Abstrakt pracy dyplomowej;
The accuracy assessment of computer guided template-based implantology: A Systematic Review
New diagnostic methods and informatics equipment led to the development of wide number of new treatment possibilities in medicine including implantology.
Surgical templates and immediate restorations prefabricated thanks to computer-aided design/ computer-aided manufacturing (CAD/CAM), on the base of stereolithographic models, made by three-dimensional CT-scan is becoming a very common procedure. Additionally this procedure allows flapless, transmucosal, implant placement which offers number of benefits to patient like: post-operative morbidity and treatment times could be reduced significantly ,“one visit” procedure, reduced chair-time and theoretically reduced risk of bone perforation. The only disadvantage seems to be higher cost. We should consider if: Is really the guided implant placement a risk-free procedure? What are critical success factors influencing final outcome of this procedure? How big is the scale of deviations between planned and final implant position?
Aim of the study: The aim of this systematic review was to analyse the literature regarding the accuracy of computer guided template-based dental implantology.
Material and method: Electronic search of papers published between 2000 and 2011, for studies focusing on reviews were performed using the PubMed search engine completed with manual search, using expressions: guided implant placement; surgical template; CT in implantation; guided implant placement; guided surgery; guided implantation; surgical template; CT in implantation; CT in dental planning; flapless surgery; flapless implantation. Concentrating on the computer-guided implantology obtained accuracy data were searched.
Results: Out of found articles, fourteen were analysed. Total of 1139 implants placed with the help of six different systems for computer guided implant surgery. In all studies, authors reported implant position deviation in entry and apex points, in twelve angle deviation was measured and in four results of height error are assessed. The mean error at the entry point in fourteen studies was between 0.6mm SD 0.3 and 1.7 mm SD 0.52 whereas the mean error at the apex was between 0.76mm SD 0.15 and 3.07 mm. The mean errors in height for clinical studies were 1.0mm SD 1.0 and 0.1mm SD 0.5. In the study using cadaver models the mean errors in height were 0.28mm SD 0.28 and 0.60mm SD 0.4. The mean error in angulation in twelve studies was between: 1.8 SD 0.8 and 8.44 SD 3.0.
Conclusion: CAD/CAM and computer-guided implant placement technology requires significantly more financial investment, but appears superior to conventional technique thanks to limiting possible manual placement errors and to systematize reproducible treatment success. Additionally the potential protection of critical anatomic structures and the aesthetic and functional advantages must be considered.
Based on the literature review computer-guided implant placement technology is a predictable procedure with accuracy at the same level as conventional technique and providing better patient satisfaction. Based on this review it appears that the template-guided surgery concept involves several steps that can cause deviations between the planned and the placed implant position. The overall accuracy of the implant placement is the sum of all errors that occur during the entire treatment procedure. However, the study of accuracy could provide clinicians with a better understanding of the deviations that might occur during the treatment procedure. The highest deviations cross clinically acceptable parameters. Therefore, it is essential for clinicians to take this information into consideration.