Demonstrator of Prosthodontics, Faculty of Dentistry, Damanhour University, Damanhour, Egypt.
Professor and Chairman, Prosthodontic Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
J Prosthet Dent. 2021 Apr;125(4):620-627. doi: 10.1016/j.prosdent.2020.02.025. Epub 2020 May 7.
The accuracy of partially guided implant placement protocols in comparison with fully guided protocols is still unclear. C-shaped guide holes have become popular; however, their effect on drilling and implant position accuracy has not been thoroughly investigated.
The purpose of this split-mouth clinical study was to evaluate the accuracy of implant placement by using fully guided versus partially guided surgical guides with cylindrical versus C-shaped guiding holes.
Adopting 80% power of the study in calculating sample size, a total of 48 implants were placed in the mandibular interforaminal area of 12 edentulous participants, who were randomly divided into 2 groups: a fully guided group, comprising 24 implants placed on 1 side by using a fully guided protocol and a partially guided group, comprising 24 implants placed on the other side in a partially guided protocol. Each group was further subdivided into 2 subgroups: cylindrical, including 12 implants placed through cylindrical guide holes, and C-shaped (12 implants) placed through C-shaped guiding holes. Postoperative cone beam computed tomography scans were made, and based on image fusion, the total deviations between the virtually preplanned and actual implant positions were determined and compared between both groups and subgroups. The linear horizontal deviation of the implant hexagon and apex, together with apical depth deviation and angular deviations between the position of the actually placed and virtually planned implants, were analyzed in 3 dimensions. The Kolmogorov-Smirnov test of normality was used. Comparisons were carried out by using the Kruskal-Wallis test. Post hoc pair-wise comparisons when the Kruskal-Wallis test was significant were carried out by using the Dunn-Sidak test (α=.05).
No statistically significant differences were found in coronal linear deviation (P>.05), apical linear deviation (P>.05), apical depth deviation (P=.086), or angular deviation (P=.247), between the fully guided protocol and the partially guided protocol.
The accuracy of partially guided implant placement was clinically comparable with that of fully guided placement whether the guiding holes were cylindrical or C-shaped.
部分引导种植体放置方案与完全引导方案相比的准确性仍不清楚。C 形引导孔已经很流行；然而，其对钻孔和种植体位置准确性的影响尚未得到彻底研究。
本研究采用完全引导与部分引导手术导板，比较圆柱状与 C 形引导孔对种植体放置准确性的影响，旨在评估使用完全引导与部分引导手术导板时种植体植入的准确性。
根据计算样本量的研究 80%的效力，总共在 12 名无牙颌患者的下颌骨牙槽嵴区植入 48 颗种植体，患者随机分为 2 组：完全引导组，24 颗种植体植入一侧，采用完全引导方案；部分引导组，24 颗种植体植入另一侧，采用部分引导方案。每组进一步分为 2 个亚组：圆柱状导孔组，包括 12 颗种植体；C 形导孔组，包括 12 颗种植体。术后行锥形束 CT 扫描，基于图像融合，确定并比较两组和亚组之间虚拟预规划和实际种植体位置之间的总偏差。分析了 3 个维度的种植体六角形和尖端的线性水平偏差、根尖深度偏差和实际植入物与虚拟计划植入物之间的角度偏差。采用 Kolmogorov-Smirnov 检验进行正态性检验。采用 Kruskal-Wallis 检验进行比较。当 Kruskal-Wallis 检验显著时，采用 Dunn-Sidak 检验进行事后两两比较（α=.05）。
完全引导方案与部分引导方案相比，在冠向线性偏差（P>.05）、根尖线性偏差（P>.05）、根尖深度偏差（P=.086）和角度偏差（P=.247）方面均无统计学差异。
无论引导孔为圆柱状还是 C 形，部分引导种植体放置的准确性与完全引导放置具有临床可比性。
