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Technological advances in dental implant surgery
1.
Technological advances in dental implant
surgery Copyright ©2021 Periowiki.com 1
2.
Contents -Introduction - Two Dimensional
imaging - CAD/CAM Technology â related history - Computer-aided-design/Computer- aided-manufacturing (CAD/CAM) technology - Computer guided implant surgery (CGIS) - Computer navigated implant surgery (CNIS) - Studies comparing CGIS, CNIS and Laboratory made acrylic guide - Robotics in dental implantology - Conclusion - References 2 Copyright ©2021 Periowiki.com
3.
INTRODUCTION Prosthetic replacement of
missing teeth with implants has become a predictable procedure. However, numerous clinicians are encountering difficult cases, with insufficient amount of bone. This has created an increasing demand for advanced presurgical imaging procedures, which enables the clinician to evaluate the osseous and vital anatomic structures adjacent to the implant site prior to surgical intervention. Various cross-sectional imaging techniques and innovative software programs have been developed to help create an accurate presurgical plan. 3 Copyright ©2021 Periowiki.com
4.
Conventional dental panoramic
tomography and plain film tomography are usually performed with the patient wearing a radiographic template with integrated metal spheres at the position of the waxup. Based on the magnification factor and the known dimensions of the metal sphere, the depth and dimensions of the implants are planned. Two Dimensional imaging 4 Copyright ©2021 Periowiki.com
5.
Computerized Implant Dentistry Computed Tomography
(CT) imaging CT â based implant planning software CAD/CAM technology 5 Copyright ©2021 Periowiki.com
6.
Computerized tomography (CT)
was founded by Sir Godfrey Houndsfield and Allen M. Cormack in 1972. In 1986, Fellingham et al. first demonstrated the use of interactive graphics and 3D modeling for surgical planning, prosthesis, and implant design. In 1986, Dev et al. developed a computer-controlled, indirect milling machine for reproduction of an anatomical structure. History 6 Copyright ©2021 Periowiki.com
7.
Computed Tomography (CT) Tomos
= slice; graphein = to write. Definition - imaging of an object by analyzing its slices. 7 Copyright ©2021 Periowiki.com
8.
Computed Tomography (CT) Generation
1 (1972) X ray beam - Linear (pencil â like) shape. Detector â Single. Movement â translation and then rotation of both x ray beam and detector. Scan time â 4.5 mins. 8 Copyright ©2021 Periowiki.com
9.
Computed Tomography (CT) Generation
2 (1973) X ray beam - Fan shaped. Detectorsâ Multiple (Upto 30) . Movement â translation and then rotation of both x ray beam and detector. Scan time â 2.5 mins. 9 Copyright ©2021 Periowiki.com
10.
Computed Tomography (CT) Generation
3 (1974) X ray beam - Fan shaped. Detectorsâ Multiple (288). Movement â Continuous rotation of both X ray beam and detectors. Scan time â 18 secs. 1989 â Spiral CT based on 3rd generation 10 Copyright ©2021 Periowiki.com
11.
Computed Tomography (CT) Generation
4 (1975) Only X ray tubes rotates, detectors are stationary. This technology was later abandoned. 2 seconds scan time. 11 Copyright ©2021 Periowiki.com
12.
Computed Tomography (CT) Generation
5 (1984) X-ray tube is not mechanically spun in order to rotate the source of X-ray photons. 50ms scanning time. 12 Copyright ©2021 Periowiki.com
13.
Helical CT scanning
involves simultaneous patient translation and X-ray exposure, generating data specific to an angled plane of section with each rotation of the X-ray tube. Rapid acquisition of data set eliminates respiratory misregistration artefacts and prevents discontinuities in the reconstructions due to the minimization of motion artefacts. In addition, helical CT scanning allows production of overlapping images without additional radiation exposure. Helical Computed Tomography (CT) 13 Copyright ©2021 Periowiki.com
14.
CT â based
dental implant planning software Computer program that works with a CT scan to determine exact placement of dental implants and a final design of a prosthesis (crown, bridge or denture). 14 Copyright ©2021 Periowiki.com
15.
Computed Tomography (CT)
based implant planning software Advantages -Digital planning and fabrication of a virtual wax-up, implant position, abutment design, surgical guide, provisional restoration, and as well as final restoration. -Allows predetermination of the size of the implant, the abutment and the provisional restoration. - Averts any possible complications by highlighting the inaccuracies in the selection of implant size or position, during virtual planning, which, can then be easily rectified using the software. 15 Copyright ©2021 Periowiki.com
16.
Computed Tomography (CT)
based implant planning software Advantages -Assists in anticipation, guiding and planning of procedures like alveolectomy, alveoplasty, implant positioning in situations with anatomical limitations, visualization of the amount of available bone in each area and aids in selecting the ideal donor site for osseous grafts, graft location, shape and volume of graft, sinus lift technique and placement of implants in one step surgery, treatment of atrophic maxillae as well as placement of transzygomatic implants etc. - Allows for the storage of the treatment plan and all other data of the patients on the computer. - Demonstration of the virtual treatment plan to the patient is possible. 16 Copyright ©2021 Periowiki.com
17.
