Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Chulalongkorn University, Bangkok, Thailand.
Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
Clin Implant Dent Relat Res. 2021 Aug;23(4):635-643. doi: 10.1111/cid.13032. Epub 2021 Jul 19.
Different designs of surgical drilling systems have been developed for the purpose of static Computer-Assisted Implant Surgery (sCAIS), but there is at present little understanding of how design principles affect the accuracy of implant placement.
The aim of this in vitro study was to compare the accuracy of implant placement among five drilling systems of sCAIS in a controlled experimental setting.
Twenty-five 3D printed models with two edentulous bilateral premolar spaces were allocated to five different drilling systems: group A: sleeve-in-sleeve, group B: sleeve-in-sleeve with self-locking, group C: mounted sleeve-on-drill, group D: integrated sleeve-on-drill with metal sleeve in the guide, group E: integrated sleeve-on-drill without metal sleeve. Models were scanned with CBCT and optical scanner. All implants were digitally planned and 10 implants placed with sCAIS in each group. Postoperative 3D deviation of placed vs planned position was measured by means of platform, apex and angular deviation. Data was analyzed using Kruskal-Wallis test (P ≤ .05). Pairwise comparisons were tested with Dunn's test with adjusted P values.
The overall platform deviation ranged from 0.42 ± 0.12 mm (group B) to 1.18 ± 0.19 mm (group C). The overall apex deviation ranged from 0.76 ± 0.22 mm (group B) to 1.95 ± 0.48 mm (group D). The overall angular deviation ranged from 2.50 ± 0.89 degree (group B) to 5.30 ± 1.04 degree (group E). Group A and B showed significantly less angular deviation than groups D and E (P < .05). There was no statistically significant differences in all parameters between group A and B, as well as between group D and E (P > .05).
Significant differences were found with regards to accuracy among the five sCAIS systems tested, suggesting that the drilling protocol, the devices used and the design principles of the guides could influence the accuracy of implant placement.
为了实现静态计算机辅助种植手术（sCAIS），已经开发出了不同设计的手术钻孔系统，但目前对于设计原理如何影响种植体放置的准确性知之甚少。
本体外研究的目的是在受控实验环境下比较五种 sCAIS 钻孔系统在种植体放置精度方面的差异。
将 25 个具有两个无牙双侧前磨牙空间的 3D 打印模型分配到五个不同的钻孔系统中：A 组：套管-套管，B 组：带自锁的套管-套管，C 组：安装在钻头上的套管，D 组：带金属套管的集成式套管-钻头，E 组：无金属套管的集成式套管-钻头。使用 CBCT 和光学扫描仪对模型进行扫描。使用 sCAIS 在每个组中分别对所有种植体进行数字化规划和 10 个种植体的植入。通过平台、根尖和角度偏差测量植入物与计划位置的术后 3D 偏差。使用 Kruskal-Wallis 检验（P≤.05）进行数据分析。使用 Dunn 检验进行两两比较，并调整 P 值。
总体平台偏差范围为 0.42±0.12mm（B 组）至 1.18±0.19mm（C 组）。总体根尖偏差范围为 0.76±0.22mm（B 组）至 1.95±0.48mm（D 组）。总体角度偏差范围为 2.50±0.89 度（B 组）至 5.30±1.04 度（E 组）。A 组和 B 组的角度偏差明显小于 D 组和 E 组（P<.05）。在所有参数中，A 组和 B 组之间以及 D 组和 E 组之间均无统计学差异（P>.05）。
在所测试的五种 sCAIS 系统中，在准确性方面存在显著差异，这表明钻孔方案、使用的设备以及导板的设计原理可能会影响种植体的放置精度。
