Pilot-drill guided vs. full-guided implant insertion in artificial mandibles—a prospective laboratory study in fifth-year dental students

Abstract

Background As a growing field in dentistry, the practical education during the undergraduate curriculum in implant dentistry should be extended. Not only the theoretical background but also practical skills are crucial to place implants in patients. In order to determine the exact implant position, several positioning aids are available. In the present laboratory study, the accuracy of implant insertion using two different guiding modes in a group of inexperienced participants was assessed. Methods After three-dimensional planning using the data of a cone beam computed tomography of artificial mandibles, surgical templates were manufactured by thermoforming. In region 35, a sleeve for the pilot drill was used, whereas in region 45, a sleeve allowing a full-guided implant insertion was inserted. Subsequently, a total of 104 implants were placed by 52 undergraduates. Radiographical assessment of the three-dimensional accuracy was performed. Furthermore, the time required to insert the implants was recorded. Statistical analysis followed. Discussion When comparing the three-dimensional accuracy of the virtually planned to the actual inserted implant, a statistically significantly higher accuracy in three-dimensional angulation was achieved for the full-guided (3.388 ± 1.647°) compared to the pilot-drill guided mode (5.792 ± 3.290°). Furthermore, the time required to insert the implant was shorter for the full-guided template (6.23 ± 1.78 min) vs. for the pilot-drill guided (8.84 ± 2.39 min). Both differences reached a statistical significance ( p < 0.001). Conclusion Within the limit of this laboratory study, the results suggest that inexperienced surgeons benefit from a full-guided implant insertion. However, the clinical effects have to be discussed as the mismatch was varying in the decimillimeter range.

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

“…In addition, this superiority was shown for anterior and posterior implants. Such observations confirm the advantage of the FG protocol in controlling all the steps of osteotomy and implant placement [7,9,15,16]. On the contrary, the inaccuracies of the PG and FH protocols were generally similar and tended to be approximately double the inaccuracies of the FG protocol.…”

“…For example, Rungcharassaeng et al found that the FG protocol reduced differences between experienced and inexperienced operators for placing single posterior implants no difference between experienced and inexperienced operators when FG protocol guides were used, while the differences became obvious when implants were placed without surgical guides [13,14]. According to Schulz et al, in the hand of final-year dental students, FG implant placement was more accurate than PG implant placement [15]. 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.…”

“…On the contrary, the PG protocol inaccuracy seemed comparable to the FH protocol, which could be due to the execution of most of the drilling steps and implant placement without the use of guides, leading to inevitable deviation of the drills and implant placement. This is further accentuated in the hands of inexperienced operators who may not precisely control the subsequent drilling steps [14,15]. While the actual difference between the FG and PG protocols in all the variables is minimal, and still within the recommended safety zone of 2 mm [17], it can still be of clinical significance in cases where the available bone is limited, surgical site is compromised, and the implant is in close proximity to natural teeth and vital anatomical structures [17].…”

“…Currently, there are two protocols for sCAIP: fully guided (FG) and pilot-guided (PG) protocols [15,16]. The FG protocol is related to implant manufacturers and has the advantage of controlling all the drilling, tapping, and implant placement through the surgical guide.…”

Influence of the Digital Mock-Up and Experience on the Ability to Determine the Prosthetically Correct Dental Implant Position during Digital Planning: An In Vitro Study

“…A correct combination of anatomical information and virtual prosthetic planning allows the positioning of the implant according to the prosthetic's needs [10]. The incorporation of the digital mock-up into the dental implant planning process and digital flow in implantology can influence the accuracy of dental implant placements and reduce the variability associated with the professional experience [11].…”