Computer-aided-design/Computer- aided-manufacturing (CAD/CAM) technology Transferring
the virtual treatment plan into actual patient treatment has been made possible by the revolutionary CAD/CAM technique. The use of the CT based implant planning software system incorporated CAD/CAM technology is used to create guides and frameworks for the dental prosthesis. 17 Copyright ©2021 Periowiki.com
18.
Computer-aided-design/Computer- aided-manufacturing (CAD/CAM) technology Computer
guided implant Surgery (static system) Computer navigated implant Surgery (dynamic system) 18 Copyright ©2021 Periowiki.com
19.
- Introduction of
helical CT (spiral or volume acquisition CT) has dramatically improved the application of CT imaging in implant dentistry. -Helical CT, along with advancements in stereolithography, has allowed for the development of a CAD/CAM processed surgical guide to be placed directly on the bony site. Computer guided implant surgery (Static system) 19 Copyright ©2021 Periowiki.com
20.
Stereolithography Stereolithography is a
computer-guided laser dependent, rapid prototyping polymerization process that can duplicate the exact shape of the patientâs skeletal anatomical landmarks in a sequential layer of a special polymer to produce a special three- dimensional transparent resin model, which fits intimately with the hard and/or soft tissue surface. Nikzad S, Azari A. J Oral Maxillofac Surg 2008;66:1446-54. 20 Copyright ©2021 Periowiki.com
21.
Computer guided implant
surgery (Static system) The use of a static surgical template that reproduces the virtual implant position directly from computerized tomographic data and does not allow for intraoperative modification of the implant position. 21 Copyright ©2021 Periowiki.com
22.
Three or more
implants in a row. Proximity to vital anatomic structures. Problems related to the proximity of adjacent teeth. Questionable bone volume. Implant position that is critical to the planned restoration. Flapless implant placement. Multiple unit or full-arch immediate restorations, with or without extractions and immediate placement. Significant alteration of the soft tissue or bony anatomy by prior surgery or trauma Patients with physical, medical, and psychiatric comorbidities. CT-guided implant surgery - Indications 22 Copyright ©2021 Periowiki.com
23.
CT-guided implant surgery
- Sequence of steps Step 1 â Preparing Diagnostic wax up Step 2 - Preparing radiographic guide Step 3 â CT/CBCT scan made Step 4 - Images imported to software programs Step 5 â Manufacturing of surgical guide Step 6 â Ideal placement of the dental implants Step 7 - Prosthesis 23 Copyright ©2021 Periowiki.com
24.
Step 1 :
Preparing - Diagnostic wax up Computer Guided planning and placement of dental implants Upper and lower arch impressions are made, and a bite registration is obtained. Poured models are mounted on an articulator. The prosthodontist or restorative dentist first creates an ideal restorative treatment plan, determining the planned tooth position by creating a diagnostic wax-up that indicates the exact anatomy and position of the teeth to be replaced. This ideal diagnostic wax-up is then incorporated, by a dental laboratory, into an acrylic prosthesis, referred to as a radiographic guide, scan prosthesis or scan appliance. 24 Copyright ©2021 Periowiki.com
25.
Computer Guided planning
and placement of dental implants Step 2: Preparing radiographic guide (i.e. Scan prosthesis or scan appliance) NobelGuide Radiographic Guide SimPlant radiographic barium stent EZ Guide radiographic appliance 25 Copyright ©2021 Periowiki.com
26.
Step 3 :
CT/CBCT scan Computer Guided planning and placement of dental implants According to the individual system protocols, the CT/CBCT scan is then taken with the patient wearing the scan prosthesis. 26 Copyright ©2021 Periowiki.com
27.
Step 4: Images
are then imported into the various proprietary software programs. Computer Guided planning and placement of dental implants NobelGuide SimPlant EZ Guide 27 Copyright ©2021 Periowiki.com
28.
Computer Guided planning
and placement of dental implants 28 Copyright ©2021 Periowiki.com
29.
Step 5: The
digital treatment plan is then downloaded to the manufacturer for fabrication of a surgical guide. NobelBiocare NobelGuide SimPlant SurgiGuide EZ Guide Computer Guided planning and placement of dental implants 29 Copyright ©2021 Periowiki.com
30.
Types of guide
supporting surfaces 30 Kalaivani, Gunalan et al. âExpectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review.â Journal of Indian Society of Periodontology vol. 24,5 (2020): 398-408. doi:10.4103/jisp.jisp_92_20 Copyright ©2021 Periowiki.com
31.
Design of sleeves
in the surgical guide 31 (a) Metallic sleeve; (b) non-metallic sleeve; (c) customized open sleeve Kalaivani, Gunalan et al. âExpectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review.â Journal of Indian Society of Periodontology vol. 24,5 (2020): 398-408. doi:10.4103/jisp.jisp_92_20 Copyright ©2021 Periowiki.com
32.
