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Accuracy of Palatal Orthodontic Mini-Implants Placed Using Fully Digital Planned Insertion Guides: A Cadaver Study
Lea Stursa1, Brigitte Wendl1, Norbert Jakse1
1Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria.
Journal of Clinical Medicine
|November 14, 2023
Summary
Commercial digital insertion guides for orthodontic mini-implants (OMIs) showed greater accuracy than in-house guides. While angular deviations were reduced, precise insertion depth was not consistently achieved with either digital guide type.
Area of Science:
- Orthodontics
- Biomaterials Engineering
- Digital Dentistry
Background:
- Digital workflows enhance orthodontic diagnosis and treatment efficiency.
- One-visit protocols using digital planning reduce chair time and risks.
- Orthodontic mini-implants (OMIs) are crucial for anchorage in various treatments.
Purpose of the Study:
- To compare the transfer accuracy of fully digital planned insertion guides for OMIs against freehand insertion.
- To evaluate the precision of commercially available versus in-house fabricated digital insertion guides.
- To assess angular and depth accuracy in OMI placement using different digital guide strategies.
Main Methods:
- Utilized cone-beam computed tomography (CBCT) and intraoral scans of 32 cadaver maxillae.
- Placed 64 OMIs in the anterior palate across three groups: commercial guides (A), in-house guides (B), and freehand (C).
- Analyzed postoperative CBCT data superimposed with planning models using orthodontic software.
Main Results:
- Commercial guides (A) showed significantly lower transverse angular deviations (4.81°) compared to in-house (B: 12.66°) and freehand (C: 5.02°) insertions (p=0.003).
- Sagittal angular deviations were also significantly lower for commercial guides (A: 2.26°) versus freehand (C: 5.34°) (p=0.007), with in-house guides (B: 2.20°) performing similarly to commercial.
- Neither guide group achieved accurate insertion depth; Group A was shallower (-0.17 mm), and Group B was deeper (+0.65 mm) than planned.
Conclusions:
- Commercial, computer-aided design/computer-aided manufacturing (CAD/CAM) insertion guides offer superior angular accuracy for OMI placement compared to in-house fabricated guides.
- Accurate insertion depth remains a challenge for both commercial and in-house digital OMI insertion guides.
- Outsourcing the planning and fabrication of digital insertion guides may be advantageous for specific orthodontic applications, as demonstrated by the commercial templates' performance.
