Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Japan.
Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Indonesia.
J Prosthodont Res. 2022 Jan 11;66(1):29-39. doi: 10.2186/jpr.JPR_D_20_00184. Epub 2021 Jan 26.
To review the current clinical studies regarding the accuracy of implant computer-guided surgery in partially edentulous patients and investigate potential influencing factors.
Electronic searches on the PubMed and Cochrane Central Register of Controlled Trials databases, and subsequent manual searches were performed. Two reviewers selected the studies following our inclusion and exclusion criteria. Qualitative review and meta-analysis of the implant placement accuracy were performed to analyze potential influencing factors. Angular deviation, coronal deviation, apical deviation, and depth deviation were evaluated as the accuracy outcomes.
Eighteen studies were included in this systematic review, including six randomized controlled trials, nine prospective studies, and three retrospective clinical studies. A total of 1317 implants placed in 642 partially edentulous patients were reviewed. Eight studies were evaluated using meta-analysis. Fully guided surgery showed statistically higher accuracy in angular (P <0.001), coronal (P <0.001), and apical deviation (P <0.05) compared with pilot-drill guided surgery. A statistically significant difference (P <0.001) was also observed in coronal deviation between the bounded edentulous (BES) and distal extension spaces (DES). A significantly lower angular deviation (P <0.001) was found in implants placed using computer-aided design/computer-aided manufacturing (CAD/CAM) compared to the conventional surgical guides.
The edentulous space type, surgical guide manufacturing procedure, and guided surgery protocol can influence the accuracy of computer-guided surgery in partially edentulous patients. Higher accuracy was found when the implants were placed in BES, with CAD/CAM manufactured surgical guides, using a fully guided surgery protocol.
回顾目前关于部分无牙患者种植计算机引导手术准确性的临床研究，并探讨潜在的影响因素。
对 PubMed 和 Cochrane 中央对照试验注册数据库进行电子检索，并进行后续的手动检索。两位审查员根据我们的纳入和排除标准选择研究。对种植体放置准确性进行定性评价和荟萃分析，以分析潜在的影响因素。角偏差、冠向偏差、根尖偏差和深度偏差被评估为准确性结果。
本系统评价共纳入 18 项研究，包括 6 项随机对照试验、9 项前瞻性研究和 3 项回顾性临床研究。共回顾了 642 名部分无牙患者的 1317 个种植体。其中 8 项研究进行了荟萃分析。与导向钻引导手术相比，全引导手术在角向（P <0.001）、冠向（P <0.001）和根尖向偏差（P <0.05）方面具有更高的准确性。在有界无牙区（BES）和远中延伸空间（DES）之间，冠向偏差也存在统计学显著差异（P <0.001）。与传统手术导板相比，使用计算机辅助设计/计算机辅助制造（CAD/CAM）的种植体的角向偏差显著降低（P <0.001）。
无牙区类型、手术导板制造过程和引导手术方案都会影响部分无牙患者计算机引导手术的准确性。在 BES 中使用 CAD/CAM 制造的手术导板，采用全引导手术方案时，种植体的准确性更高。
