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A influência da broca plana em cirurgia de implantes parcialmente guiada
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Abstract(s)
Introdução: A cirurgia de implantes parcialmente guiada visa aumentar a precisão clínica do ato cirúrgico. Este estudo, tem como principal objetivo analisar o impacto da broca plana na precisão espacial da colocação de implantes Bone Level (BL) no protocolo cirúrgico parcialmente guiado. Secundariamente, pretende-se avaliar a influência da densidade óssea e da macrogeometria do implante nessa precisão. Materiais e Métodos: Após cálculo amostral, foram colocados 120 implantes (Straumann® BL, BLT e BLX) em blocos homogéneos de poliuretano simulando quatro níveis de densidade óssea (D13D4). A preparação do leito implantar foi realizada com recurso a guias cirúrgicas seguindo um protocolo cirúrgico guiado, com ou sem o auxílio da broca plana. Já a colocação dos implantes foi feita sem recurso a guia cirúrgica. As discrepâncias entre as posições planeadas virtualmente no software coDiagnostiX® e as posições finais obtidas foram avaliadas com a ferramenta <Treatment Evaluation= do referido software, analisando desvios tridimensionais e angulares ao nível do colo e do ápice do implante. A análise estatística recorreu ao software IBM® SPSS® Statistics v. 24., para um nível de significância de p<0,05. Resultados: Numa análise geral, os maiores desvios tridimensionais foram observados a nível do ápice (0,88mm) comparativamente com o colo do implante (0,56mm), sem utilização da broca plana. A utilização da broca plana diminuiu, de forma estatisticamente significativa (p=0,007), o desvio angular na colocação dos implantes (de 3,40¡ para 2,45¡). No que concerne à densidade óssea, apesar de não identificarmos diferenças significativas no desvio angular, este foi maior para o osso D4 (3,60¡). Registamos diferenças significativas ao nível do colo do implante quer tridimensionalmente (p=0,027; osso D3=0,40mm; osso D1=0,99mm), quer linearmente nos sentidos mesio-distal (p=0,036; osso D2/D3=0,08mm; osso D1=0,12mm) e buco-lingual (p<0,001; osso D3=0,06mm; osso D1=0,58mm). Quando analisado o ápice do implante, apenas encontramos significância para os desvios lineares no sentido apico-coronal (p=0,005), sendo maiores no osso D1 e menores no osso D3 (0,84mm e 0,46mm, respetivamente). Em termos de macrogeometria dos implantes, não encontramos diferenças nos desvios angulares dos implantes em estudo. Quanto aos desvios obtidos a nível do colo, os implantes BLX registaram valores significativamente mais elevados, tridimensionalmente (p=0,001; 0,91 mm), buco-lingual (p=0,02; 0,25mm) e apicocoronal (p=0,032; 0,70mm). Analisados os desvios a nível apical, os implantes BLT apresentaram maiores desvios em todos os parâmetros, mas com significância apenas na direção buco-lingual (p=0,045; 0,49mm). Conclusão: A broca plana melhora a precisão angular da colocação de implantes em protocolos parcialmente guiados, mantendo níveis de precisão linear comparáveis aos procedimentos convencionais. A densidade óssea e a macrogeometria do implante não influenciam significativamente os desvios angulares, mas mostram ser variáveis a considerar no planeamento de cirurgia implantar uma vez que podem potenciar desvios tridimensionais e lineares quer a nível do colo quer no ápice do implante.
