Search Results (35)

Background and Clinical Significance: Advanced periodontitis with severe vertical bone loss and grade III mobility is usually managed by extraction and implant placement. Digital workflows and modern regenerative techniques have opened the possibility of preserving teeth that would traditionally be considered for extraction. This report describes a digitally guided modified intentional replantation (MIR) protocol applied to a maxillary tooth with severe periodontal involvement and unfavourable prognosis. Case Presentation: A 68-year-old male, non-smoker, with a history of heart transplantation under stable medical control, presented with generalized Stage IV, Grade C periodontitis. Tooth 21 showed >75% vertical bone loss, probing depths ≥ 9 mm, bleeding on probing, and grade III mobility. After non-surgical therapy and periodontal stabilization, a CAD/CAM-assisted MIR procedure was planned. Cone-beam computed tomography (CBCT) and a 3D-printed tooth replica were used to design a surgical guide for a new recipient socket. The tooth was atraumatically extracted, stored in chilled sterile saline, and managed extraorally for approximately 10 min. Apicoectomy and retrograde sealing with Biodentine^® were performed, followed by immediate replantation into the digitally prepared socket, semi-rigid splinting, and guided tissue regeneration using autologous bone chips, xenograft (Bio-Oss^®), enamel matrix derivative (Emdogain^®), and a collagen membrane (Bio-Gide^®). A conventional orthograde root canal treatment was completed within the first month. At 12 months, tooth 21 exhibited grade 0 mobility, probing depths of 3–4 mm without bleeding on probing, and stable soft tissues. Standardized periapical radiographs and CBCT showed radiographic bone fill within the previous defect and a continuous periodontal ligament-like space, with no signs of ankylosis or root resorption. The tooth was fully functional and asymptomatic. Conclusions: In this medically complex patient, digitally guided MIR allowed preservation of a tooth with severe periodontal involvement and poor prognosis, achieving favourable short-term clinical and radiographic outcomes. While long-term data and larger series are needed, MIR may be considered a tooth-preserving option in carefully selected cases as an alternative to immediate extraction and implant placement. Full article

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, Scopus, and Web of Science (1 January 2019–2025). Eligible populations were adults receiving conventional or zygomatic implants in vivo, plus validated in vitro human-jaw models using plan-versus-placement workflows; studies had to report study-level means with dispersion for ≥1 primary outcome with ≥5 implants per arm. Interventions were r-CAIS, d-CAIS, or s-CAIS; with a baseline as the freehand technique. Risk of bias used RoB 2 (RCTs), ROBINS-I (non-randomized clinical), and QUIN (in vitro). Because of heterogeneity in definitions and workflows, we performed a descriptive synthesis by modality (no meta-analysis). Registration: OSF. Results: Forty-three studies (7 RCTs, 10 non-randomized clinical, 26 in vitro) reported more than 4000 implants. Across studies, typical study-level means for global linear deviation clustered around < 1 mm (r-CAIS), ~1 mm (d-CAIS), ~1.3 mm (s-CAIS), and ~1.8 mm (FH). In clinical contexts, d-CAIS often showed slightly lower angular deviation than s-CAIS. Conclusions: CAIS improves accuracy versus freehand. d-CAIS and s-CAIS show similar linear accuracy, with d-CAIS frequently yielding slightly lower angular deviation; r-CAIS exhibits tight error clusters in our dataset, but limited comparative clinical evidence precludes superiority claims. Limitations: non-uniform registration/measurement, variable operator experience, and absence of meta-analysis. Full article

Computer-assisted implant surgery (CAIS) using 3D-printed surgical templates has become a preferred approach for improving implant placement accuracy. Despite its clinical advantages over conventional freehand techniques, CAIS remains limited by the presence of cone beam computed tomography (CBCT) metal artefacts, which compromise the 3D data alignment during implant planning and guide fabrication. This narrative review aims to explore the impact of metal artefacts on the accuracy of 3D-printed surgical implant templates and to evaluate current approaches and modifications in implant planning workflows. This article reviews accuracy studies, case reports and technology research on CAIS from the past 5 years. It summarised the CAIS clinical decision framework and data alignment methods to provide alternatives for guided implant therapy in the future. Studies indicate that metal artefacts can distort anatomical data, leading to potential misalignment in 3D data superimposition during surgical guide designs and fabrication. However, various strategies have shown promise in reducing these distortions. Accurate implant planning and template fabrication are essential to ensure clinical success. Special consideration should be given to artefact management during data acquisition. Modified workflows that account for the presence of metal artefacts can enhance guide precision and improve patient outcomes. Full article

