Digital implant planning and guided implant surgery – workflow and reliability

Key Points

  • Discusses the advantages and the reliability of digital implant planning and guided implant surgery.

  • Discusses limitations and sources of error in digital implant planning and guided implant surgery.

  • Describes the workflow from digital implant planning to guided implant surgery.

Abstract

Modern oral implantology and implant prosthetics depend on comprehensive diagnostics and precise planning to ensure the desired outcome and meet the patient's and the dentist's expectations. In this context, digital implant planning and guided implant surgery based on three-dimensional radiographic data and the digitised intraoral surfaces can be of excellent service. They provide valuable information and permit stringent backward planning to optimise the implantological and prosthetic result, improving the safety and efficiency of the surgical procedure and rendering the restorative outcome more predictable in terms of function, biology and aesthetics. However, template-guided implant surgery carries its own specific risks in terms of manufacturing inaccuracies and application errors. These possible sources of error must be recognised and carefully considered in order to avoid adverse consequences.

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References

  1. 1

    Beuer F, Schweiger J, Edelhoff D . Digital dentistry: an overview of recent developments for CAD/CAM generated restorations. Br Dent J 2008; 204: 505–511.

    PubMed  Article  PubMed Central  Google Scholar 

  2. 2

    Miyazaki T, Hotta Y, Kunii J, Kuriyama S, Tamaki Y . A review of dental CAD/CAM: current status and future perspectives from 20 years of experience. Dent Mater J 2009; 28: 44–56.

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3

    van Noort R . The future of dental devices is digital. Dent Mater 2012; 28: 3–12.

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4

    Beuer F, Schweiger J, Stimmelmayr M, Edelhoff D . CAD/CAM-fabricated high-performance polymers in implant dentistry. Implantologie 2010; 18: 397–404.

    Google Scholar 

  5. 5

    Tinschert J, Natt G, Hassenpflug S, Spiekermann H . Status of Current CAD/CAM Technology in Dental Medicine. Int J Comput Dent 2004; 7: 25–45.

    PubMed  PubMed Central  Google Scholar 

  6. 6

    Tran D, Nesbit M, Petridis H . Survey of UK dentists regarding the use of CAD/CAM technology. Br Dent J 2016; 221: 639–644.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7

    Scherer M D . Presurgical implant-site assessment and restoratively driven digital planning. Dent Clin North Am 2014; 58: 561–595.

    PubMed  Article  PubMed Central  Google Scholar 

  8. 8

    Ganz S D . Cone beam computed tomography-assisted treatment planning concepts. Dent Clin North Am 2011; 55: 515–536, viii.

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9

    Nickenig H J, Eitner S . Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates. J Craniomaxillofac Surg 2007; 35: 207–211.

    PubMed  Article  PubMed Central  Google Scholar 

  10. 10

    Sarment D P, Sukovic P, Clinthorne N . Accuracy of implant placement with a stereolithographic surgical guide. Int J Oral Maxillofac Implants 2003; 18: 571–577.

    PubMed  PubMed Central  Google Scholar 

  11. 11

    Flugge T V, Nelson K, Schmelzeisen R, Metzger M C . Three-dimensional plotting and printing of an implant drilling guide: simplifying guided implant surgery. J Oral Maxillofac Surg 2013; 71: 1340–1346.

    PubMed  Article  PubMed Central  Google Scholar 

  12. 12

    Lanis A, Alvarez Del Canto O . The combination of digital surface scanners and cone beam computed tomography technology for guided implant surgery using 3Shape implant studio software: a case history report. Int J Prosthodont 2015; 28: 169–178.

    PubMed  Article  PubMed Central  Google Scholar 

  13. 13

    Flugge T, Derksen W, Te Poel J, Hassan B, Nelson K, Wismeijer D . Registration of cone beam computed tomography data and intraoral surface scans – A prerequisite for guided implant surgery with CAD/CAM drilling guides. Clin Oral Implants Res 2017; 28: 1113–1118.

    PubMed  Article  PubMed Central  Google Scholar 

  14. 14

    Sammartino G, Marenzi G, Citarella R, Ciccarelli R, Wang H L . Analysis of the occlusal stress transmitted to the inferior alveolar nerve by an osseointegrated threaded fixture. J Periodontol 2008; 79: 1735–1744.

    PubMed  Article  PubMed Central  Google Scholar 

  15. 15

    Tay A B, Zuniga J R . Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 2007; 36: 922–927.

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16

    Vercruyssen M, Laleman I, Jacobs R, Quirynen M . Computer-supported implant planning and guided surgery: a narrative review. Clin Oral Implants Res 2015; 26 Suppl 11: 69–76.