Proper placement of
stereolithographic guide using index in static-guided approach 32 Kalaivani, Gunalan et al. âExpectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review.â Journal of Indian Society of Periodontology vol. 24,5 (2020): 398-408. doi:10.4103/jisp.jisp_92_20 Copyright ©2021 Periowiki.com
33.
Step 6: CT/CBCT-guided
surgery allows for the ideal placement of multiple dental implants according to the planned restoration(s), the relationships of implants to surrounding anatomy, and principles of ideal prosthodontic implant positioning and spacing. Computer Guided planning and placement of dental implants 33 Copyright ©2021 Periowiki.com
34.
Computer Guided planning
and placement of dental implants Step 7: CT/CBCT-guided surgery allows for the ideal placement of multiple dental implants according to the planned restoration(s), the relationships of implants to surrounding anatomy, and principles of ideal prosthodontic implant positioning and spacing. 34 Copyright ©2021 Periowiki.com
35.
âą It precisely
guides the osteotomy drills. ⹠Directs the surgeon in the exact location and angulation to place the implant based on virtual treatment plan. ⹠It allows flapless surgery, which entails less bleeding, less swelling, decreased healing time and postoperative pain. ⹠Aids in the preservation of hard and soft tissue and maintains blood circulation to the surgical site. ⹠Considerably increased accuracy of implant placement. ⹠Avoidance of vital structures. ⹠Shorter period required for surgery. The computer guided implant surgery employing surgical template has the following advantages: 35 Copyright ©2021 Periowiki.com
36.
The computer guided
implant surgery employing surgical template has the following drawbacks and limitations: -Error in data acquisition or incorrect processing of the image. -Deviations from planned implant positions especially in the coronal and apical portions of the implants as well as with implant angulation. - Inaccurate fixation of the guide resulting in displacement during perforation - Mechanical errors caused by angulation of the drills during Perforation. - Changed positioning of surgical instruments due to reduced mouth opening. 36 Copyright ©2021 Periowiki.com
37.
The computer guided
implant surgery employing surgical template has the following drawbacks and limitations: -Fracture of the surgical guide. -Complexity of the whole system. - The total cost of tools needed including the software program and surgical templates. -The potential for thermal injury secondary to reduced access for external irrigation during osteotomy preparation during flapless implant placement with surgical guides. - Does not allow intraoperative modification of implant position. 37 Copyright ©2021 Periowiki.com
38.
Planning of implant
positions using cone-beam CT data and surgical guide templates 38 Nickenig HJ, Eitner S in 2007 assessed the reliability of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates. They performed the study on 102 patients (250 implants, 55.4% mandibular; mean patient age, 40.4 years) who had undergone implant treatment therapy in an armed forces dental clinic (Cologne, Germany) . They were treated with a system that allows transfer of virtual planning to surgical guide templates. The study conclusion was as follows: Implant placement after virtual planning of implant positions using cone beam CT data and surgical templates can be reliable for preoperative assessment of implant size, position, and anatomical complications. It is also indicative of cases amenable to flapless surgery. Nickenig HJ, Eitner S. Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates. J Craniomaxillofac Surg. 2007 Jun-Jul;35(4-5):207-11. doi: 10.1016/j.jcms.2007.02.004. Epub 2007 Jun 18. PMID: 17576068. Copyright ©2021 Periowiki.com
39.
Computer navigated implant
Surgery (CNIS) (dynamic system) The use of a surgical navigation system that reproduces the virtual implant position directly from computerized tomographic data and allows for intraoperative changes in implant position. 39 Copyright ©2021 Periowiki.com
40.
Computer navigated implant
surgery (CNIS) has many advantages over CGIS âą It allows intraoperative changes in implant position that is, the virtual surgical plan can be altered or modified during surgery and the clinician can use the navigation system to concurrently visualize the patientâs anatomy, permitting the surgeon to steer around obstacles, defects etc., that were not apparent on the presurgical scan. âą Bur tracking allows the drill to be continuously visualized on a computer screen in all three-dimensions (x, y and z). âą It overcomes other limitations of CGIS like secondary thermal injury, displacement or fracture of guide etc. 40 Copyright ©2021 Periowiki.com
41.
Computer navigated implant
surgery (CNIS) Procedure Step 1 - The anatomy of the patientâs jaw, with a dental splint incorporating special fiducial markers, is first captured on CT. This CT anatomy forms the virtual patient. The fiducial markers superimpose the virtual patient on the real patient during surgery. 41 Copyright ©2021 Periowiki.com
42.
Computer navigated implant
surgery (CNIS) Procedure Step 2 - During surgery, the IGITM System tracks the position of the patientâs jaw and the drill through signals from the infrared light emitters fitted to the patient and surgical instruments. The spatial position of the drill in relation to the patient is calculated by the systemâs processing unit and is visually displayed in real-time on the navigation screen. 42 Copyright ©2021 Periowiki.com
43.
