Influence of bone condition on implant placement accuracy with computer-guided surgery

Abstract

Background The impact of the jaw bone condition, such as bone quantity and quality in the implant placement site, affecting the accuracy of implant placement with computer-guided surgery (CGS) remains unclear. Therefore, this study aimed to evaluate the influence of bone condition, i.e., bone density, bone width, and cortical bone thickness at the crestal bone on the accuracy of implant placement with CGS. Methods A total of 47 tissue-level implants from 25 patients placed in the posterior mandibular area were studied. Implant placement position was planned on the simulation software, Simplant® Pro 16, by superimposing preoperative computed tomography images with stereolithography data of diagnostic wax-up on the dental cast. Implant placement surgery was performed using the surgical guide plate to reflect the planned implant position. The post-surgical dental cast was scanned to determine the position of the placed implant. Linear and vertical deviations between planned and placed implants were calculated. Deviations at both platform and apical of the implant were measured in the bucco-lingual and mesio-distal directions. Intra- and inter-observer variabilities were calculated to ensure measurement reliability. Multiple linear regression analysis was employed to investigate the effect of the bone condition, such as density, width, and cortical bone thickness at the implant site area, on the accuracy of implant placement (α = 0.05). Result Intra- and inter-observer variabilities of these measurements showed excellent agreement (intra class correlation coefficient ± 0.90). Bone condition significantly influenced the accuracy of implant placement using CGS (p < 0.05). Both bone density and width were found to be significant predictors. Conclusions Low bone density and/or narrow bucco-lingual width near the alveolar bone crest in the implant placement site might be a risk factor influencing the accuracy of implant placement with CGS.

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

“…In clinical practice, numerous factors besides bone density may influence the accuracy of CAIS. Because of the weak correlation between bone density and the accuracy of CAIS reported in the literature [ 30 , 31 ] and in the present study, to control these risk factors, further in vitro studies may be required to assess the role of bone density in the accuracy of CAIS. A possible interpretation of this result might be that it is more difficult to deviate from the path of the pilot drill in denser bone.…”

“…The influence of bone density on the accuracy of static CAIS is also controversial, with some studies reporting a statistically significant negative correlation between bone density and the accuracy of CAIS [ 31 , 32 ]. However, according to other studies, no correlation [ 28 , 33 ] or statistically significant positive correlation has been observed between bone density and the accuracy of CAIS [ 29 ].…”

“…In their clinical study, Ochi et al carried out full-guided surgery with mucosa-supported, pin-anchored templates on edentulous jaws and concluded that implants tend to be placed deeper than planned at sites with lower bone density and more superficially at sites with high bone density [ 30 ]. In a study by Putra et al, half-guided implant placement was carried out with a tooth-supported template and the results suggested a weak, statistically significant negative correlation between bone density and the accuracy of implant placement [ 31 ]. Ozan et al found in their study that there was a statistically significant negative correlation between bone density and the accuracy of guided implant placement when performing half-guided static CAIS with mucosa-supported templates [ 32 ].…”

“…Most studies have employed conventional CT scans for preoperative planning and postoperative control [ 28 , 29 , 31 , 32 ]. However, other studies, such as the present one, have used CBCT for planning implant placement, designing templates and conducting follow-up [ 30 , 33 ].…”

“…There is limited evidence in the literature on the influence of recipient bone quality on the accuracy of static CAIS. Few cadaver [ 28 ] and clinical [ 29 , 30 , 31 , 32 , 33 ] studies have been conducted with differing methodology and results to correlate cortical bone thickness, bone quality and bone density with the accuracy of guided implant placement.…”