J Adv Prosthodont.  2016 Jun;8(3):207-213. 10.4047/jap.2016.8.3.207.

Accuracy of a direct drill-guiding system with minimal tolerance of surgical instruments used for implant surgery: a prospective clinical study

Affiliations
  • 1Department of Prosthodontics, School of Dentistry, A3DI, Kyungpook National University, Daegu, Republic of Korea. kblee@knu.ac.kr
  • 2Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.
  • 3Department of Bio-medical Research Institute, A3DI, Kyungpook National University Hospital, Daegu, Republic of Korea.
  • 4Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.

Abstract

PURPOSE
A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses.
MATERIALS AND METHODS
For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (α=.05).
RESULTS
The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually.
CONCLUSION
The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

Keyword

Accuracy; Guided surgery; Dental implants; Tolerance; Surgical drills

MeSH Terms

Computer-Aided Design
Cone-Beam Computed Tomography
Dental Implants
Humans
Prospective Studies*
Surgical Instruments*
Dental Implants

Figure

  • Fig. 1 Implant treatment planning. (A) cross-sectional image of virtually placed implant, (B) three-dimensional image of virtual restorations.

  • Fig. 2 Designing the surgical guide.

  • Fig. 3 Surgical instruments used in the direct drill-guiding system (R2GATE). Left to right: initial drill, stop drill, handpiece connector, ratchet connector (a: stopper part, b: guide part, c: drilling part).

  • Fig. 4 Guide sleeve component of the guide template. The stepped structure of the sleeve restricts the depth of drilling by corresponding with the stopper of the drill.

  • Fig. 5 (A) Implant osteotomy using shank-modified drills, (B) Implant placement using the ratchet and ratchet connector.

  • Fig. 6 Definition of measurement parameters (A: horizontal deviation, B: vertical deviation, and C: angular deviation).

  • Fig. 7 Discrepancy values for horizontal and vertical deviations in three dimensions (MD: mesiodistal, BL: buccolingual, OG: occlusogingival. *Significant difference).

  • Fig. 8 Discrepancy values for angular deviations (MD: mesiodistal, BL: buccolingual).


Cited by  2 articles

An assessment of accuracy of half-guided implant surgery using implant surgical guide: A case report
Choongkil Kim, Wonsup Lee, Ho-Beom Kwon
J Korean Acad Prosthodont. 2019;57(2):150-159.    doi: 10.4047/jkap.2019.57.2.150.

Time efficiency and operator convenience of using a micro-screw in image registration for guided implant surgery
Hai Yen Mai, Du-Hyeong Lee
J Korean Acad Prosthodont. 2019;57(3):219-224.    doi: 10.4047/jkap.2019.57.3.219.


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