Background: Dynamic computer-aided navigation systems are a real-time motion tracking technology widely applied in oral implantology and endodontics to enhance precision and reduce complications. However, their reliability, accuracy, and usability in dentoalveolar surgery and maxillary bone augmentation remain underinvestigated. Methods: A systematic review following PRISMA guidelines was conducted and registered on PROSPERO (CRD42024610153). PubMed, Scopus, Web of Science, and Cochrane Library databases were searched until October 2024 to retrieve English eligible studies, without restrictions on the publication year, on dynamic computer-assisted navigation systems in dentoalveolar and bone augmentation surgeries. Exclusion criteria were surgery performed without dynamic computer-assisted navigation systems; dental implant placement; endodontic surgery; and maxillo-facial surgery. The outcomes were reliability, accuracy, post-operative course, surgical duration, complications, patient- and clinician-reported usability, acceptability, and satisfaction. Included studies were qualitatively synthetized and judged using dedicated tools for the different study designs. Results: Twenty-nine studies with 214 patients were included, showing high reliability in dentoalveolar and bone augmentation surgeries comparable to or superior to freehand surgeries, higher accuracy in dentoalveolar surgery compared to maxillary bone augmentation, and reduced complication rates across all surgeries. While overall surgical duration slightly increased due to technology installation, operative time was reduced in third molar extractions. Patient-reported outcomes were poorly investigated. Clinician-reported outcomes were mixed, but difficulties in the differentiation of soft tissue from hard tissue were recorded, especially in sinus floor elevation. Conclusions: Dynamic computer-assisted navigation systems enhance accuracy and safety in dentoalveolar and bone augmentation surgery. Further studies are needed to assess the underinvestigated patient-reported outcomes and standardize protocols. Full article

Background/Objectives: Orthodontic temporary anchorage devices (TADs) in the lateral maxillary region are useful tools for successful orthodontic treatment. Radiological anatomical knowledge is crucial for the successful placement of TADs. The use of cone-beam computed tomography (CBCT) is essential for evaluating the relationship between the ideal placement point (IPP) and dental structures, particularly in cases with anatomical limitations. Accordingly, this study aims to assess the anatomical conditions for orthodontic mini-implant (MI) insertion in the posterior maxilla using CBCT as the gold standard. Methods: This retrospective study included 62 patients (37.1% male, 62.9% female) aged 11 to 50 years. CBCT scans (sagittal and axial cross-sections) were used to evaluate interdental bone characteristics in different regions. The evaluated regions were defined as follows: Region 1 (canine and first premolar), Region 2 (first and second premolars), Region 3 (second premolar and first molar), and Region 4 (first and second molars). All parameters were assessed at three predefined levels: A, B, and C, located 4, 3, and 2 mm, respectively, from the alveolar crest. At the aforementioned levels, we performed measurements, such as the interdental width (IDW) in the mesiodistal direction and buccopalatal depth (BPD). The last observation was the relationship between the ideal TAD placement point (IPP) and dental structures, such as contact points (CPs) and cusp tips (C1-cusp of mesial tooth, C2-cusp of distal tooth, in each region). Results: A statistically significant positive correlation was found between the IDW and BPD at Levels A, B, and C in Region 1, while a negative correlation was observed between the IDW and BPD at Level C in Region 2′. The highest percentages of IDW exceeding 3 mm were found in Region 4 at Level A (67.7%), followed by Region 1′ and 2′, both at Level A. The mean interdental width measured at each level on the right and left sides was highest at Level A, exceeding 3 mm, and the width decreased with each successive level. The mean BPD measured at each level on the right and left sides was also highest at Level A. Conclusions: This methodological approach could assist in ensuring precise and efficient implant insertion. Furthermore, it can be concluded that the safe zone for buccal and interdental mini-implant placement is located 4 mm from the alveolar crest at Level A. Also, the CBCT analysis algorithm may serve as a valuable tool for clinicians in determining optimal TAD placement in different dental regions. Full article

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article

Background and Objectives: Static Computer-Assisted Implant Surgery (sCAIS) can be performed with different drill guiding systems. This study aimed to compare the accuracy of two guiding concepts of sCAIS in partially edentulous cases. Materials and Methods: Forty polyamide models of partially edentulous maxillae with seven implantation sites were fabricated. In total, 140 replica implants were placed with keyless (KL) and drill-key (DK) guiding systems using static, full-arch, tooth-supported surgical guides. Three-dimensional crestal and apical, angular and vertical deviations from the planned implant positions were compared using Mann–Whitney U and Kruskal–Wallis H tests. Intergroup homogeneity of variance homogeneity was examined using Levene’s test to assess the precision. Results: Overall median 3D crestal and apical deviations of implants placed in the KL group were significantly higher compared to the DK group (0.86 mm [0.63–0.98] vs. 0.72 mm [0.52–0.89], p = 0.006 and 1.26 [0.98–1.52] vs. 1.13 [0.70–1.45], p = 0.012). In the subgroup analysis, implants placed with a KL system showed higher 3D crestal (p = 0.029), 3D apical (p < 0.001) and angular (p < 0.001) deviations in the extended anterior area, higher 3D crestal (p < 0.001) deviations in the proximal posterior single-tooth gap and higher vertical (p < 0.001) deviations in the distal site of free-end situation. Contrarily, the KL group showed lower 3D crestal (p = 0.007), 3D apical (p < 0.001), angular (p < 0.001) and vertical (p = 0.003) deviations in the distal posterior single-tooth gap, lower 3D apical (p = 0.007) and angular (p = 0.007) deviations in the distal site of free-end situation and lower vertical (p = 0.019) deviations in the proximal site of free-end situation. Conclusions: The deviations of both guiding concepts did not exceed the recommended safety margins. Statistically significant differences in deviations were found between two guiding concepts. Guiding concepts with superior accuracy varied across different sites of implantation. Full article