    Article  Google Scholar 

  17. 17

    Misir A F, Sumer M, Yenisey M, Ergioglu E . Effect of surgical drill guide on heat generated from implant drilling. J Oral Maxillofac Surg 2009; 67: 2663–2668.

    PubMed  Article  PubMed Central  Google Scholar 

  18. 18

    dos Santos P L, Queiroz T P, Margonar R et al. Evaluation of bone heating, drill deformation, and drill roughness after implant osteotomy: guided surgery and classic drilling procedure. Int J Oral Maxillofac Implants 2014; 29: 51–58.

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19

    Sannino G, Gherlone E F . Thermal Changes During Guided Flapless Implant Site Preparation: A Comparative Study. Int J Oral Maxillofac Implants 2018; 33: 671–677.

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20

    Jung R E, Schneider D, Ganeles J et al. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants 2009; 24 Suppl: 92–109.

    PubMed  PubMed Central  Google Scholar 

  21. 21

    Hassan B, Couto Souza P, Jacobs R, de Azambuja Berti S, van der Stelt P . Influence of scanning and reconstruction parameters on quality of three-dimensional surface models of the dental arches from cone beam computed tomography. Clin Oral Investig 2010; 14: 303–310.

    PubMed  Article  PubMed Central  Google Scholar 

  22. 22

    Spin-Neto R, Gotfredsen E, Wenzel A . Impact of voxel size variation on CBCT-based diagnostic outcome in dentistry: a systematic review. J Digit Imaging 2013; 26: 813–820.

    PubMed  Article  PubMed Central  Google Scholar 

  23. 23

    Widmann G, Bale R J . Accuracy in computer-aided implant surgerya review. Int J Oral Maxillofac Implants 2006; 21: 305–313.

    PubMed  PubMed Central  Google Scholar 

  24. 24

    Pettersson A, Komiyama A, Hultin M, Nasstrom K, Klinge B . Accuracy of virtually planned and template guided implant surgery on edentate patients. Clin Implant Dent Relat Res 2012; 14: 527–537.

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25

    Dreiseidler T, Tandon D, Kreppel M et al. CBCT device dependency on the transfer accuracy from computer-aided implantology procedures. Clin Oral Implants Res 2012; 23: 1089–1097.

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26

    Guth J F, Keul C, Stimmelmayr M, Beuer F, Edelhoff D . Accuracy of digital models obtained by direct and indirect data capturing. Clin Oral Investig 2013; 17: 1201–1208.

    PubMed  Article  PubMed Central  Google Scholar 

  27. 27

    Keul C, Stawarczyk B, Erdelt K J, Beuer F, Edelhoff D, Guth J F . Fit of 4unit FDPs made of zirconia and CoCr-alloy after chairside and labside digitalizationa laboratory study. Dent Mater 2014; 30: 400–407.

    PubMed  Article  PubMed Central  Google Scholar 

  28. 28

    Ender A, Mehl A . Full arch scans: conventional versus digital impressionsan in-vitro study. Int J Comput Dent 2011; 14: 11–21.

    PubMed  PubMed Central  Google Scholar 

  29. 29

    Ender A, Attin T, Mehl A . In vivo precision of conventional and digital methods of obtaining complete-arch dental impressions. J Prosthet Dent 2016; 115: 313–320.

    PubMed  Article  PubMed Central  Google Scholar 

  30. 30

    Patzelt S B M, Emmanouilidi A, Stampf S, Strub J R, Att W . Accuracy of full-arch scans using intraoral scanners. Clin Oral Invest 2014; 18: 1687–1694.

    Article  Google Scholar 

  31. 31

    Ahlholm P, Sipila K, Vallittu P, Jakonen M, Kotiranta U . Digital Versus Conventional Impressions in Fixed Prosthodontics: A Review. J Prosthodont 2018; 27: 35–41.

    PubMed  Article  PubMed Central  Google Scholar 

  32. 32

    Lee C Y, Ganz S D, Wong N, Suzuki J B . Use of cone beam computed tomography and a laser intraoral scanner in virtual dental implant surgery: part 1. Implant dent 2012; 21: 265–271.

    PubMed  Article  PubMed Central  Google Scholar 

  33. 33

    Ritter L, Reiz S D, Rothamel D et al. Registration accuracy of three-dimensional surface and cone beam computed tomography data for virtual implant planning. Clin Oral Implants Res 2012; 23: 447–452.

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34

    van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P . A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants 2002; 17: 663–670.

    PubMed  PubMed Central  Google Scholar 

  35. 35

    Park JM, Yi TK, Koak JY, Kim SK, Park EJ, Heo SJ . Comparison of five-axis milling and rapid prototyping for implant surgical templates. The International journal of oral & maxillofacial implants 2014; 29: 374–83

    Article  Google Scholar 

  36. 36

    Ligon S C, Liska R, Stampfl J, Gurr M, Mulhaupt R . Polymers for 3D Printing and Customized Additive Manufacturing. Chem Rev 2017; 117: 10212–10290.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37

    Stansbury J W, Idacavage M J . 3D printing with polymers: Challenges among expanding options and opportunities. Dent Mater 2016; 32: 54–64.