Computer navigated implant
surgery (CNIS) Procedure The system guides the surgeon to prepare the receptacle site in accordance with the planned position of the implant. The virtual position, angulation and depth of the drill tip are displayed in real time in relation to the pre-acquired CT image of the anatomical structures. Any deviation from the planned path of drilling will trigger an audio and visual alert. This guides the surgeon to maintain the planned course and avoid encroaching on critical structures during surgery. 43 Copyright ©2021 Periowiki.com
44.
Computer navigated implant
surgery (CNIS) Procedure 44 Copyright ©2021 Periowiki.com
45.
Dynamic navigation system 45 (a)
Components: Patient jaw attachment, handpiece attachment and a system consisting of a camera, overhead blue emitting lights, computer and sensor; (b) ) Surgical procedure: I- Thermoplastic stent attaches with the remaining teeth in the arch using the radiographic marker; II-Digital planning; III and IV- Preoperative planning; V- Osteotomy drilling by viewing on the screen; VI- Postoperative image after implant placement. Kalaivani, Gunalan et al. âExpectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review.â Journal of Indian Society of Periodontology vol. 24,5 (2020): 398-408. doi:10.4103/jisp.jisp_92_20 Copyright ©2021 Periowiki.com
46.
Computer navigated implant
surgery (CNIS) 46 Copyright ©2021 Periowiki.com
47.
Computer navigated implant
surgery (CNIS) - Limitations ⹠They are sensitive to reflections and interference with the line of sight between the sensors and the cameras that is, a line-of-sight between the tracking device and the instrument to be tracked has to be maintained, which is not always convenient especially with the typical seating arrangement of dental surgeon and assistant and hence may preclude tracking of instruments. ⹠More expensive and requires an expensive hardware. ⹠Requires rigorous intraoperative referencing. ⹠Significant learning curve. 47 Copyright ©2021 Periowiki.com
48.
Computer Guided Implant
Surgery (CGIS) â related studies Schneider D, Marquardt P, Zwahlen M, Jung RE. Clin Oral Implants Res 2009;20 Suppl. 4:73-86. Implant survival rates of 91-100% after an observation time of 12- 60 months are reported in six clinical studies with 537 implants mainly restored immediately after flapless implantation procedures. Early surgical complications occurred in 9.1%, early prosthetic complications in 18.8% and late prosthetic complications in 12% of the cases. 48 Copyright ©2021 Periowiki.com
49.
Computer Guided Implant
Surgery (CGIS) â related studies Vasak et al., (2014) also verified the viability of the CGIS concept and revealed a cumulative survival rate and success rate of 98.8% and 96.3% of immediate and delayed loaded implants respectively, placed using CGIS technique. Meloni et al. (2013) conducted a clinical trial where in 23 edentulous jaws were treated with three-dimensional software planning, guided surgery, and immediate loading and restored with CAD-CAM full arch frameworks and concluded that computer-guided surgery and immediate loading seem to represent a viable option for the immediate rehabilitations of completely edentulous jaws with fixed implant supported restorations. 49 Copyright ©2021 Periowiki.com
50.
50 As per the
results and conclusions drawn by Azari A, Nikzad S (2008) in their study: ïcomputer-assisted/-guided/-aided implantology was found to overcome the errors encountered during implant osteotomies and to position the implants more precisely. ïThe protocols followed by this sophisticated technique are based upon the advocated concept of prosthetic-driven implantology and CT-scan analysis recently approved. Azari A, Nikzad S. Computer-assisted implantology: historical background and potential outcomes-a review. Int J Med Robot. 2008 Jun;4(2):95-104. doi: 10.1002/rcs.188. PMID: 18348182. Computer Guided Implant Surgery (CGIS) â related studies Copyright ©2021 Periowiki.com
51.
M Siessegger et
al. Journal of cranio maxillofacial surgery 2001; 29(5):276-81. Five patients were treated with the aid of CAS, a total of 18 dental implants being placed. Only difficult operation sites, e.g. following bone augmentation or anatomically malformed jaws were included in this study. An infra-red light based navigation system (Vector Vision 2, BrainLAB, Munich, Germany) including a three-dimensional planning approach for maxillofacial surgery was used. The use of an image-guided navigation system provides a valuable tool in implant dentistry and proved superior to conventional implant surgery especially in difficult anatomical regions. Computer Guided Implant Surgery (CGIS) â related studies 51 Copyright ©2021 Periowiki.com
52.