Objectives: The study’s objective was to evaluate the accuracy of dynamic computer-assisted surgical implant placement systems during practical training on fresh defrozen cephali. Methods: Three defrozen cephali with terminal dentition received a total of 26 implants (15 4.3 × 13 mm and 11 4.3 × 13 mm, Nobel Biocare Service AG (Zrich-Flughafen Switzerland)) following a standardized protocol: a digital scanning and planning protocol followed by dynamic navigation surgery (X-Guide, X-Nav Technologies, LLC, Lansdale, PA, USA). All surgical interventions were performed by two surgeons: a senior oral surgeon (OE) with more than 5 years of implant dentistry experience and a non-experienced surgeon (NE). Results: Different linear and angular measurements (i.e., deviation shoulder point; deviation tip point; depth deviation shoulder point; depth deviation tip point; B/L and M/D angular deviations) were calculated in duplicate to estimate the discrepancy of the virtual digital planning with respect to the real clinical scenario. The differences between the two operators were also explored. The results of the bivariate analysis detected clinical negligible differences between the operators, without any statistically significant differences for all investigated parameters (p > 0.05). Conclusions: The preliminary positive findings of this pilot study suggest that the investigated dynamic navigation system could be a viable and safe technique for implant surgery and may offer additional safety benefits to non-experienced operators, despite the required learning. Full article

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice. Full article

Bone augmentation prior to dental implant placement is a common scenario in the dental implantology field. Among the important intraoral harvesting sites to obtain bone blocks is the ramus/retromolar region that has a high success rate and long-lasting alveolar ridge augmentation. Preserving the bone volume and quality at the donor site is crucial for preventing further complications or to serve as a site for re-harvesting. Healing of the intraoral donor sites has been described in the maxillofacial field. This study aimed to evaluate the spontaneous healing of the mandibular retromolar donor site utilizing computer-assisted quantification 6 and 12 months after bone harvesting. Materials and methods: The study was conducted on patients who underwent an alveolar ridge augmentation using an intraoral retromolar bone graft. Three CBCT scans were performed—intraoperative, and at six months and one year after the surgical procedure. By using the Materialise Mimics Innovation Suite software 26.0 features segmentation by thresholding, Hounsfield unit averaging, and superimposition of the tomographies, we could precisely quantify the healing process utilizing spatial and characteristic measures. Results: In all cases, the computer-aided quantification showed that six months following surgery, the donor site had recovered up to 64.5% ± 4.24 of its initial volume, and this recovery increased to 89.2% ± 2.6 after one year. Moreover, the Hounsfield unit averaging confirmed dynamic bone quality healing, starting at 690.3 ± 81 HU for the bone block, decreasing to 102 ± 27.8 HU at six months postoperatively, and improving to 453.9 ± 91.4 HU at the donor site after a year. Conclusions: This study demonstrates that there is no need for additional replanting at the donor site following retromolar bone block harvesting, whether autogenous or allograft, since spontaneous healing occurs 12 months following the surgery. Full article

This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6–3.9°) than group A, with a value of 6.3° (95% CI 4.0–8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92–2.78 mm) and 1.62 mm for workflow B (95% CI 1.2–2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures. Full article

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was −1.22 degrees (95% CI, −1.06–−1.39), the mean coronal deviation was −0.15 mm (95% CI, −0.24–−0.07), and the mean apical deviation was −0.19 mm (95% CI, −0.27–−0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery. Full article

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches. Full article

For robot-assisted dental implant surgery, it is necessary to feed the instrument into a specified position to perform surgery. To improve safety and efficiency, a preoperative planning framework, including a finite-parameter surrogate model (FPSM) and an automatic instrument-placement method, is proposed in this paper. This framework is implemented via two-stage optimization. In the first stage, a group of closed curves in polar coordinates is used to represent the oral cavity. By optimizing a finite number of parameters for these curves, the oral structure is simplified to form the FPSM. In the second stage, the FPSM serves as a fast safety estimator with which the target position/orientation of the instrument for the feeding motion is automatically determined through particle swarm optimization (PSO). The optimized feeding target can be used to generate a virtual fixture (VF) to avoid undesired operations and to lower the risk of collision. This proposed framework has the advantages of being safe, fast, and accurate, overcoming the computational burden and insufficient real-time performance of complex 3D models. The framework has been developed and tested, preliminarily verifying its feasibility, efficiency, and effectiveness. Full article

(1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8–73.8). The mean follow-up time was 9.1 years (range 7.3–11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery. Full article