Dental School, Faculty of Medicine and Health Sciences, University of Ghent, Department of Periodontolgy and Oral Implantology, Ghent, Belgium.
All Saints Green Dental Practice, Norwich, UK.
Clin Implant Dent Relat Res. 2020 Aug;22(4):454-467. doi: 10.1111/cid.12901. Epub 2020 May 13.
The advent of computer-guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols.
(a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval.
A PUBMED search was performed in July 2018. A first search was based on a general search string limited to "Dental Implants" and "flapless surgery." A second search focused on accuracy of computer-guided surgery using search string "Surgery, Computer-Assisted" or "guided surgery," and "Dental implants." The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta-analysis. Reviews not mentioning accuracy were excluded in search 2.
Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth-supported guides show more accuracy than bone or mucosa-supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty-four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki.
Guided flapless surgery is comparable to free-hand surgery in terms of implant survival, marginal bone remodeling, and peri-implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding compliance with research ethics, we should question whether scientific reports of clinical trials performed without an ethical umbrella are trustworthy. Compliance of ethics standards is imperative for submitted research papers.
计算机引导手术的出现消除了对复杂手术干预的需求，例如广泛的皮瓣提升、二期植入物暴露以及与传统方案相关的并发症。
(a) 分析报告无瓣手术（有或无计算机引导）适用性、准确性和临床结果的现有文献。(b) 评估研究的质量，包括科学证据水平和伦理委员会批准。
2018 年 7 月进行了 PUBMED 检索。第一次搜索基于一般搜索字符串，仅限于“牙种植体”和“无瓣手术”。第二次搜索集中于使用搜索字符串“计算机辅助手术”或“引导手术”和“牙种植体”的计算机引导手术的准确性。应用以下纳入标准：(a) 英文研究；(b) 人体研究（排除尸体）；(c) 系统评价；(d) 有荟萃分析的系统评价。第二次搜索中排除了未提及准确性的综述。
总共纳入 9 项综述。种植体存活率在 89%至 100%之间。9 篇综述中报道的早期手术和修复体并发症在 9.1%至 36.4%之间。牙支持的导板比骨或黏膜支持的导板具有更高的准确性。全引导手术具有更高的准确性，水平冠状、水平根尖和角度偏差值分别为 1.00、1.23 和 3.13°mm，而半引导手术分别为 1.44、1.91 和 4.30°mm。9 项综述中纳入的 71 项人体研究中有 34 项提到了伦理委员会批准或符合赫尔辛基宣言。
在种植体存活率、边缘骨重塑和种植体周围变量方面，引导无瓣手术与徒手手术相当。临床医生在方案的所有步骤中都应谨慎操作，并在虚拟计划种植体周围保留安全裕度。关于研究伦理的合规性，我们应该质疑在没有伦理保护伞的情况下进行的临床试验的科学报告是否可信。提交的研究论文必须符合伦理标准。
