Journal of Oral Implantology October 2012 - (Page 569)

RESEARCH Precision of Implant Placement With Stereolithographic Templates: A Pilot In Vitro Study Hakan Bilhan, DDS, PhD Selda Arat, DDS, PhD Emre Mumcu, DDS, PhD Onur Geckili, DDS, PhD* Olcay x akar, DDS, PhD S This pilot study assesses the accuracy of 2 bone-supported stereolithographic surgical templates with respect to placement of implants in originally planned positions, and it tests the precision of dental volumetric tomography planning. Two mandibles retrieved from formalin-fixed human cadavers were scanned by dental volumetric tomography for planning of the implant positions, leading to stereolithographic models and fabrication of surgical guides. The situation immediately following drilling and implant insertion by an experienced surgeon was scanned and the outcome compared with the initial planning. The 3-dimensional discrepancies were then analyzed and determined. The results show deviations of the placed implants from the original planning, especially in the vertical direction, making the seating of a prefabricated denture impossible. At present, the flapless surgery technique based on stereolithographic surgical templates appears unsafe; further improvement is required. Key Words: dental volumetric tomography, stereolithographic surgical template, flapless surgery, dental implants INTRODUCTION ince the introduction of the concept of osseointegration in dentistry, the technology and science of endosseous implants has improved greatly, and the current trend is to decrease the number of surgical interventions, thereby reducing costs and patient discomfort. With the advent of 3dimensional (3D) computer technology, simulated ideal implant locations are assumed to be transferred intraorally via a stereolithographic surgical template obtained from cone-beam computerized tomography (CBCT) images.1 Indeed, while implant selection and placement have always been based on radiological judgment, usually determined via 2dimensional radiographic images, this new method Department of Prosthodontics, Istanbul University, Istanbul, Turkey. * Corresponding author, e-mail: geckili@istanbul.edu.tr DOI: 10.1563/AAID-JOI-D-10-00109 S provides the clinician with radiological data in all 3 dimensions. The stereolithographic template is reported to have the ability to precisely control implant positions in 3D.1–3 This capability is claimed to make possible flapless surgery4 and fabrication of provisional or definitive implant dentures prior to implant surgery.5–10 Flapless surgery for dental implants decreases postoperative patient discomfort and reduces intraoperative bleeding, although it is a blind procedure (because of the difficulty in evaluating alveolar bone shape). Alveolar bone–supported templates were preferred until recently as stereolithographic guides; however, there was no depth control of the osteotomy drills.11 Tooth or mucosa-supported guides were then used to insert implants without the need for flap elevation.12,13 With implant insertion via stereolithographic surgical templates based on dental volumetric tomography, soft tissue was reported to create a Journal of Oral Implantology 569

Table of Contents for the Digital Edition of Journal of Oral Implantology October 2012

Should the Implant Fit the Patient or Should the Patient Fit the Implant?
Histologic and Biomechanical Evaluation of Alumina-Blasted/Acid-Etched and Resorbable Blasting Media Surfaces
Impact of Dental and Zygomatic Implants on Stress Distribution in Maxillary Defects: A 3-Dimensional Finite Element Analysis Study
Precision of Implant Placement With Stereolithographic Templates: A Pilot In Vitro Study
An Evaluation of Biocompatibility of Indigenously Produced Pure Titanium: An Experimental Study in Rabbits
Relationship Between Smoking and Bleeding on Probing
Stress Analysis in Platform-Switching Implants: A 3-Dimensional Finite Element Study
Acrylic Resin Polymerization in Direct Contact to the Abutment and the Temperature at Bone-Implant Interface: A Pilot In Vitro Study
Clinical Application of Stereolithographic Surgical Guide With a Handpiece Guidance Apparatus: A Case Report
Fixed Rehabilitation of Severely Atrophic Jaws Using Immediately Loaded Basal Disk Implants After In Situ Bone Activation
A Functional Open-Tray Impression Technique for Implant-Retained Overdenture Prostheses
Use of Plasma Rich in Growth Factor for Schneiderian Membrane Management During Maxillary Sinus Augmentation Procedure
A Technique to Facilitate the Fabrication of Provisional Restorations for ITI Solid Abutments
Influence of Etiologic Factors in Peri-Implantitis: Literature Review and Case Report
Simplistic Partially Limiting Surgical Guide for Flapless Implant Placement: A Case Report
Types of Implant Surgical Guides in Dentistry: A Review
Rehabilitation of Atrophic Posterior Maxilla With Zygomatic Implants: Review

Journal of Oral Implantology October 2012