    PubMed  Article  Google Scholar 

  38. 38

    Sommacal B, Savic M, Filippi A, Kuhl S, Thieringer F M . Evaluation of Two 3D Printers for Guided Implant Surgery. Int J Oral Maxillofac Implants 2018; 33: 743–746.

    PubMed  Article  Google Scholar 

  39. 39

    Laederach V, Mukaddam K, Payer M, Filippi A, Kuhl S . Deviations of different systems for guided implant surgery. Clin Oral Implants Res 2017; 28: 1147–1151.

    PubMed  Article  Google Scholar 

  40. 40

    Van Assche N, Vercruyssen M, Coucke W, Teughels W, Jacobs R, Quirynen M . Accuracy of computer-aided implant placement. Clin Oral Implants Res 2012; 23 Suppl 6: 112–123.

    Article  Google Scholar 

  41. 41

    Koop R, Vercruyssen M, Vermeulen K, Quirynen M . Tolerance within the sleeve inserts of different surgical guides for guided implant surgery. Clin Oral Implants Res 2013; 24: 630–634.

    PubMed  Article  PubMed Central  Google Scholar 

  42. 42

    Valente F, Schiroli G, Sbrenna A . Accuracy of computer-aided oral implant surgery: a clinical and radiographic study. Int J Oral Maxillofac Implants 2009; 24: 234–242.

    PubMed  PubMed Central  Google Scholar 

  43. 43

    Schneider D, Schober F, Grohmann P, Hammerle C H, Jung R E . In-vitro evaluation of the tolerance of surgical instruments in templates for computer-assisted guided implantology produced by 3D printing. Clin Oral Implants Res 2015; 26: 320–325.

    PubMed  Article  PubMed Central  Google Scholar 

  44. 44

    Bencharit S, Staffen A, Yeung M, Whitley D, 3rd, Laskin D M, Deeb G R . In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery. J Oral Maxillofac Surg 2018; 76: 1431–1439.

    PubMed  Article  PubMed Central  Google Scholar 

  45. 45

    Bover-Ramos F, Vina-Almunia J, Cervera-Ballester J, Penarrocha-Diago M, Garcia-Mira B . Accuracy of Implant Placement with Computer-Guided Surgery: A Systematic Review and Meta-Analysis Comparing Cadaver, Clinical, and In Vitro Studies. Int J Oral Maxillofac Implants 2017; 33: 101–115.

    PubMed  Article  PubMed Central  Google Scholar 

  46. 46

    Younes F, Cosyn J, De Bruyckere T, Cleymaet R, Bouckaert E, Eghbali A . A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients. J Clin Periodontol 2018; 45: 721–732.

    PubMed  Article  PubMed Central  Google Scholar 

  47. 47

    Ozan O, Turkyilmaz I, Yilmaz B . A preliminary report of patients treated with early loaded implants using computerized tomography-guided surgical stents: flapless versus conventional flapped surgery. J Oral Rehabil 2007; 34: 835–840.

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48

    Ozan O, Turkyilmaz I, Ersoy A E, McGlumphy E A, Rosenstiel S F . Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement. J Oral Maxillofac Surg 2009; 67: 394–401.

    PubMed  Article  PubMed Central  Google Scholar 

  49. 49

    Tahmaseb A, Wismeijer D, Coucke W, Derksen W . Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants 2014; 29 Suppl: 25–42.

    PubMed  Article  PubMed Central  Google Scholar 

  50. 50

    Kauffmann P, Rau A, Engelke W et al. Accuracy of Navigation-Guided Dental Implant Placement with Screw Versus Hand Template Fixation in the Edentulous Mandible. Int J Oral Maxillofac Implants 2018; 33: 383–388.

    PubMed  Article  PubMed Central  Google Scholar 

  51. 51

    Farley N E, Kennedy K, McGlumphy E A, Clelland N L . Split-mouth comparison of the accuracy of computer-generated and conventional surgical guides. Int J Oral Maxillofac Implants 2013; 28: 563–572.

    PubMed  Article  PubMed Central  Google Scholar 

  52. 52

    Ersoy A E, Turkyilmaz I, Ozan O, McGlumphy E A . Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants. J Periodontol 2008; 79: 1339–1345.

    PubMed  Article  PubMed Central  Google Scholar 

  53. 53

    Behneke A, Burwinkel M, Behneke N . Factors influencing transfer accuracy of cone beam CTderived template-based implant placement. Clin Oral Implants Res 2012; 23: 416–423.

