In Vivo Accuracy of Implant Placement Using a Full Digital Planning Modality and Stereolithographic Guides

Purpose: The aim of this study was to investigate a guided implant surgery procedure performed without any manual processes, by assessing the in vivo results following a digital planning and placement of dental implants using surgical templates. Materials and Methods: Eligible patients were screened and enrolled in this prospective clinical study. A cone beam computed tomography (CBCT) scan was acquired, and the remaining dentition and soft tissues were recorded by an intraoral scanner after enrollment. The CBCT data and intraoral scan were fused in the planning software. The prosthetic reconstructions were digitally designed by a prosthodontist, and the ideal position of the dental implants was determined. The surgical template was digitally designed based on this plan, and a guide design was exported and manufactured in a stereolithographic process. The entire surgical procedure was performed with the aid of the template. An intraoral scan was performed 10 days after stage-two surgery using scan bodies placed on the implants. Digital preoperative and postoperative models were compared, and the metric difference between the planned and achieved implant positions was calculated. Results: Twenty-seven implants were placed in 20 patients using tooth-supported surgical templates after a digital planning procedure. No implants were lost during the study period. The mean lateral deviation measured at the coronal point was 1.05 mm (SD: 0.59; range: 2.74 to 0.36). The mean lateral deviation measured at the apical point was 1.63 mm (SD: 1.05; range: 5.16 to 0.56). The mean depth displacement was + 0.48 mm (SD: 0.50; range: 1.33 to -0.52). The mean angle deviation was 3.85 degrees (SD: 1.83; range: 8.6 to 1.25). Conclusion: A simplified full digital planning procedure yields results comparable to conventional guided implant surgery. The main deviation between the planned and achieved implant positions in this prospective clinical study was angular. More clinical studies are needed to verify the procedure further. Keywords: clinical study, dental implant surgery, dental implants, digital treatment planning, guided implant surgery