Navigation implant surgery accuracy in different types of edentulism: A systematic review and meta-analysis.

BackgroundGuided endodontics technique has been introduced for years, but the accuracy in different types of teeth has yet to be assessed. The aim of this study is to evaluate the accuracy of three dimensional (3D)-printed endodontic guides for access cavity preparation in different types of teeth, and to evaluate the predictive ability of angular and linear deviation on canal accessibility ex vivo.MethodEighty-four extracted human teeth were mounted into six jaw models and categorised into three groups: anterior teeth (AT), premolar (P), and molar (M). Preoperative cone beam computed tomography (CBCT) and surface scans were taken and matched using implant planning software. Virtual access cavity planning was performed, and templates were produced using a 3D printer. After access cavities were performed, the canal accessibility was recorded. Postoperative CBCT scans were superimposed in software. Coronal and apical linear deviations and angular deviations were measured and evaluated with nonparametric statistics. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of angular and linear deviation for canal accessibility in SPSS v20.ResultsA total of 117 guided access cavities were created and 23 of them were record as canal inaccessibility, but all canals were accessible after canal negotiation. The average linear deviation for all groups was 0.13 ± 0.21 mm at coronal position, 0.46 ± 0.4 mm at apical position, and 2.8 ± 2.6° in angular deviation. At the coronal position, the linear deviations of the AT and P groups were significantly lower than M group deviation (P < 0.05), but no statistically significant difference between AT group and P group. The same results were found in linear deviation at the apical position and in angular deviation. The area under the ROC curve was 0.975 in angular deviation, 0.562 in linear deviation at the coronal position, and 0.786 at the apical position. Statistical significance was noted in linear deviation at the apical position and in angular deviation (P < 0.001).ConclusionsIn conclusion, this study demonstrated that the accuracy of access cavity preparation with 3D-printed endodontic guides was acceptable. The linear and angular deviations in the M group were significantly higher than those in the other groups, which might be caused by the interference of the opposite teeth. Angular deviation best discriminated the canal access ability of guided access cavity preparation.Graphical

Aim:The aim is to assess and compare angular, linear, and depth deviation and difference in bone density of dental implants placed using computer aided design/computer aided manufacturing (CAD/CAM) fabricated surgical guides versus implants placed using Bone Pen Kit. Till now, no original research exists in the search engines such as Pubmed, Google Scholar, Science Direct, and Research Gate on this kit.Settings and Design:In vivo- Randomised control trial.Materials and Methods:Twenty clinical cases were selected and split into two distinct groups. Group 1 involved the placement of 10 implants using CAD/CAM fabricated three dimensional guides and Group 2 involved the placement of 10 implants using Bone Pen Kit. Four deviation parameters were evaluated, which included: (a) Angular deviation, (b) Linear deviation at implant platform, (c) Linear deviation at implant apex, and (d) Depth deviation and difference in bone density before and after implant placement was also evaluated.Statistical Analysis Used:SPSS software version 23 was utilized for the analysis of the data. The comparison was made using the Whitney test, and Wilcoxon signed rank test.Results:When comparing angular deviation, the results indicated a statistically significant difference with a P < 0.05. The values observed for angular and linear deviation in Group 2 were significantly greater than those in Group 1. No statistically significant difference in depth and linear deviation was found at the implant platform among the two groups. Bone density before and after implant placement was significantly higher in Group 1.Conclusions:(1) Angular and linear deviation at the apex in Group 2 exhibited higher values in comparison to Group 1, (2) No difference in depth and linear deviation at the implant platform was found among the two groups, and (3) There was no difference in change in bone density among two groups.

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.

Introduction: Edentulism is a significant cause of poor oral health among the elderly in India. It affects their quality of life, particularly in terms of nutrition, phonetics and aesthetics. Most studies assessing edentulism in India are hospital-based, which may not provide an accurate representation of the general population. Therefore, community-based studies are essential to accurately estimate the prevalence of edentulism and enable the planning of specific strategies to promote oral health. Aim: To estimate the prevalence of partial and complete edentulism, identify the associated factors, assess the treatment needs and evaluate the perceived barriers influencing the treatment needs of the affected population. Materials and Methods: This was a community-based, mixedmethod study conducted in Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. The study was carried out over six months from May 2017 to October 2017 and included 328 elderly individuals aged 60 years and above. A pretested semi-structured proforma was used to collect data. Quantitative data on the extent of partial and complete edentulism and treatment needs were collected, while perceived barriers to seeking treatment were assessed qualitatively through indepth interviews. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 22.0, with a p-value of &lt;0.05 considered statistically significant. Results: The mean age of the participants was 71.4±7.6 years. The overall prevalence of edentulism was found to be 297 (90.5%) (95% CI=86.7%-93.2%). Of these, partial edentulism was found in 253 (13.4%) (95% CI=72.1%-81.4%), while 13.4% (95% CI=10.1%-17.7%) were completely edentulous. Out of the 297 edentate subjects, 65 (22%) participants reported a perceived need for dental treatment, while 232 (78%) did not perceive a need. Similarly, 285 (96%) participants were professionally determined to need dental treatment and 12 (4%) did not require dental treatment. Age, gender and tobacco use had a statistically significant association with edentulism (p-value &lt;0.05). About 227 (76.4%) of the edentate subjects reported difficulty in chewing. The striking findings revealed a low level of denture use among the participants, with only 20 (6.7%) of the 297 edentulous individuals using dentures. The most common perceived barriers to treatment were a lack of awareness regarding oral health, unaffordability and a lack of social support. Conclusion: The study found a high prevalence of edentulism among the elderly, with significant disparities between perceived and actual needs for prosthetic treatment. Only a small proportion of participants use dentures or seek dental care, emphasising the importance of targeted interventions to raise oral health awareness, reduce treatment costs and provide social support. Policymakers should prioritise oral health promotion programs for the elderly in order to bridge these gaps and improve their quality of life.