    PubMed  Article  PubMed Central  Google Scholar 

  54. 54

    Hinckfuss S, Conrad H J, Lin L, Lunos S, Seong W J . Effect of surgical guide design and surgeon's experience on the accuracy of implant placement. J Oral Implantol 2012; 38: 311–323.

    PubMed  Article  PubMed Central  Google Scholar 

  55. 55

    Fernandez-Gil A, Gil H S, Velasco M G, Moreno Vazquez J C . An In Vitro Model to Evaluate the Accuracy of Guided Implant Placement Based on the Surgeon's Experience. Int J Oral Maxillofac Implants 2017; 32: 151–154.

    PubMed  Article  PubMed Central  Google Scholar 

  56. 56

    Cushen S E, Turkyilmaz I . Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study. J Prosthet Dent 2013; 109: 248–254.

    PubMed  Article  PubMed Central  Google Scholar 

  57. 57

    Van de Velde T, Glor F, De Bruyn H . A model study on flapless implant placement by clinicians with a different experience level in implant surgery. Clin Oral Implants Res 2008; 19: 66–72.

    PubMed  PubMed Central  Google Scholar 

  58. 58

    Moraschini V, Velloso G, Luz D, Barboza E P . Implant survival rates, marginal bone level changes, and complications in full-mouth rehabilitation with flapless computer-guided surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2015; 44: 892–901.

    PubMed  Article  PubMed Central  Google Scholar 

  59. 59

    Arisan V, Karabuda C Z, Mumcu E, Ozdemir T . Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study. Int J Oral Maxillofac Implants 2013; 28: 190–204.

    PubMed  Article  PubMed Central  Google Scholar 

  60. 60

    Vermeulen J . The Accuracy of Implant Placement by Experienced Surgeons: Guided vs Freehand Approach in a Simulated Plastic Model. Int J Oral Maxillofac Implants 2017; 32: 617–624.

    PubMed  Article  PubMed Central  Google Scholar 

  61. 61

    Hultin M, Svensson K G, Trulsson M . Clinical advantages of computer-guided implant placement: a systematic review. Clin Oral Implants Res 2012; 23 Suppl 6: 124–135.

    Article  Google Scholar 

  62. 62

    Nokar S, Moslehifard E, Bahman T, Bayanzadeh M, Nasirpouri F, Nokar A . Accuracy of implant placement using a CAD/CAM surgical guide: an in vitro study. Int J Oral Maxillofac Implants 2011; 26: 520–526.

    PubMed  PubMed Central  Google Scholar 

  63. 63

    Fortin T, Isidori M, Bouchet H . Placement of posterior maxillary implants in partially edentulous patients with severe bone deficiency using CAD/CAM guidance to avoid sinus grafting: a clinical report of procedure. Int J Oral Maxillofac Implants 2009; 24: 96–102.

    PubMed  PubMed Central  Google Scholar 

  64. 64

    S2-kLeitlinie. Indications for implantological 3D X-ray diagnostics and navigational implantology [Indikationen zur implantologischen 3D-Ro¨ntgendiagnostik und navigationsgestu¨tzten implantologie]. AWMF-Registernummer: 083–011 aktueller Stand: 12/2011.

  65. 65

    Harris D, Buser D, Dula K et al. E A O. guidelines fo the use of diagnostic imaging in implant dentistry. A consensus workshop organized by the European Association for Osseointegration in Trinity College Dublin. Clin Oral Implants Res 2002; 13: 566–570.

    PubMed  Article  PubMed Central  Google Scholar 

  66. 66

    Harris D, Horner K, Grondahl K et al. E A O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res 2012; 23: 1243–1253.

    PubMed  Article  PubMed Central  Google Scholar 

  67. 67

    Benavides E, Rios H F, Ganz S D et al. Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report. Implant Dent 2012; 21: 78–86.

    PubMed  Article  PubMed Central  Google Scholar 

  68. 68

    Colombo M, Mangano C, Mijiritsky E, Krebs M, Hauschild U, Fortin T . Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized controlled trials. BMC Oral Health 2017; 17: 150.

    PubMed  PubMed Central  Article  Google Scholar 

  69. 69

    Jacobs R, Quirynen M . Dental cone beam computed tomography: justification for use in planning oral implant placement. Periodontol 2000 2014; 66: 203–213.

    PubMed  Article  PubMed Central  Google Scholar 

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Correspondence to O. Schubert.

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Schubert, O., Schweiger, J., Stimmelmayr, M. et al. Digital implant planning and guided implant surgery – workflow and reliability. Br Dent J 226, 101–108 (2019). https://doi.org/10.1038/sj.bdj.2019.44

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