Accuracy of Static Computer-Aided Implant Surgery
Amsterdam 2018
Digital Technologies
Consensus Statement
Surgical Planning and Procedures
Preamble

Prosthetically driven implant placement is considered the optimal approach when treating patients with dental implants. Detailed pre-treatment planning is necessary to ensure a correct three-dimensional (3D) implant position within the alveolar bone relative to surrounding anatomical structures and the future prosthetic restorations.

The virtual model of the area of interest in static computer-aided implant surgery (s-CAIS) can be created by aligning the 3D volumetric data scan (DICOM file) with the surface scans (STL file) of the patient in the appropriate planning software. In addition, design and production software (CAD/CAM) and associated hardware are necessary to design and produce the surgical guide to perform static computer-guided implant surgery.

The findings of previous systematic reviews have highlighted a clinically unacceptable range of deviations in accuracy between the planned and final implant position. Due to developments in the technology used in computer-aided implant surgery, the authors of the current systematic review decided to search the literature staring form 2008 to find out if these developments do lead to improved accuracy of treatment.

The primary aim of this study was to assess the literature on the accuracy of static computer-aided implant surgery. In addition, factors such as guide support, implanted jaw, and degree of edentulism were assessed for their effect on accuracy.

Electronic and manual literature searches were applied to collect information about the accuracy of static computer-assisted implant systems. Meta-regression analysis was performed to summarize the accuracy studies. From a total of 372 articles, 19 studies were selected for inclusion for qualitative synthesis. A total of 2,238 implants in 471 patients that had been placed using static guides which were available for review.

There was a wide variation in levels of evidence in the studies included on static computer-assisted implant placement.

Sufficient data were available to perform meta-analysis on the primary outcome of 3-D implant position. The only factor found to influence the accuracy was the state of edentulism.

Consensus Statements

The number of included clinical studies was limited to 20 with a heterogeneous mix of study designs.

  • The mean 3-D deviation for static computer-aided implant surgery (s-CAIS) at the entry point was 1.2 mm [1.04, 1.44, 95% CL], at the apical position was 1.5 mm [1.29, 1.62 mm, 95% CL], and for angular deviation was 3.5 [3.00, 3.96, 95% CL].
    This Consensus Statement is based on 20 clinical trials (one RCT, 11 UPCSs, and eight URCSs).
     
  • With s-CAIS, there is a vertical discrepancy in the apical point of the implant between the planned and actual positions of −0.25 and −0.57 mm, 95% CL.
    This Consensus Statement is based on eight publications (one RCT, five UPCSs, and two URCSs).
     
  • With s-CAIS, there is a vertical discrepancy in the apical point of the implant between the planned and actual positions of −0.08 and 1.13 mm, 95% CL.
    This Consensus Statement is based on four publications (three UPCSs and one URCSs).
     
  • Partially edentulous cases show better accuracy using s-CAIS compared to fully edentulous cases.
    This Consensus Statement is based on eight publications (one RCT, five UPCSs, and two URCSs).
Clinical Recommendations
  • Static computer-aided implant surgery (s-CAIS) should be considered as an additional tool for comprehensive diagnosis, treatment planning and surgical procedures.
     
  • s-CAIS should be prosthetically driven.
     
  • Surgical experience and general comprehensive training are desirable to achieve an accurate and favorable outcome for implants placed using s-CAIS.
     
  • While recent studies indicate improved accuracy when using s-CAIS in partially edentulous cases, a safety margin of 2mm from critical anatomical structures should be maintained.
     
  • The alignment of surface scans, including the prosthetic planning, with 3D volumetric imaging data is recommended to improve the accuracy of the anatomical position of the implant.
     
  • Surgical guides should be digitally designed on surface scan files which have been aligned with DICOM data, which is more accurate than using DICOM data alone.
     
  • Manufacturer’s guidelines should be followed with respect to calibration protocols, for all hardware to maintain optimal accuracy.
Review Paper
Classification Tags
Consensus Statement
Guided Surgery
Surgery
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Publication date: November 16, 2018 | Review date: November 09, 2018 | Next review date: November 09, 2021