| Part 1. Accuracy of Computer-Aided Design/ Computer-Aided Manufacturing Surgical Guides for Dental Implant Placement Purpose:To evaluate the clinical outcomes of implants placed using different types of computer-aided design/computer-aided manufacturing(CAD/CAM) surgical guides, including partially guided and totally guided templates, and determine the accuracy of these guides Materials and methods:In total, 111 implants were placed in 24 patients using CAD/CAM surgical guides. After implant insertion, the positions and angulations of the placed implants relative to those of the planned ones were determined using special software that matched pre- and postoperative computed tomography(CT) images, and deviations were calculated and compared between the different guides and templates. Results:The mean angular deviations were 1.72 ± 1.67° and 2.71 ± 2.58°, the mean deviations in position at the neck were 0.27 ± 0.24 and 0.69 ± 0.66 mm, the mean deviations in position at the apex were 0.37 ± 0.35 and 0.94 ± 0.75 mm, and the mean depth deviations were 0.32 ± 0.32 and 0.51 ± 0.48 mm with tooth- and mucosa-supported stereolithographic guides, respectively(P <.05 for all). The mean distance deviations when partially guided(29 implants) and totally guided templates(30 implants) were used were 0.54 ± 0.50 mm and 0.89 ± 0.78 mm, respectively, at the neck and 1.10 ± 0.85 mm and 0.81 ± 0.64 mm, respectively, at the apex, with corresponding mean angular deviations of 2.56 ± 2.23° and 2.90 ± 3.0°(P >.05 for all). Conclusions:Tooth-supported surgical guides may be more accurate than mucosa-supported guides, while both partially and totally guided templates can simplify surgery and aid in optimal implant placement.Part 2. Using Digital Surgical Guide Template and Pickup Technique Together on Immediate Fixed restoration to Rehabilitate Patient with complete Edentulous Jaws Objective:To evaluate the preliminary clinical results of surgical guide template and pickup technique on the immediate fixed restoration in the rehabilitation of complete edentulous jaws. Method:This clinical study included 10 patients treated from 2010 to 2014. The implants were placed by surgical guide template with the prosthetic information of implants. Implant supported provisional restorations were manufactured by prefabricated dentures with pickup technique, and--- immediate loading restorations in edentulous jaws were completed. After recall examinations by CBCT, pre- and post-treatment imagines were compared on deviations between the actual placed and the planned implants, including shoulder deviation, tip deviation, angle deviation and depth deviation. Ten permanent fixed complete dentures were finished after 6 month. Patients were followed up for 1 to 5 years to evaluate survival of implants, clinical function of prostheses and marginal bone resorption and gingival condition. Pickup technique was assessed by counting the number of clinical appointment, passive implant relocation, relation between implant and jaw and patient sadness. Pre and post-treatment satisfaction from patient was also assessed. Results:(1)Sixty implants were successfully guided and placed, on which 10 prostheses, 7 maxillae and 3 mandibles, however, only 57 were immediately fixed. Other 3 implants failed immediate fix restoration due to the lack of stability. 2 implants in these three cases were lost at 2 months after immediate loading making the implant survival rate 96.67%. During following observation(from 12 to 60 months, an average of 36 months) the implants and restorations were of good immobility and stability. Marginal bone resorption was 0.67 ± 0.33 mm.(2) An average angular deviation of 51 implants was 2.31°± 1.98 as compared with the planning, while the mean linear deviation was 0.59 ± 0.66 mm at the hex, 0.84 ± 0.65 mm at the tip and 0.61 ± 0.40 mm in depth.(3) Compared with conventional methods, the pickup technique is the more obvious advantages for immediate load restoration in the rehabilitation of complete edentulous jaws.(4) Compared with traditional dentures, the satisfaction degree of the implant-supported fixed dentures was significantly higher in pronunciation, retention, comfort and mastication. Conclusions:The preliminary clinical results showed that surgical guide template combined with pickup technique was predictable and satisfying for edentulous patient. |
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