The aim of the study was to assess the effect of titanium scanbody (Ti ISB) repeated use on the accuracy of complete-arch implant impression in vitro. A mandibular resin model with four conical connection implant analogues was digitized using an extraoral scanner to achieve a reference file. Thirty-eight test files were obtained with an intraoral scanner (IOS) and superimposed to the reference file. Screw-retained sand-blasted Ti ISB were screwed and unscrewed between each test scan. Implant positions (n=152) were analyzed through linear (∆X, ∆Y and ∆Z- axis) and angular deviations (∆ANGLE). Three-dimensional (3D) deviation was calculated as Euclidean distance (∆EUC) from the linear deviations. Effect of implant position was also calculated. A significative reduction of ∆EUC over time (p=0.001, b=-0.00099) was noticed, with position 4.5 as the least accurate with a significant difference compared to 3.2. Considering ∆ANGLE a significant reduction was noticed over time (p=0.041, b=-0.0031), with position 4.5 as the least accurate with a significant difference compared to 3.2 and 4.2. Conclusions: Ti ISBs repeated use didn’t show a significant negative effect on complete-arch IOS implant impression accuracy both in terms of angular and 3D deviation. Implant position showed a significant effect on accuracy with posterior tilted identified as most critical positions.

The acquisition of digital impressions has become an integral part of clinical dentistry. The purpose of the present clinical simulation study was to evaluate the accuracy of digital impressions for maxillary full-arch implant-supported prostheses using two modern intraoral scanners with different acquisition technologies. Two models of edentulous maxilla, with six implants at positions #16,14,12,22,24,26 (FDI World Dental Federation System, ISO 3950) or #3,5,7,10,12,14 (Universal Numbering system) were digitally designed, and 3D-printed in resin material (Asiga DentaMODEL, Australia). In the first scenario, all implants were parallelized, while in the second, implants #12/#7 and #22/#10 had a 20° angulation buccally, while implants #16/#3 and #26/#14 20° angulation distally. The models were scanned with two different intraoral scanners, Trios3 (3Shape, Denmark) and CS3600 (Carestream Dental, USA). Linear (x, y, z axes-top point) and angular deviations (x, y, z axes-Δφ) were assessed. Statistical analysis was performed using Kolmogorov-Smirnov tests (significance at p < 0.05). Implant angulation showed a significant impact on accuracy, while the two scanners showed statistically significant differences. CS3600 demonstrated superior trueness, while Trios3 superior precision in both clinical scenarios. In the first clinical scenario a predominant occurrence of angular deviations was observed, while in the second scenario both angular and linear deviations were recorded. Scan body position also influenced scanning outcomes, with the last scan body captured demonstrating higher deviations. Both scanners provided acceptable accuracy in the acquisition of digital impressions. Implant angulation and scan body position significantly affected trueness and precision. Clinicians should carefully consider implant angulations in full-arch implant restorations, as well as the scanning protocol.

In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data.

Our objective was to compare guided virtual surgery to conventional surgery in terms of angular deviation of single dental implants placed in the posterior mandible. Patients with bilateral homologous single teeth missing in the posterior mandible were eligible for this split-mouth randomized clinical trial. Cone beam computed tomography (CBCT) was performed for virtual planning of implant position and manufacturing of the stereolithographic guides. One week after the surgery, a second CBCT scan was superimposed to the initial planning. Primary endpoint was the angular deviation between virtual and clinical implant position. Secondary endpoints were linear deviations and patient-reported outcomes collected with a questionnaire. Data from 12 patients were available for analysis. Angular deviation was significantly lower using stereolithographic guides as compared to conventional guides (2.2±1.1° vs. 3.5±1.6°, p=.042). Linear deviations were similar for both techniques in the coronal (2.34±1.01 vs. 1.93±0.95mm) and apical (2.53±1.11 vs. 2.19±1.00mm) dimensions (p˃.05). The selection of the surgical technique had no significant impact on the patient-reported outcomes. Our data suggest that the angular discrepancy between the virtual and the clinical implant position is slightly lower when using stereolithographic guides as compared to conventional guides.

