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Influence of Bone Density and Guide Protocol on the Accuracy of Self-Cutting Implants Using Static Guided Implant
Caroline Streichfuss1, Stefan Wolfart1, Lukas Waltenberger1
1Department of Prosthodontics and Biomaterials, Centre for Implantology, RWTH Aachen University Hospital, Aachen, Germany.
Introduction:
To investigate the influence of bone density and guide protocol on the accuracy of static guided implant placement of self-cutting implants in vitro.
Methods:
A total of 242 implant replicas of self-cutting implants and implants with a tapered design as a control were placed in 40 maxilla replica models with healed posterior ridges differing in bone density and anterior extraction sockets. After full-guided osteotomy, the implants in the healed ridge were either placed through the template or freehand. In anterior extraction sockets, a pilot-guided group was additionally investigated. Postoperative scans were superimposed with the planning and investigated for angular, coronal, and apical deviation.
Results:
For 3D coronal deviation, the study indicates significantly lower deviations in soft bone (p < 0.01) and for guided implant placement (p < 0.01) in posterior sites. Apical and angular deviations are significantly influenced by the placement protocol (p ≤ 0.03) and the presence of reference points from neighbouring teeth (p < 0.01). In the anterior site, the coronal deviation seems to be improved by a direct view of the surgical field, while 3D apical and angular accuracy appears to benefit from a high degree of guidance (p < 0.01).
Conclusion:
Within the limitations of this in vitro study, for low bone density, immediate implant placement, and in clinically challenging situations without reference to the adjacent teeth, the use of template guidance for insertion statistically significantly reduced deviation.
