Application Of Digital Template In Implant Surgery Of Aesthetic Area

Objective:With the development of computer technology and the improvement of people’s requirements for oral aesthetics,the requirements for the accuracy of three-di-mensional position of implants in oral implantation are increasing,and more attention is paid to the final aesthetic repair effect,especially in the aesthetic area with high aesthetic requirements and high surgical risk.Among many computer-aided implanting techniques,digital template is the most widely used in clinical practice.Through clinical case collec-tion and data analysis,this study compared the accuracy of static computer-assisted im-plant surgery（s-CAIS）and traditional free-hand implant surgery in the aesthetic area and evaluated the clinical aesthetic effect of the final restoration.Materials and methods:From September 2020 to February 2023,14 patients who were implanted in the aesthetic area of the the Affiliated Stomatological Hospital of Da-lian Medical University were selected and divided into s-CAIS group and free hand group,with 7 patients in each group.Before the operation,the patient was asked to take cone beam computed tomography（CBCT）at the opening position and export it in digital im-aging and communications in medicine（DICOM）.The patient’s intraoral research model was prepared by the tray,and then the model was scanned by the laser scanner or the intraoral scanner directly.The three-dimensional data of the teeth and related soft tissues were obtained and exported in standard tessellation language（STL）.The data were im-ported into the implant planning software for image segmentation,registration and fusion by the same experienced operator.After completing the matching procedure,a virtual patient was created,a virtual crown was placed guided by the restoration,and the position,size and occlusion of the crown were adjusted.Based on the principles of restoration and biology,a virtual implant was placed and the optimal three-dimensional position was ad-justed,which was superimposed on the three-dimensional reconstruction model from CBCT scan.In the s-CAIS group,the full-guided template was designed and printed ac-cording to the planned virtual implant position in the software.The implant preparation and implantation were performed under the guidance of the template,and bone or soft tissue treatment was performed according to the patient’s condition.In the free-hand group,traditional free-hand implantation was performed during the operation,and bone or soft tissue treatment was performed according to the patient’s condition.CBCT was taken in all patients after surgery,and the data were imported into the co Diagnosti X^?9.15data evaluation software.The postoperative CBCT data and preoperative data were reg-istered and fitted in a three-dimensional environment.The treatment evaluation tool in-cluded in the software was used to compare the deviation between the optimal implanta-tion position of the virtual implant designed before surgery and the actual implantation position after surgery from three aspects of implant angle deviation,implant platform deviation and implant apex deviation,and nine parameters.The difference of implantation accuracy between the s-CAIS group and the free hand group was evaluated.After 3-6months,the second-stage operation and final restoration were completed,and the aes-thetic effect of different treatment schemes was evaluated by peri-implant and crown in-dex（PICI）.Results:A total of 14 subjects were included in the study,of which 2 did not com-plete the final repair and exclusion in our hospital,so 12 subjects were finally included in the study,including 6 in the s-CAIS group,a total of 10 implants;free hand group 6people,a total of 9 implants.The results of implant accuracy showed that the angle devi-ations of s-CAIS group and free hand group were 4.09±3.05°and 7.16±3.51°,respec-tively（p>0.05）.The 3D deviations at the implant platform were 1.28±0.73 mm and1.47±0.62 mm,respectively（p>0.05）.The 3D deviations at the apex were 1.55±0.55mm and 1.95±0.49 mm（p>0.05）,respectively.Therefore,there was no significant difference in the accuracy of the three-dimensional position of the implant between s-CAIS and free hand in this study.Mann-Whitney test was used for aesthetic evaluation.The results showed that there was no significant difference in PICI scores between s-CAIS group and free hand group（p>0.05）.The visual analog scale（VAS）scores of the PICI scores of all patients were analyzed.The average VAS scores of the objective evaluation indexes of the physicians were 86.833 points,85.417 points,84.167 points,87.083 points,89.583 points,and 87.000 points,respectively.The average VAS scores of the subjective evaluation indexes of the patients were 91.250 points,93.833 points,and93.250 points,respectively.It can be seen that the patients have higher scores and higher satisfaction than the physicians.Conclusion:There was no significant difference in the accuracy of implant place-ment between s-CAIS group and free hand group.In the aesthetic evaluation index,there was no significant difference in the parameters of the PICI score between the s-CAIS group and the free hand group,and the PICI score showed that the average subjective satisfaction of patients was higher than the average objective evaluation of doctors.How-ever,due to the small number of cases included in this study,the above conclusions still need to be further expanded after the sample size to continue long-term clinical observa-tion and verification.