Background: The purpose of the present study was to detect Actinobacillus actinomycetemcomitans (Aa) using RT-PCR in patients with complete and partial edentulism before (T0) and three months after (T3) treatment with removable partial dentures (RPD) and complete dentures (CD), respectively, to compare the data between these two research groups. Methods and Results: The sample comprised 60 patients: 33 men and 27 women, aged 48 to 76 years. The patients were divided into two groups. Group 1 included 30 patients with partial edentulism who were treated with RPD. Group 2 included 30 patients with complete edentulism who were treated with CD. The samples from Group 1 were taken from the gingival sulcus of the abutment teeth by means of sterile paper points. For Group 2, the samples were taken with a sterile swab from the dorsum of the tongue. The samples were taken in T0 and T3 intervals. To detect Aa DNA, we used RT-PCR and ParodontoScreen REAL-TIME PCR Detection Kit (DNA-TECHNOLOGY). Bacterial load levels of species were conventionally represented in logarithm (Lg) of genome equivalents per sample. The results were also presented in three ranges depending on the level of bacterial load: normal (&lt; 4.0Lg), light/moderate (≥4.0 Lg), and severe (&gt;5.0 Lg). The study found a significant difference in the amount of Aa between the T0 and T3 intervals only in patients treated with RPD (0.871.58 Lg vs. 1.28 1.96 Lg, P=0.004). Patients treated with CD, however, did not differ significantly in the amount of Aa between the T0 and T3 intervals (0.030.16 Lg vs. 0). The average bacterial load in patients with RPD was significantly higher than in those with CD three months after treatment (P=0.02) (Table 2). The range of bacterial load levels in the groups is presented in Table 3. Of the 30 patients with RPD, 2(6.7%) had a severe range, 2(6.7%) had a mild/moderate range, and 26(86.7%) had a normal range. The 30 CD patients all had a normal range. There was no significant difference in the prevalence range of bacterial load level with Aa between groups (Fisher's Exact Test = 3.537, P=0.113) / Monte Carlo Sig. (2-sided) / 0.105–0.121). However, in general, RPD causes a significant increase in Aa, so the level of periodontal pathogens may be higher in RPD patients than in CD patients.

Implant placement accuracy in the distal free-end posterior region is often compromised, increasing the risk of damage to adjacent anatomical structures and negatively affecting restoration function, occlusal loading, and aesthetics. This study aimed to assess the accuracy of implant placement using static computer-assisted implant surgery (CAIS) in the posterior distal free-end partially edentulous area with varying cantilever lengths and to evaluate the correlation between cantilever length and implant deviations. A prospective observational study involved 40 patients with 72 posterior implant sites, divided into three groups: 1-unit cantilever (1-UC; distal free-end with a mesial neighboring tooth), 2-unit cantilever (2-UC; one-tooth space from the mesial neighboring tooth), and control (single-tooth space with both mesial and distal neighboring teeth). Implants were placed using fully guided static CAIS, and accuracy was assessed by comparing angular and linear deviations at the implant platform and apex using post-operative CBCT scans. The correlation between cantilever length and implant deviations was analyzed. The 2-UC group exhibited significantly higher angular deviations (5.01° ± 2.41°) compared to the 1-UC (3.60° ± 1.92°, p = 0.033) and control groups (2.62° ± 1.13°, p < 0.001). The 3D deviations at both the platform and apex were also significantly greater in the 2-UC group (1.15 ± 0.38 mm, 1.74 ± 0.53 mm, respectively) than in the 1-UC (0.86 ± 0.35 mm, p = 0.001; 1.30 ± 0.47 mm, p = 0.002) and control groups (0.72 ± 0.30 mm, p < 0.001; 1.04 ± 0.38 mm, p < 0.001). Deviations in the cantilever groups predominantly trended towards the buccal and apical directions. Additionally, positive correlations were found between cantilever length and implant deviations at both the platform (R = 0.306, p = 0.034) and apex levels (R = 0.294, p = 0.042). Cantilever length in posterior implant positions significantly affects the accuracy of implant placement using static CAIS. Implants positioned at a 2-unit cantilever or with lengths exceeding 10 mm are more prone to deviating from the planned positions.