Introduction: Partially guided implant surgery aims to increase the clinical accuracy of surgical procedures. The main objective of this study was to evaluate the impact of the milling cutter drill on the spatial accuracy of Bone Level (BL) implant placement within a partially guided surgical protocol. Secondarily, the study aimed to assess the influence of bone density and implant macrogeometry on the primary stability of implants. Materials & Methods: A total of 120 implants (Straumann® BL, BLT, and BLX) were placed into homogeneous polyurethane blocks simulating four bone density levels (D13D4). Implant placement was carried out using 3D-printed surgical guides following a partially guided protocol, with or without the use of the milling cutter drill. Deviations between the virtually planned positions on coDiagnostiX® software and the final implant positions were evaluated using the "Treatment Evaluation" tool, measuring three-dimensional and angular deviations at the implant's coronal and apical levels. Statistical analysis was performed with the software IBM® SPSS® Statistics v. 24., with significance set at p<0,05. Results: In a general analysis, the greatest three-dimensional deviations were observed at the apex (0.88mm) compared to the implant neck (0.56mm), in the absence of the milling cutter drill. The use of the milling cutter drill significantly reduced the angular deviation in implant placement (from 3.40° to 2.45°; p=0.007). Regarding bone density, although no significant differences were found in angular deviation, it was higher in D4 bone (3.60°). Significant differences were recorded at the implant neck both three-dimensionally (p=0.027; D3 bone=0.40 mm; D1 bone=0.99 mm) and linearly in the mesio-distal (p=0.036; D2/D3 bone=0.08 mm; D1 bone=0.12mm) and bucco-lingual directions (p<0.001; D3 bone=0.06 mm; D1 bone=0.58 mm). At the implant apex, significant differences were found only for linear deviations in the apico-coronal direction (p=0.005), with higher values in D1 bone and lower values in D3 bone (0.84mm and 0.46mm, respectively). In terms of implant macrogeometry, no differences were observed in angular deviations between the implant types studied. At the implant neck, BLX implants exhibited significantly greater deviations in three-dimensional (p=0.001; 0.91mm), bucco-lingual (p=0.02; 0.25mm), and apico-coronal (p=0.032; 0.70mm) directions. At the apex, BLT implants showed greater deviations in all parameters, although statistical significance was only reached in the bucco-lingual direction (p=0.045; 0.49mm). Conclusions: The milling cutter drill improves the angular accuracy of implant placement in partially guided protocols, while maintaining linear precision levels comparable to conventional procedures. Although bone density and implant macrogeometry do not significantly affect angular deviations, they are important variables to consider in implant surgery planning, as they may influence both three-dimensional and linear deviations at the neck and apex of the implant.
Introduction: Partially guided implant surgery aims to increase the clinical accuracy of surgical procedures. The main objective of this study was to evaluate the impact of the milling cutter drill on the spatial accuracy of Bone Level (BL) implant placement within a partially guided surgical protocol. Secondarily, the study aimed to assess the influence of bone density and implant macrogeometry on the primary stability of implants. Materials & Methods: A total of 120 implants (Straumann® BL, BLT, and BLX) were placed into homogeneous polyurethane blocks simulating four bone density levels (D13D4). Implant placement was carried out using 3D-printed surgical guides following a partially guided protocol, with or without the use of the milling cutter drill. Deviations between the virtually planned positions on coDiagnostiX® software and the final implant positions were evaluated using the "Treatment Evaluation" tool, measuring three-dimensional and angular deviations at the implant's coronal and apical levels. Statistical analysis was performed with the software IBM® SPSS® Statistics v. 24., with significance set at p<0,05. Results: In a general analysis, the greatest three-dimensional deviations were observed at the apex (0.88mm) compared to the implant neck (0.56mm), in the absence of the milling cutter drill. The use of the milling cutter drill significantly reduced the angular deviation in implant placement (from 3.40° to 2.45°; p=0.007). Regarding bone density, although no significant differences were found in angular deviation, it was higher in D4 bone (3.60°). Significant differences were recorded at the implant neck both three-dimensionally (p=0.027; D3 bone=0.40 mm; D1 bone=0.99 mm) and linearly in the mesio-distal (p=0.036; D2/D3 bone=0.08 mm; D1 bone=0.12mm) and bucco-lingual directions (p<0.001; D3 bone=0.06 mm; D1 bone=0.58 mm). At the implant apex, significant differences were found only for linear deviations in the apico-coronal direction (p=0.005), with higher values in D1 bone and lower values in D3 bone (0.84mm and 0.46mm, respectively). In terms of implant macrogeometry, no differences were observed in angular deviations between the implant types studied. At the implant neck, BLX implants exhibited significantly greater deviations in three-dimensional (p=0.001; 0.91mm), bucco-lingual (p=0.02; 0.25mm), and apico-coronal (p=0.032; 0.70mm) directions. At the apex, BLT implants showed greater deviations in all parameters, although statistical significance was only reached in the bucco-lingual direction (p=0.045; 0.49mm). Conclusions: The milling cutter drill improves the angular accuracy of implant placement in partially guided protocols, while maintaining linear precision levels comparable to conventional procedures. Although bone density and implant macrogeometry do not significantly affect angular deviations, they are important variables to consider in implant surgery planning, as they may influence both three-dimensional and linear deviations at the neck and apex of the implant.
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Implantes dentários Cirurgia assistida por computador Tomografia computorizada de feixe cónico Informática médica dentária Prostodontia Dental implants Computer-assisted surgery Cone-beam computed tomography Dental informatics Prosthodontics
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