| BackgroundThe placement of the implant in the optimal three-dimensional position is crucial for the implant restoration of missing teeth.Various complex cases are often encountered in the clinic,such as consecutive multiple missing teeth,complete edentulous jaws,severe jaw atrophy and special anatomical structures,which require higher surgical precision to ensure surgical safety and facilitate postoperative restoration.In the past,most of the implant surgeries were performed under freehand operation,and the implant cavity preparation and placement of implants were performed only based on the surgeon’s experience and preoperative imaging data,while studies on the accuracy of freehand implantation showed that the cervical and apical deviations were 2.8 mm and 3.1 mm,respectively,and the angular deviation was 9.1°,which were large deviations,indicating that the accuracy of freehand implantation was not ideal.In 1987,Edge first applied implant-guided templates to assist implant placement,providing a new idea for precise oral implant placement.With the development of digital technology and its gradual diffusion,precise oral implant placement became possible.Both dynamic real-time navigation and digital guides are used in clinical practice as an aid to improve implant precision,to design the implant in the ideal position,to predict the treatment difficulty in advance and to avoid surgical risks,and to make the entire treatment process and the postoperative results more predictable.Since dynamic real-time navigation and digital guides have been used in clinical practice for a relatively short period of time,few comparative studies have been conducted between them,and most of the studies related to dynamic real-time navigation are based on in vitro models.Based on the above,this study intends to collect relevant clinical cases to observe the accuracy of digital guide plate assisted implantation.In addition,the literature and data related to dynamic real-time navigation and digital guides were collected and evaluated in an evidence-based approach.Objectives1.To compare the accuracy of digital guides with different support methods and the difference in implant accuracy when applied to the upper and lower jaw.2.Meta-analysis of the accuracy of dynamic real-time navigation with digitally guided implant restoration of missing teeth was collected from relevant literature.Methods1.Patients who attended the Department of Dentistry of the First Hospital of Guangzhou Medical University from June 2020 to February 2023 and received digitally guided implants were collected as study subjects.Basic patient information and pre-and post-implantation cone beam computed tomography(CBCT)images were collected to record the digital guide support method and the location of missing teeth.The preoperative design was fitted to the postoperative CBCT image data in three dimensions,and the deviation of the actual implant position from the ideal position was measured and analyzed in terms of the cervical,apical,depth and axial angle of the implant.The measurement data were expressed as mean±standard deviation,and the IBM SPSS 25.0 statistical software was used to analyze the experimental data.A two-sample t-test was used to compare the means between the two groups,and the difference was considered statistically significant at P<0.05.2.The literature published in PubMed,Cochrane Library,EMbase,CNKI,wanfang,and CBM databases since the establishment of the database until February2023,in any language,was excluded,and those that did not meet the inclusion criteria were read in full,data extracted,and evaluated for quality,using Revman 5.4 software Meta-analysis of the data was performed and forest plots were drawn,and the effect indicators included the mean and 95%confidence interval for neck deviation,apical deviation,and angular deviation.Results1.(1)A total of 60 implants were collected from 35 cases and CBCT data were measured before and after implantation.The deviations of the cervical,apical,depth and angle of the implants were(1.15±0.37)mm,(1.32±0.42)mm,(0.73±0.40)mm and(2.60±1.18)°,respectively.(2)Comparing the accuracy of tooth-supported and mixed tooth-mucosa-supported digital guide implants,there was a significant difference in cervical and apical deviations(P<0.05),and no significant difference in depth and angular deviations(P>0.05).When comparing the accuracy of maxillary and mandibular implant placement,there were no significant differences in cervical,apical,depth,and angular deviations(P>0.05).2.(1)Meta-analysis included 9 publications with 223 cases and 613 prepared cavities or implants,all of which were randomized controlled trials.(2)Cervical bias[MD=0.08,95%CI(0.02,0.14),I~2=90%,P=0.007],apical bias[MD=0.30,95%CI(0.23,0.37),I~2=93%,P<0.00001],angular bias[MD=0.75,95%CI(0.58,0.93),I~2=84%,P<0.00001],the cervical,apical and angular deviations at dynamic real-time navigation implantation were smaller than those of digital guides,and the differences were statistically significant,but there was significant heterogeneity between studies and the results of the combined analysis were not reliable.(3)Compared with the digital guide,the apical deviation was smaller in the socket preparation with dynamic real-time navigation(P<0.05);cervical and angular deviations were not significantly different(P>0.05);apical deviations were smaller in edentulous implants(P<0.05),and cervical and angular deviations were not significantly different(P>0.05);and there was no significant difference in accuracy between in vitro model experiments and clinical cases(P>0.05).ConclusionsClinical observations showed less cervical and apical deviations with tooth-supported guide assisted implantation,while no significant difference was found in the accuracy of maxillary and mandibular implantation.Dynamic real-time navigation showed less apical deviation than digital guides in cavity preparation and edentulous implants,while no significant differences were observed in the remaining subgroups. |
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