| Objective:The purpose of this study was to study the effects of different computer-assisted surgical techniques on the accuracy of immediate implantation in the aesthetic zone of upper anterior teeth.The differences in angles and positions of implant placement guided by digital dynamic navigation,digital static guides,and guides combined with navigation systems were measured and compared to analyze the relevant factors that may affect the accuracy of the digital technique,so as to provide some theoretical basis and experimental data for achieving accurate implantation,reducing intraoperative trauma and risk,and promoting digital diagnosis and treatment of oral implant in China.Methods:This study screened 39 patients who visited the Department of Implantology,Shanxi Medical University Stomatology Hospital from December 2020 to January 2023 and were guided with computer-assisted surgical techniques for immediate implantation in the aesthetic zone of upper anterior teeth.They were randomly divided into three groups,Dynamic Navigation(DN),Static Guide(SG),and Pioneer Drill Guide combined with Dynamic Navigation group.The ideal three-dimensional position of the implant was designed by using Yizhimei planting planning software,3Shape planting studio planting guidance software and Co Diagnosti X planting guidance software.Then the light-curing rapid prototyping technology was used to make the guide plate,and 42 maxillary anterior teeth were implanted according to each group of procedures.The CT(Cone BeamComputed Tomography,CBCT)of cone surgery was taken again after operation,and the preoperative design and postoperative image data were matched and overlapped in professional software.Subsequently,the deviation between the ideal position before operation and the actual position after operation was measured and evaluated.The evaluation indexes include: total error at entry,total error at apex,error in the implant angle,lateral error at entry,lateral error at apex,error in the depth of the implantation point,and error in the depth of the end point.Based on the measurement results,the influence of clinical factors such as three different auxiliary implant methods,flap and non-flap surgery,and implant length on the implant placement accuracy was analyzed.Results:1.Accuracy of implant placement guided by three assisted implant modalitiesA total of 14 implants were placed in 13 patients in the DN group,19 implants in 17 patients in the SG group,and 9 implants in 9 patients in the combined group.The total error of implant placement points in the three groups were 1.007±0.299 mm,1.260±0.187 mm and 0.723±0.365 mm respectively;the total error of end points were1.206±0.314 mm,1.327±0.219 mm and 1.018±0.303 mm respectively;the error of implant angles were 2.559±0.744°,3.282±0.805°and 2.179±0.397°respectively;the implantation point level errors were 1.038±0.277 mm,1.132±0.462 mm,0.782±0.216mm;the end point level errors were 1.090±0.380 mm,1.407±0.493 mm,0.723±0.450 mm.The implantation point depth errors were 0.815±0.334 mm,0.757±0.321 mm,0.756±0.456mm;the end point depth errors were 0.864±0.252 mm,0.711±0.328 mm,0.747±0.461 mm,respectively.statistical analysis revealed that only the implantation point depth errors and end point depth errors were not statistically significant(P>0.05).2.Analysis of the effect of different implant lengths on surgical precisionThe statistical results of the implant placement accuracy of two different lengths of implants in the 11-12 mm implant group(18 implants)and the 13-14 mm implant group(24 implants)were analyzed and found that the differences between the groups of totalend-point error,implant angle error,and end-point level error were statistically significant(P<0.05).3.Analysis of the impact of different surgical methods on surgical precisionStatistical analysis of the linear error values and axial angle error values between the two different surgical approaches of flap surgery(28 flaps)and non-flap surgery(14flaps)showed no statistically significant difference between the two groups(P>0.05).Conclusion:1.All three different digital surgical techniques guide the immediate implantation in the aesthetic zone of the upper anterior teeth to improve the accuracy of the implantation,and the Pioneer Drill Guide combined with the dynamic navigation technique has the highest accuracy,especially for the control of the total error of the implantation point and the axial angle error.2.In this study,the implantation accuracy of the short implant group was higher than that of the long implant group,and the differences were shown in the total end-point error,end-point horizontal error and implant angle error.3.In computer-assisted surgical guidance for immediate implant surgery,there was no significant difference in implant accuracy between the two groups when comparing flaps with and without flaps. |
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