The Pros and Cons of Computer-aided Dental Implant Surgical Planning

Although computer-aided dental implant surgery and the aid of surgical guides were originally developed to reduce the risks of standard implant procedures, dental professionals must still weigh the cons and pros of such procedures. Much research has been conducted to offer a clinical perspective on the accuracy of computer-aided oral implant surgery and computer-designed (SLA) surgical guides. Some findings have concluded computer-aided implant surgery, using three-dimensional (3D) virtual planning software and computer-aided surgical guides, is a reliable procedure to optimally position dental implants; however, some disadvantages have been reported as well.

Combined technologies of computed tomography (CT) scans integrated with three-dimensional (3D) virtual planning software, and computer-aided design/computer-assisted manufacture (CAD/CAM) allows the “clinicians to virtually plan the location, angle, depth, and diameter of the virtual implants on the basis of the diagnostic casts and by using wax-ups as an exact replica of the final restoration” (Beretta, Poli, and Maiorana). Its worth mentioning more cutting edge dental laboratories are using 3D printers, such as Stratasys 3D printers, to print diagnostic casts or models at a faster rate with acute accuracy then previously manufactured.

Intraoral digital scanners, such as iTero, create high-resolution 3D images of the surrounding oral cavity; allowing the dentist to check on the health of the tooth, their roots and bone surrounding them. Computer-aided implant surgical planning utilizes 3D imaging software from a CT system, such as Carestream, to customize surgical templates to help the dentist correctly drill and position the dental implant. With 3D imaging software, there are many possibilities to enhance the treatment planning process and improve patient care. Features range from implant placement planning to viewing in 3D high-resolution the sagittal, coronal, axial, obliques and panoramic angles for a more accurate diagnosis of dental treatment. 

In 2014, the Science Journal of Periodontal & Implant Science published a clinical study aimed at evaluating the accuracy of flapless, computer-aided implant placement by comparing the angular deviations of the planned and placed implant positions. They concluded that “computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected” (Beretta, Poli, and Maiorana). They found no complications and all implants achieved successful osseointegration. Their research also affirmed the development of “more accurate 3D planning programs for the CT scan analysis and virtual planning contributed to the progress of this type of surgery and implant rehabilitation with a one- or two-stage approach” (Beretta, Poli, and Maiorana).

Here are several Pros of computer-aided oral implant surgery that Beretta’s study reported:

·         Flapless surgery with a consequent decrease in surgical time and patient morbidity.

·         Preservation of soft tissue structure and hard tissue volume in the surgical site.

·         Integration of the restorative determinants into the surgical planning, resulting in a more aesthetic, functional, and predictable prosthetic outcome.

·         Simplification of the technique-sensitive and operator-dependent surgical procedure (Beretta, Poli, and Maiorana).

Beretta’s study reported some cons to computer-aided oral implant surgery as well:

·         The surgeon's inability to visualize anatomic structures.

·         The increased risk of axis and depth deviations during implant placement.

·         A decreased ability to contour the jawbone topography when needed for prosthetic purposes (Beretta, Poli, and Maiorana).

Although this digital technique was originally developed to reduce the risks involved during standard implant procedures, providing greater control of the system, the problem of deviation between the planned and the placed implant positions still occurs. In a 2012 clinical study, researchers evaluated the accuracy of computer-designed (SLA) surgical guides for 116 implants inserted in both partially and completely edentulous patients. By comparing the three-dimensional positions of the planned and actual placement of the implants, they were able to report some deviations. However, “[the implants] do not appear to have resulted in important clinical complications. This suggests the necessity of always keeping a safety zone of at least 2 mm to avoid critical anatomical structures” (Cassetta et al).

In Baretta’s study, they make suggestions on how to achieve an optimal accurate and stable position of the surgical guide for best outcomes in dental implant placement. In order to improve the stability of surgical guides, it is suggested the use of anchor pins inserted into the jawbone is necessary to prevent micromovements and “better results were obtained with the use of [such] stabilizing devices” (Beretta, Poli, and Maiorana). According to Cassetta et al., the use of three osteosynthesis screws in a tripod formation was the best option for the necessary stability of the surgical guide.

Although there are some cons to computer-aided implant surgery and the use of surgical guides, if the procedures are implemented and executed correctly there can be major pros that out weigh the cons. The advent of technological advances in dental care provides clinicians with viable options to providing better patient care. Dental professionals should not only keep up-to-date with new techniques and procedures in order to make the best decisions for their patients, but also weigh the cons and pros for assured quality.

About Iverson Dental Laboratories

Iverson Dental Laboratories is a leading edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products and to provide excellent dental lab services. As a full service dental laboratory, they specialize in all-ceramic restorations, dental implants, cosmetic dentistry and digital dentistry. They have developed their own surgical guide, AccuGuideÒ, to maximize the use of available bone and provide greater accuracy for implant placement. They built an onsite operatory and training facility to train new and experienced dentists on new implant procedures and digital intraoral scanner systems to help enhance their practice. They proudly manufacture 100% of their dental lab products in-house at their Southern California lab, allowing them to have one of the fastest turnaround rates in the industry.

To inquire more about computer-aided implant surgery and surgical guide products, please visit http://www.iversondental-labs.com.

Sources:

1. Mario Beretta, Pier Paolo Poli, and Carlo Maiorana. "Accuracy of Computer-aided Template-guided Oral Implant Placement: A Prospective Clinical Study." J Periodontal Implant Sci Journal of Periodontal & Implant Science: 184. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148631/>.

2. M. Cassetta, LV. Stefanelli, M. Giansanti, and S. Calasso. "Accuracy of Implant Placement with a Stereolithographic Surgical Template." Int J Oral Maxillofac Implants 27.3 (2012): 655-63. Pubmed.gov. Int J Oral Maxillofac Implants. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pubmed/22616060>.