The article is devoted to the clinical testing of the developed protocol of dental implantation surgery, including guided bone regeneration and temporary prostheses, for patients with complete edentulism and atrophy of the alveolar bone. The clinical testing of the proposed prosthetics technology involved 24 patients aged 55 to 72 years with complete absence of teeth and atrophy of the jaw bones. All patients underwent surgery according to the developed protocol. At the same time, 18 patients underwent dental implantation on the lower jaw on the day of surgery for installation of an individual titanium mesh for guided bone regeneration with the possibility of temporary prosthetics. A total of 260 dental implants were installed, 144 in the upper jaw and 116 in the lower jaw. The meshes were loaded with temporary non-removable orthopedic structures on the day of surgery. The effectiveness of dental implantation was assessed using cone beam computed tomography and resonance frequency analysis on the day of installation, during temporary and permanent prosthetics, and one year after surgery. As a result of the conducted research, it was found that the average increase in bone tissue in height and width of the upper jaw was 4.3 and 4.1 mm, respectively, and the lower jaw was 3.8 and 4.1 mm. The high stability of dental implants was noted both immediately after installation and under conditions of functional load. The assessment of the quality of life of patients in the study group was carried out both before surgery and during the postoperative period of 14, 30, 90 and 180 days. The results of the study showed that temporary dental prosthetics using non-removable structures based on individual titanium meshes made using 3D printing technology significantly improves all parameters of the quality of life of patients with complete edentulism.

PurposeTo evaluate the influence of guide support on the accuracy of sCAIS using a keyless guiding system in different cases of partial edentulism.MethodsSixty polyamide models of partially edentulous maxillae, simulating anterior and posterior single-tooth gaps as well as anterior and distal extended edentulous areas, were fabricated. Full-arch, 2-teeth, and 4-teeth supported surgical guides were used to place implants at FDI 15, 17, 21, 26 sites in Model A and at FDI 12, 22, 15 sites in Model B. In total, 210 replica implants were placed using 120 surgical guides in seven implantation sites. Three-dimensional crestal and apical, angular and vertical deviations from the planned implant positions were compared using the Kruskal-Wallis H test with Dunn’s procedure for multiple pairwise comparisons.ResultsOverall median 3D crestal and apical deviations of implants placed with 2-teeth guide support (0.62 mm [0.45–0.84], 0.92 mm [0.69–1.25]) and 4-teeth guide support (0.65 mm [0.52–0.81], 1.01 mm [0.8–1.26]) were significalty lower compared to the full-arch support group (0.86 mm [0.63–0.98], 1.26 mm [0.98–1.52]) with values of p < 0.017. Overall angular and vertical deviations of implants placed with 2-teeth guide support (2.61° [1.71–3.75], 0.32 mm [0.15–0.44]) were significantly lower compare to the full-arch support group (3.22° [2.25–4.41], 0.46 mm [0.24–0.62]). In the subgroup analysis, implants placed at the FDI 12, 22, and 15 positions exhibited significantly higher 3D and angular deviations with full-arch guide support, whereas the 3D apical and angular deviations of were significantly lower with 2-teeth guide support at the FDI 21 site.ConclusionsThe deviations in all guide support groups did not exceed the recommended safety margins. Statistically significant differences were found between guide support groups, with influence of guide support on the accuracy of sCAIS varying across different implantation sites.Trial registrationNot applicable.

Computer-aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer-aided dental implant surgery still requires improvement and should be considered as in the developmental stage.

Evaluation of the accuracy of implant placement by using fully guided versus partially guided tissue-supported surgical guides with cylindrical versus C-shaped guiding holes: A split-mouth clinical study

ObjectiveThis study aimed to evaluate the effect of fence tray matching care (FTMC) in bracket bonding by measuring excess adhesive, as well as linear and angular deviations, and by comparing it with the half-wrapped tray (HWT).Materials and methodsAn intraoral scanner was used to acquire data on the maxillary dental arch of a patient with periodontitis.Furthermore, 20 maxillary dental arch models were 3D printed. Using 3Shape, PlastyCAD software, and 3D printing technology, 10 FTMC (method I) and HWT (method II) were obtained. By preoperative preparation, intraoperative coordination, and postoperative measurement, the brackets were transferred from the trays to the 3D-printed maxillary dental arch models. Additionally, the bracket’s excess adhesive as well as linear and angular deviations were measured, and the differences between the two methods were analyzed.ResultsExcess adhesive was observed in both methods, with FTMC showing less adhesive (P< 0.001), with a statistical difference. Furthermore, HWT’s vertical, tip and torque, which was significantly greater than FTMC (P< 0.05), with no statistical difference among other respects. The study data of incisors, canines, and premolars, showed that the premolars had more adhesive residue and were more likely to have linear and angular deviations.ConclusionsThe FTMC had higher bracket bonding effect in comparison to HWT, and the adhesive residue, linear and angular deviations are smaller. The fence tray offers an intuitive view of the precise bonding of the bracket, and can remove excess adhesive to prevent white spot lesions via care, providing a different bonding method for clinical applications.