Facilitate™ is a computer guided planning tool for efficient, accurate and predictable implant treatment based on a 3D visualization of the patient's anatomy, including vital structures, implants, abutments and teeth. Facilitate is based on the successful SimPlant™ software from Materialise Dental™. The summaries present the Facilitate™ techniques and its advantages in various situations.
Accuracy of implant placement with a stereolitographic surgical guide
Purpose: A novel CAD/CAM technique utilizing stereolitographic rapid prototyping have been developed in order to transfer virtual preoperative planning to the surgical field. The aim of this study was to investigate the accuracy of stereolitographic surgical guides compared to conventional surgical guides.
Materials and methods: One examiner planned the placement of 10 implants in each of 5 edentulous epoxy mandibles, by using SimPlant software (Materialise). Before taking CT scans of the jaws, 2 mm channels were created in the long-axis of 5 premolars (under a scanographic template) located on the right side of the jaws.
The jaw and template were scanned using a conebeam CT scanner (Xoran Technologies) equipped with high isotropic spatial resolution. Implants were planned so that the restorative post would be in the long axis of each tooth on the right side (control). On the left side (test), where no template was present, 5 parallel implants were placed to simulate a clinical scenario. A standard surgical guide was applied on the right side and was compared to a stereolitographic Surgi-guide equipped with incremental guiding tubes on the left side.
Five experienced surgeons, independent of each other, got access to the implant planning and performed the drilling and implant placement (on one jaw each). The jaws were then returned for a comparable CT scanning. Two reference points were located; the center of the entrance of the osteotomy and center of the virtual implant apex. The location measurements were repeated twice on different days by the same examiner.
Comparisons between the test and control groups were performed using 2-tailed t-test, and standardization of measurement was established by calculating inter-examiner correlation. The interexaminer reliability was evaluated using repeated measure-ments of implant lengths and angles.
Result: The average distance of the planned osteotomy and actual osteotomy was 1.5 mm (SD ±0.7mm) for conventional guides and 0.9 mm (SD ±0.5mm) for test guides. The distance at apex from planned to actual location was 2.1 mm (SD ±0.97mm) and 1.0 mm (SD ±0.6mm) for control and test guide respectively. These differences were statistically significant. Interindividual variations as well as variations between surgeons were reduced using the test guide.
Statistically significant better accuracy was found at the test sites (4.5 ±2 degrees) compared to the standard technique (8 ±4.5 degrees) when analysing the angle formed between the planned and actual implant preparation.
Discussion and conclusion: To the authors' knowledge, this is the first attempt to compare traditional guides with CAD/CAM produced guides. The result showed on improved accuracy when using the stere-olitographic CAD/CAM guide compared to the conventional guides. Variations from the mean were also reduced. However, the costbenefit should be consid-ered as not all patients have clear advantages of this technique. Clinical benefits are obvious when multiple parallel distant implants are placed, and for the achievement of a single prosthetic path of insertion.
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