de Almeida Jenival Correia, Soares Mariana Quirino Silveira, Mamani Mariela Peralta, Franco Ademir, Junqueira José Luiz Cintra
PhD student, Oral Radiology Division, São Leopoldo Mandic Research Institute (SLM), Campinas, Brazil.
Professor, Oral Radiology Division, São Leopoldo Mandic Research Institute (SLM), Campinas, Brazil.
J Prosthet Dent. 2025 Jun;133(6):1463.e1-1463.e8. doi: 10.1016/j.prosdent.2024.01.004. Epub 2024 Feb 8.
Guided surgical techniques in implant dentistry use virtual planning to accurately position implants. Understanding the effect of a surgeon's experience on guided surgery is essential to ensure successful outcomes.
The purpose of this systematic review and meta-analysis of randomized clinical trials was to evaluate the influence of a surgeon's experience on the accuracy of implant positioning in guided surgery for completely or partially edentulous patients.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searches were conducted in the PubMed, Scopus, Web of Science, EMBASE, Cochrane Library, SciELO, and nonpeer-reviewed literature databases. Studies that met the population, intervention, control, and outcome (PICO) strategy were included: a completely or partially edentulous maxilla or mandible, guided surgery performed by experienced and inexperienced surgeons, and assessing implant positioning accuracy. A random-effects meta-analysis with a 95% confidence interval was conducted using Stata 15.1. The risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials (RoB2), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022302288).
Three articles from 2017 to 2020 encompassing 43 participants (22 men and 21 women) with a mean age of 61.2 years and a total of 150 implants were included. No significant difference was found between experienced and inexperienced surgeons in terms of angular, cervical, or apical deviations of the implants (95% confidence interval, P<.05). The difference between surgeons regarding positioning accuracy was less than 0.01 degrees for angular deviation, 0.35 mm for apical deviation, and 0.16 mm for cervical deviation. Low heterogeneity was observed for angular deviations (Q P=.021, I=34%, and t<.001) and cervical deviations (Q P=.18, I2=45%, and t=.064). High heterogeneity was observed for apical deviations (Q P<.001, I=87% and t=.522). The overall bias risk was moderate, with the evidence certainty ranging from low to moderate.
In guided surgery, the surgeon's experience did not significantly impact the occurrence of deviations in implant positioning.
种植牙科中的引导式手术技术使用虚拟规划来精确放置种植体。了解外科医生的经验对引导式手术的影响对于确保成功结果至关重要。
本系统评价和随机临床试验的荟萃分析旨在评估外科医生的经验对完全或部分无牙患者引导式手术中种植体定位准确性的影响。
按照系统评价和荟萃分析的首选报告项目（PRISMA）2020指南，在PubMed、Scopus、科学网、EMBASE、Cochrane图书馆、SciELO和非同行评审文献数据库中进行检索。纳入符合人群、干预、对照和结局（PICO）策略的研究：完全或部分无牙的上颌或下颌、由经验丰富和经验不足的外科医生进行的引导式手术，以及评估种植体定位准确性。使用Stata 15.1进行95%置信区间的随机效应荟萃分析。使用Cochrane随机试验偏倚风险工具（RoB2）评估偏倚风险，并使用推荐分级、评估、制定和评价（GRADE）工具评估证据确定性。该研究已在国际前瞻性系统评价注册库（PROSPERO）数据库中注册（CRD42022302288）。
纳入了2017年至2020年的3篇文章，共43名参与者（22名男性和21名女性），平均年龄61.2岁，共150颗种植体。在种植体的角度、颈部或根尖偏差方面，经验丰富和经验不足的外科医生之间未发现显著差异（95%置信区间，P<.05）。外科医生在定位准确性方面的差异在角度偏差方面小于0.01度，根尖偏差方面为0.35毫米，颈部偏差方面为0.16毫米。角度偏差（Q P=.021，I=34%，t<.001）和颈部偏差（Q P=.18，I2=45%，t=.064）观察到低异质性。根尖偏差观察到高异质性（Q P<.001，I=87%，t=.522）。总体偏倚风险为中度，证据确定性范围为低到中度。
在引导式手术中，外科医生的经验对种植体定位偏差的发生没有显著影响。