Rolf Ewers, MD,
Kurt Schicho, Michael Truppe, Rudolf Seemann, Astrid Reichwein, Michael Figl, and Arne Wagner. J Oral Maxillofac Surg 62:329-334, 2004. In 7 years (1995 to 2002), 55 patients with 327 dental implants were successfully positioned with computer-aided navigation technology. The mean number of implants per patient was 6 (minimum, 1; maximum, 11). No complications were observed; the preoperative planning could be exactly realized. The average expenditure of time for the preparation of a surgical intervention with navigation decreased from 2 to 3 days in the initial phase to one-half day in clinical routine use with software that is optimized for dental implantology. Computer Navigated Implant Surgery (CNIS) â related studies 52 Copyright ©2021 Periowiki.com
53.
Elian N, Jalbout
ZN, Classi AJ, Wexler A, Sarment D, Tarnow DP. (2008) The accuracy in implant placement by the CNIS system demonstrated a mean linear accuracy of less than 1 mm at both the implant neck and apical tip and the reported mean angular deviation of less than 4° for the implants placed via CNIS system that is, an accurate match between the planned implant and final implant was revealed. Computer guided implant surgery (CGIS) Versus Computer navigated implant surgery (CNIS) Related Studies 53 Copyright ©2021 Periowiki.com
54.
Computer guided implant
surgery (CGIS) Versus Computer navigated implant surgery (CNIS) Related Studies Ozan O, Turkyilmaz I, Ersoy AE, Mc Glumphy EA, Rosenstiel SF. J Oral Maxillofac Surg 2009;67:394-401. Di Giacomo GA, Cury PR, de Araujo NS, Sendyk WR, Sendyk CL. J Periodontol 2005;76:503-7. A mean linear accuracy ranging between 1.1 mm and 1.45 mm at the implant neck and between 1.41 mm and 2.99 mm at the implant apical tip along with a mean angular deviation ranging between 2° and 7.25° in the implants placed with stereolithographic guides has been reported Based on the preceding studies, it can be assumed that CNIS system provides higher accuracy than the CGIS system. 54 Copyright ©2021 Periowiki.com
55.
Ruppin J, Popovic
A, Strauss M, SpĂŒntrup E, Steiner A, Stoll C Clin Oral Implants Res 2008;19:709-16. Evaluated the accuracy of optical tracking versus stereolithographic system for implant placement, no statistically significant differences were found between the two systems. Computer guided implant surgery (CGIS) Versus Computer navigated implant surgery (CNIS) Related Studies 55 Copyright ©2021 Periowiki.com
56.
CGIS Versus CNIS
Versus Laboratory made acrylic guide Related Studies Somogyi-Ganss E, Holmes HI, Jokstad A Clin Oral Implants Res 2014 Accuracy of a dynamic CNIS system was compared with three commercial CGIS static systems and the use of an acrylic stent for implant osteotomy preparation. It was revealed that the dynamic and static systems provided superior accuracy versus a laboratory-made acrylic guide and that both dynamic and static systems showed an average error of <2 mm and 5°. 56 Copyright ©2021 Periowiki.com
57.
Colombo M, Mangano
C, Mijiritsky E, Krebs M, Hauschild U, Fortin T. Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized controlled trials. BMC Oral Health. 2017;17(1):150. 57 Conclusions : Based on the results of the screened literature it is evident that the overall scientific evidence in the field of image guided implant placement is low. Only two RCTs with at least 6 months of follow-up could be identified. The only evidence that is retrieved is there are no statistically significant differences between conventional and computer-guided implant placement procedures, both for patient outcomes and implant survival rate. Reduction of post-operative pain and surgical time are discussed. Consequently, certain clinical recommendations cannot be given. However, indications for guided-implant surgery could be the need for minimally traumatic or flapless surgery, optimal implant positioning and immediate loading. Copyright ©2021 Periowiki.com
58.
MarliĂšre DAA, DemĂštrio
MS, Picinini LS, Oliveira RG, Netto HDMC. Accuracy of computer- guided surgery for dental implant placement in fully edentulous patients: A systematic review. Eur J Dent. 2018;12(1):153-160. doi:10.4103/ejd.ejd_249_17 58 Conclusions : Seven articles were included in this review. They describe the use of bone and muco-supported guides, demonstrating angular deviations cervically and apically ranging from (minimum and maximum means), respectively, 1.85â8.4 (°), 0.17â2.17 (mm), and 0.77â2.86 (mm). Angular deviations obtained most inaccuracy in maxilla. For cervical and apical deviations, accuracy was preponderantly lower in maxilla. Despite the similar deviations measurement approaches described, clinical relevance of this study may be useful to warn the surgeon about the safety margins in clinical situations. Copyright ©2021 Periowiki.com
59.
Daniele De Santis,
Luciano Malchiodi, Alessandro Cucchi, Adam Cybulski, Giuseppe Verlato, Federico Gelpi, Pier Francesco Nocini, "The Accuracy of Computer-Assisted Implant Surgery Performed Using Fully Guided Templates versus Pilot-Drill Guided Templates", BioMed Research International, vol. 2019, 10pages. 59 Computer-assisted stereolithographically guided surgery allows an ideal implant placement for prosthetic restoration. Two types of stereolithographic templates are currently available: a fully guided template and a pilot-drill guided template. A total of 50 implants were inserted in 15 patients using CAD-CAM templates. The authors observed: Fully guided implant surgery was more accurate than pilot-drill guided surgery for different parameters. For both types of surgery, a safety margin of at least 2mm should be preserved during implant planning to prevent damage to nearby anatomical structures. Copyright ©2021 Periowiki.com
60.
