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. 2019 Jun 26;5(1):23.
doi: 10.1186/s40729-019-0176-4.

Pilot-drill guided vs. full-guided implant insertion in artificial mandibles-a prospective laboratory study in fifth-year dental students

Matthias C Schulz  1 , Francisca Hofmann  2 , Ursula Range  3 , Günter Lauer  2 , Dominik Haim  2
Affiliations

Pilot-drill guided vs. full-guided implant insertion in artificial mandibles-a prospective laboratory study in fifth-year dental students

Matthias C Schulz et al. Int J Implant Dent. .

Abstract

Background: As a growing field in dentistry, the practical education during the undergraduate curriculum in implant dentistry should be extended. Not only the theoretical background but also practical skills are crucial to place implants in patients. In order to determine the exact implant position, several positioning aids are available. In the present laboratory study, the accuracy of implant insertion using two different guiding modes in a group of inexperienced participants was assessed.

Methods: After three-dimensional planning using the data of a cone beam computed tomography of artificial mandibles, surgical templates were manufactured by thermoforming. In region 35, a sleeve for the pilot drill was used, whereas in region 45, a sleeve allowing a full-guided implant insertion was inserted. Subsequently, a total of 104 implants were placed by 52 undergraduates. Radiographical assessment of the three-dimensional accuracy was performed. Furthermore, the time required to insert the implants was recorded. Statistical analysis followed.

Discussion: When comparing the three-dimensional accuracy of the virtually planned to the actual inserted implant, a statistically significantly higher accuracy in three-dimensional angulation was achieved for the full-guided (3.388 ± 1.647°) compared to the pilot-drill guided mode (5.792 ± 3.290°). Furthermore, the time required to insert the implant was shorter for the full-guided template (6.23 ± 1.78 min) vs. for the pilot-drill guided (8.84 ± 2.39 min). Both differences reached a statistical significance (p < 0.001).

Conclusion: Within the limit of this laboratory study, the results suggest that inexperienced surgeons benefit from a full-guided implant insertion. However, the clinical effects have to be discussed as the mismatch was varying in the decimillimeter range.

Keywords: Full-guided implant insertion; Laboratory study; Orientation template.

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Conflict of interest statement

Matthias C. Schulz, Francisca Hofmann, Ursula Range, Günter Lauer, and Dominik Haim declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Virtual planning of the implant position and angulation in region 35 and 45 using the coDiagnostiXTM software. Images in clockwise order: upper right—horizontal plane. The green elliptical line depicts the panoramic curve. Lower right—panoramic view of the mandibular model with virtually inserted implants in region 35 and 45. Lower left—three-dimensional reconstruction of the mandibular model. Center left—lateral aspect of the virtually planned implant in region 35. The pink circle located anterior-caudal of the implant depicts the mental foramen. Upper left—anterior aspect of the virtually planned implant in region 35
Fig. 2
Fig. 2
Superimposition of the pre-operative scan (left image) and the post-operative scan of the mandibular model with the attached template. The gray circular areas are depicting the region in which both scans are matched to each other
Fig. 3
Fig. 3
Three-dimensional superimposition of the pre-operatively planned position (blue) and the actual position (red) of the implant. a In this case, a mesio-lingual mismatch of the implant in region 35 is detectable. b In region 45, there is a slight mismatch to the distal and vestibular direction. In both images, the implant tip shows a higher deviation than the implant base
See this image and copyright information in PMC

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