Influence of Drilling Sequence and Guide-hole Design on the Accuracy of static Computer-Assisted Implant Surgery in Extraction Sockets and Healed Sites - An In Vitro Investigation.

Raabe, Clemens; Dulla, Fabrice Alain; Yilmaz, Burak; Chappuis, Vivianne; Abou-Ayash, Samir (2023). Influence of Drilling Sequence and Guide-hole Design on the Accuracy of static Computer-Assisted Implant Surgery in Extraction Sockets and Healed Sites - An In Vitro Investigation. Clinical oral implants research, 34(4), pp. 320-329. Wiley-Blackwell 10.1111/clr.14042

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OBJECTIVES

To evaluate the effect of drilling sequence, guide-hole design, and alveolar ridge morphology on the accuracy of implant placement via static Computer-Assisted Implant Surgery (sCAIS).

MATERIALS AND METHODS

Standardized maxillary bone models including single tooth gaps with fresh extraction sockets or healed alveolar ridge morphologies were evaluated in this study. Implants were placed using different drilling sequences (i.e., complete (CDS) or minimum (MDS), and guide-hole designs (i.e., manufacturer's sleeve (MS) or sleeveless (SL) guide-hole designs). The time for implant placement via sCAIS procedures was also recorded. The angular, crestal, and apical three-dimensional deviations between planned and final implant positions were digitally obtained. Statistical analyses were conducted by a non-parametric three-way ANOVA (α=0.05).

RESULTS

Based on a sample size analysis, a total of 72 implants were included in this study. Significantly higher implant position accuracy was found at healed sites compared to extraction sockets, and in SL compared to MS guide-hole design in angular, crestal, and apical 3D deviations, p≤0.048). A tendency for higher accuracy was observed for the CDS compared to the MDS, although the effect was not statistically significant (p=0.09). The MDS required significantly shorter preparation times compared with CDS (p<0.0001).

CONCLUSION

Implant placement via sCAIS resulted in higher accuracy in healed sites than extraction sockets, when using SL compared to MS guides, and tended to be more accurate when using CDS compared to MDS. Therefore, even though surgery time was shorter with MDS, its use should be limited to strictly selected cases.

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