Daniele De Santis,
Luciano Malchiodi, Alessandro Cucchi, Adam Cybulski, Giuseppe Verlato, Federico Gelpi, Pier Francesco Nocini, "The Accuracy of Computer-Assisted Implant Surgery Performed Using Fully Guided Templates versus Pilot-Drill Guided Templates", BioMed Research International, vol. 2019, 10pages. 60 Authors could suggest the pilot-drill guided surgery when : (1) coronal osteoplasty is required; (2) flap-raising is essential to improve the view near important anatomical structures; (3) soft tissue plastic surgery is needed; (4) implantation under crestal bone is planned; (5) keratinised tissue is sparse; (6) a bone-regeneration procedure is required; (7) an implant is to be placed near remaining teeth; and (8) the interocclusal distance is insufficient. Copyright ©2021 Periowiki.com
61.
Kalaivani G, Balaji
VR, Manikandan D, Rohini G. Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review. J Indian Soc Periodontol. 2020;24(5):398-408. doi:10.4103/jisp.jisp_92_20 61 Includes reference of publications from 2000 to 2019, which is related to promising outcomes using computer-assisted static or dynamic navigation system for the placement of implant. Out of these, 809 were related to the computer- guided implant placement. Authors noted: ïGuided implant surgery provides precise, effective, and efficient implant placement compared to freehand implant surgery without damaging the critical anatomic dental structures. ïThe major advantage of the dynamic design is the ability to intraoperatively adjust the planned implant positioning. Copyright ©2021 Periowiki.com
62.
List of complications/failures
may encounter using computer-assisted implant placement: 62 Early surgical complication/failures ï§Limited access ï§Fracture of template ï§Unpredicted bony dehiscence ï§Infection ï§Difficulties when bone augmentation needed ï§Insertion of wider, narrower or shorter implant than planned ï§Lack of implant stability ï§Soft tissue deficiency ï§Fistula ï§Pain Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clin Oral Implants Res. 2009;20(Suppl 4):73â86. [PubMed: 19663953] Copyright ©2021 Periowiki.com
63.
List of complications/failures
may encounter using computer-assisted implant placement: 63 Early prosthetic complication/failures ï§Misfit or loosening of prosthesis ï§Occlusal problem ï§Difficulties in speech ï§Cheek biting Late prosthetic complication/failures ï§Loosening of screw ï§Fracture or misfit of prosthesis ï§Occlusal wear ï§Esthetic unhappiness Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clin Oral Implants Res. 2009;20(Suppl 4):73â86. [PubMed: 19663953] Copyright ©2021 Periowiki.com
64.
Robotic implant surgery Pre
operative surgical planning Haptic based environment- DICOM dataset patient model is converted into wavefront.obj 64 Copyright ©2021 Periowiki.com
65.
Robotic implant surgery The
position in the virtual environment are related with the position of the robotic manipulator through image guided navigation system to maintain the alignment between prototype surgical manipulator end effector and the drill to perform the safe experimental surgery. 65 Copyright ©2021 Periowiki.com
66.
Robotics in Dental
Implantology Although dental implants date back to thousands of years, it wasnât a major breakthrough until the 1980s. Many medical research teams in the 1990s used interactive computer applications including hardware and software as an aid for implant planning (Azari A, Nikzad S. 2008). For instance, SIM/PLANT a computer guided implant treatment was the first commercially released software in 1993 which provided the clinicians with the ability to view and interact with the CT scan data to pre-surgically place the implant body and visualize the prosthodontic implications virtually at the same time (Verstreken K, Van Cleynenbreugel J, Marchal G, et al. 1996). 66 Copyright ©2021 Periowiki.com
67.
Robotics in Dental
Implantology The United States, the first robotic dental surgery system was cleared by the Food and Drug Administration for dental implant procedures in 2017. At the end of 2017, the world's first autonomous dental implant placement system was developed by Zhao and colleagues in China. This so-called intelligent robot has a high degree of autonomy, can automatically adjust during intraoperative procedures, and can execute surgical tasks directly on patients without any apparent control by a surgeon. Wu Y, Wang F, Fan S, Chow JK (2019) 67 Copyright ©2021 Periowiki.com
68.
Robotics in Dental
Implantology ⹠A Robot-guided Implantology increases accuracy and aesthetics in dental implant procedures through visual and physical guidance and a simple digital workflow. Robot-assisted Implantology ⹠A fully autonomous implant robot on the other hand is independent under the supervision of a Dentist (Bhat T 2017). Fully autonomous Implant Robots. 68 Copyright ©2021 Periowiki.com
69.
