failure of osseointegration in cases of conventional loading 18 , 23 , 28 was reported in 0.69%‐3.23% of the implants placed, affecting 1.52%‐9.09% of patients.…”

“…The studies utilized a wide diversity of instruments, from validated questionnaires such as the Modified Dental Anxiety Scale, OHiP 14, 9 McGill pain and health-related quality of life (HRQoL) questionnaires, 40 established practices such as 1-10 visual analog scale (VAS) scores of PRE (pain, swelling), 8,15,41 to nonstandardized custom-made questionnaires. 22,28 Noncomparative studies often reported high levels of "satisfaction" using descriptive questionnaires 19,22,42 ; such conclusions cannot, however, be extrapolated beyond the limits of each individual study. Five RCTs 8,9,29,36,43 with a total of 282 patients (conventional freehand, n = 117; CAIS, n = 166), one small case-control study, 16 and one cross-sectional survey, 42 have assessed different aspects of PROs and PRE between patients with s-CAIS/d-CAIS and conventional placement controls.…”

Preliminary Study with the Use of a Titanium Mesh as Space Maker and Implant Primary Stabilization for One-Stage Sinus Lift in Cases with Less Than 1.5 mm Residual Bone

“…The Image J open software (https://imagej.nih.gov/; accessed on 13 September 2021), calibrated for each measurement based on the known implant length [16], was used to measure the peri-implant marginal bone level at mesial and distal sites, on the panoramic radiographs at prosthetic insertion and at 1-year post loading. For calibration with the known implant length, the reference points were implant apex and implant collar.…”

Could Pro-Inflammatory Cytokines Levels IL-6, IL-8, TNFα, Total Antioxidant Status and Lactate Dehydrogenase Be Associated with Peri-Implant Bone Loss? A Pilot Study

“…Before any radiological examination, a film holder was directly customized in the patient's mouth using auto-polymerizing acrylic resin to reproduce the same position of the film, thereby obtaining superimposable dental radiographs at different time intervals. Bone level was measured on digital radiographs using Image J open software (imagej.nih.gov, accessed on 28 July 2021), calibrated for each measurement based on the known implant length [24]. For calibration with the known implant length, the reference points were implant apex and implant collar, and for mesial and distal bone level measurements, the reference points were the correspondent horizontal point of the implant apex and the most coronal bone to implant contact.…”