In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery

Purpose: Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. Materials and Methods: A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P = .01), box plots, and 95% confidence intervals for the mean. Results: Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n = 20) were 0.17 +/- 0.78 mm, 0.44 +/- 0.78 mm, 0.23 +/- 1.08 mm, -0.22 +/- 1.44 mm, and -0.32 degrees +/- 2.36 degrees, respectively. The corresponding implant deviations for the partially guided protocol (n = 11) were 0.33 +/- 1.38 mm, -0.03 +/- 1.59 mm, 0.62 +/- 1.15 mm, -0.27 +/- 1.61 mm, and 0.59 degrees +/- 6.83 degrees. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P = .006 and P < .001, respectively). No statistically significant difference was found between the software programs. Anterior implants had less variation in deviation than posterior implants. Conclusions: Fully guided implant surgery is more accurate than partially guided implant surgery. Implant positional deviation is influenced by implant location but not implant systems or software. If possible, clinicians should use guided surgery protocols that allow placement of implants through a surgical guide. (C) 2018 American Association of Oral and Maxillofacial Surgeons