Robot guided implantology o
Spearheaded by Neocis, a company based in the United States of America (Miami, Florida, USA). o Founded in 2009, this organization has been approved by Food and Drug Administration (FDA) to use its flagship product âYomiâ with real-world patients in a clinical setting. o Yomi three basic components :- 1) Sensors, 2) Effectors 3) Control systems Consortium on Cognitive Science Instruction, Parts of Robots. http://www.mind.ilstu.edu/curriculum/medical_ro botics/parts_of_robots.php. Accessed January 6, 2018. 69 Copyright ©2021 Periowiki.com
70.
Robot guided implantology Sensors âą
Help robots gather information about the environment to guide its actions. ⹠Some of the commonly used sensors are microphones, buttons, cameras etc. Effector ⹠An effector of the robot is the one that actually does the work. ⹠An example of effectors is robotic arms helping a surgeon pick a surgical knife. Control system ⹠Also known as the brains of the robot determines the behaviour of the robot. 70 Copyright ©2021 Periowiki.com
71.
Robot guided implantology primary
input to the robot-guided Yomi comes from a CT scan. CT information is then fed into dynamic planning software that allows the surgeon plan the surgery accounting for key anatomical features like the nerves, sinus and adjacent teeth. This step sets the parameters of the implant surgery and establishes limits for visual and physical guidance. 71 Copyright ©2021 Periowiki.com
72.
Robot guided implantology Visual
guidance âą Is a real time three dimensional graphics that provide navigation during surgery and confirms progress. Physical guidance âą by robotic arm âą guides the surgeon to position and drill till appropriate depth. âą robotic arm physically constraints the surgeonâs drill movement to match the plan through Haptic guidance technology. âą This collaborative robotic arm enables minimally invasive surgery which leads to faster surgery, faster recovery and less pain for the patients. Patient tracking âą Patient tracking throughout the surgery is done through intra- operative tracking that maintains accuracy throughout the surgery and follows the patient if they move. Yomi prevents any deviation from the plan with full view of the surgical site. The surgeon precisely drills into the osteotomy and is stopped when reaching the planned depth. 72 Copyright ©2021 Periowiki.com
73.
Robot guided implantology 73 Copyright
©2021 Periowiki.com
74.
Robot guided implantology Advantages 1)
Extremely high accuracy and precision, 2)Stable and untiring repeated performance and 3)Ability to accurately process quantitative information fed into the system. Limitations 1) Include the fact that the judgment of the situation is limited to the data fed into the software and/or tracked by patient tracking system, 2) Supervision by an experienced Dentist is still required and the cost of the system is prohibitive. 74 Copyright ©2021 Periowiki.com
75.
Fully-Autonomous Robotic Implantology 75 Robot
dentist is first to fit implants without a human touch. South China Morning Post. http://www.scmp.com/news/china/article/2112197 /chinese-robot-dentist-first-fit-implants-patients-mouth- without-any-human. Published September 22, 2017. Accessed January 7, 2018. Copyright ©2021 Periowiki.com
76.
Fully-Autonomous Robotic Implantology 76 The
one hour procedure resulted in implant fitted within a margin of error of 0.2- 0.3mm. The artificial teeth the robot implanted were created by 3D printing which is another breakthrough technology gaining popularity among Dentists since early 2000s (Ventola L. 2014). Fully autonomous Robot took four years to develop jointly by the Stomatological Hospital, based in Xian, and the robot institute at Beihang University in Beijing. The technology is still in its infancy in a demonstration stage when compared to Robot-guided technology which Neocis (maker of Yomi) claims that the units are being sold to Dentists in the USA. Nevertheless the achievement is significant and has set a high bar for Implant technologies being developed. Copyright ©2021 Periowiki.com
77.
Fully-Autonomous Robotic Implantology 77 Fully-autonomous
surgery by a Robot being the first of its kind, it involved a lot of planning and multiple Dentists supervision. The dental staff fitted position orientation equipment to the patient and the robot was programmed to move into the correct position to carry out the surgery in a pre- determined movements, angle and depth needed to fit the new teeth. The robot adjusted its positions in-line with patientâs own movement. The functioning, process and set up is very similar to Robot-guided Implantology discussed above with the exception that in an ideal implementation a fully-autonomous robot will require minimal to zero Dentist involvement. Dr. Manju Natarajan. A review of robotics in dental implantology. e-MIDAS Chennai 2018;5(1):1-16. Copyright ©2021 Periowiki.com
78.
78 A phantom experiment
of image-guided robotics for dental implantation concluded that the system accuracy is comparable to other similar systems for dental implantation with a Fiducial Registration Error (FRE) and Target Registration Error (TRE) values recorded as less than 0.30 mm and 1.42+/- 0.7mm (Sun X, Mckenzie FD, Bawab S, Li J, Yoon Y, Huang J-K. 2011). FRE is a common measure which is the root-mean square error in fiducial alignment between image space and physical space (Fitzpatrick JM. Fiducial registration error and target registration error are uncorrelated. Medical Imaging 2009: Visualization, Image-Guided Procedures, and Modeling. 2009. doi:10.1117/12.813601.). The estimate of FRE error is an indication of the accuracy of the systemâs ability to provide guidance to surgical targets for a given case. TRE is the measure of displacement of actual probe from the target in a guidance system (Fitzpatrick JM. The role of registration in accurate surgical guidance. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2009;224(5):607- 622. doi:10.1243/ 09544119jeim589). . Robotics in Dental Implantology Copyright ©2021 Periowiki.com
79.
79 Robotics in Dental
Implantology Copyright ©2021 Periowiki.com
80.
Conclusion With significant achievements
accomplished in the field of computerized implant-dentistry implant placement has become highly predictable, even in patients where implant surgery was contra-indicated formerly. As a result, attempts are now been made toward complete automation of implant-dentistry. Yet, keeping the limitation of high radiation dose, computerized implant-dentistry must be limited to anatomically complicated cases. Future tasks include advanced intraoperative imaging techniques for navigated surgeries along with sophisticated mechanized surgical tools and new robotic developments, which will revolutionize the field of implantology. 80 Copyright ©2021 Periowiki.com
81.
References ï±Carranzaâs Clinical Periodontology.
10th edition. Recent advances in implant surgical technology. ï±Kathleen M Dâsouza, Meena A Aras Applications of computer-aided design/computer assisted manufacturing technology in dental implant planning. Journal of Dental Implants | Jan - Jun 2012 | Vol 2 | Issue 1. ï±Christoph H. F. HĂ€mmerle, Paul Stone, Ronald E. Jung, Theodoros Kapos, Nadine Brodala. Consensus Statements and Recommended Clinical Procedures Regarding Computer-Assisted Implant Dentistry. The International Journal of Oral & Maxillofacial Implants Volume 24, Supplement, 2009. ï± Computer-Guided Planning and Placement of Dental Implants. Gary Orentlicher, Douglas Goldsmith, Marcus Abboud. Atlas Oral Maxillofacial Surg Clin N Am 20 (2012) 53â79. ï±Rolf Ewers, Kurt Schicho, Michael Truppe,Rudolf Seemann, Astrid Reichwein, Michael Figl and Arne Wagner. Computer-Aided Navigation in Dental Implantology: 7 Years of Clinical Experience. J Oral Maxillofac Surg 62:329-334,2004. ï±Minkle Gulati, Vishal Anand, Sanjeev Kumar Salaria, Nikil Jain, Shilpi Gupta. Computerized implant-dentistry: Advances toward automation. Journal of Indian Society of Periodontology. 81 Copyright ©2021 Periowiki.com
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ï±Lucia H. C.
Cevidanes, A Scott Tucker, B Martin Styner, C Hyungmin Kim,D Jonas Chapuis, E Mauricio Reyes, F William Proffit, G Timothy Turvey, H and Michael Jaskolkai. Three-dimensional surgical simulation. Am J Orthod Dentofacial Orthop 2010;138:361-71. ï±Amjad Ali Syed, Amir Mahmood Soomro, Arbab Nighat Khizar, Xing-guang Duan, Huang Qiang, Farhan Manzoor. Tele-Robotic Assisted Dental Implant Surgery with Virtual Force Feedback. TELKOMNIKA Indonesian Journal of Electrical Engineering Vol.12, No.1, January 2014, pp. 450 â 458. ï± Wu Y, Wang F, Fan S, Chow JK. Robotics in Dental Implantology. Oral Maxillofac Surg Clin North Am. 2019 Aug;31(3):513-518. doi: 10.1016/j.coms.2019.03.013. Epub 2019 May 15. PMID: 31103316. ï±Bhat T. How Technology is Shaping the Future of Dental Implants. Zentist. https://blog.zentist.io/how-technology-is-shaping-the-future-of-dental-implants- 5e92348fbcab?gi=811f28db1812. Published October 31, 2017. Accessed January 6, 2018 ï±Yomi, The First Robotic Dental Surgery System Now Cleared by FDA |. Medgadget. https://www.medgadget.com/2017/03/yomi-first-robotic-dental-surgery-system-now- cleared-fda.html. Published March 2, 2017. Accessed January 6, 2018. References 82 Copyright ©2021 Periowiki.com
83.
References 83 ï± Consortium on
Cognitive Science Instruction, Parts of Robots. http://www.mind.ilstu.edu/curriculum/medical_ro botics/parts_of_robots.php. Accessed January 6, 2018. ï±Ventola L. Medical Applications for 3D Printing: Current and Projected Uses. Pharmacy and Therapeutics. 2014;39(10):704-711. Periowiki.com holds copyright of this power point presentation only . References are provided for the photographs and information used in preparing this presentation . Copyright ©2021 Periowiki.com