Introduction
Following the introduction of digital dental implant planning in 1999, computer-guided implant surgical procedure (CGIS) has been one of the vital evolving areas in digital dentistry. Principally, it entails computed tomography (CT) of the jaw, imaging of the deliberate prosthesis, placement of a digital implant, and manufacturing of a stereolithographic surgical information for the precise placement of the implant. This know-how facilitates surgical execution of implant placement based mostly on best prosthetic positioning and radiographic anatomic concerns.1 When launched, benefits anticipated have been elevated accuracy of implant place, lowered surgical procedure invasiveness, shortened chair-side time, and elevated affected person acceptance of dental implant therapy.2 Moreover, quite a few research have reported an implant survival charge of 91% to 100% with CGIS.3–6 Though elevated accuracy of implant place has been reported,6,7 some research revealed a substantial three-dimensional (3-D) deviation between digital planning and the precise implant place.8,9 To enhance the result of the implant place, a number of elements need to be thought-about, together with high quality of CT imaging, the clinician’s information of CT evaluation, high quality of 3-D reconstruction,10 and exact switch of the digital plan to the intraoral place utilizing mounted intraoral reference factors.11–13 The pc-guided strategy may very well be the much less most popular one by the clinician or the affected person for quite a few causes: the extra price, elongated therapy planning time, and studying curve related to the appliance of this know-how. These days, software program designers and 3-D printing producers have quickly encompassed implant dentistry into the digital business. Subsequently, it’s important that dental caregivers consider the need of incorporating the digital dentistry strategy into their affected person care routine. The purpose of this research was to analyze and evaluate the perspective of clinicians towards computer-guided implant surgical procedure (CGIS) and traditional non-CGIS in dental implant therapy.
Supplies and Strategies
This observational cross-sectional research was accredited by the Analysis Ethics Committee of the School of Dentistry (REC-FD) at King Abdulaziz College (Moral approval # 42-38828) in full accordance with the World Medical Affiliation Declaration of Helsinki. Verbal knowledgeable consent course of was accredited by the REC-FD and obtained from all contributors. The present methodology was reviewed by an impartial statistician.
An internet-based questionnaire was ready utilizing the Survey Monkey web site (Survey Monkey, San Mateo, CA, USA). The event of the survey was based mostly on the reported benefits, disadvantages, and standards for CGIS and the standard strategy within the literature complemented by the writer’s opinion. Questionnaire objects have been reviewed by two dentists acquainted with digital implant dentistry for readability of directions and questions, order of questions, and comprehensiveness. Following the evaluation, an settlement on the objects to be included within the questionnaire was reached.
A pilot survey was undertaken by 20 dentists to check the lucidity of the questions. The questionnaire was then modified earlier than continuing with the precise research. Reliability evaluation carried out on the information collected from 20 contributors utilizing IBM Statistical Package deal for the Social Sciences (SPSS model 22 software program; Armonk, NY, USA) reported Cronbach’s alpha of 0.72, 0.73, and 0.83.
From October 2017 to February 2018, the questionnaire was electronically despatched to 150 dental professionals who had the expertise of inserting 10 or extra dental implants. The focused topics included college members and Saudi board residents within the implantology, oral surgical procedure, periodontics, and prosthodontics disciplines at King Abdulaziz College (Jeddah, Saudi Arabia) and King Saud College (Riyadh, Saudi Arabia), in addition to members of the Saudi Implant Membership. This cohort represented the dentists training implantology in Saudi Arabia.
The questionnaire was in English and included 30 questions distributed over 3 pages. The primary web page concerned questions on gender, specialty (common dentists, periodontists, oral surgeons, prosthodontists), expertise with implant placement when it comes to variety of implants positioned (positioned <100 implants, positioned 100–200 implants, or positioned >200 implants), expertise with utilizing CGIS (customers or non-users), and curiosity in utilizing this know-how ( or not-interested). The second web page had statements on parameters associated to non-CGIS procedures, together with implant place accuracy, chair-side time, predictability of flapless surgical procedure, holding tempo with technological developments, surgery-related stress, required surgical abilities, therapy price, and therapy planning time. Lastly, the final web page included the identical statements, however in relation to CGIS, together with parameters particular to CGIS, equivalent to accessibility to coaching programs, entry to planning software program, studying curve, communication with manufacturing facilities, and totally different scientific conditions the place CGIS is indicated. On a 10-point Likert scale, contributors have been anticipated to decide on a quantity from 0 (completely disagree) to 10 (completely agree) for every given assertion. The record of included questions are proven in Table 1. Information entry was carried out manually, and statistical evaluation was carried out utilizing STATA Model 13.0 (StataCorp, Faculty Station, Texas, USA). Descriptive evaluation variables have been introduced utilizing frequencies and percentages (gender, specialty, expertise degree, utilizing standing, and curiosity). The end result variables of the contributors’ perspective towards the traits of guided and non-guided surgical procedure have been introduced utilizing median and interquartile vary, and the affiliation between them was examined utilizing the Spearman correlation take a look at. Moreover, the affiliation between final result variable (perspective towards traits of guided surgical procedure) and predictors (gender, specialty, expertise degree, precise use) was examined utilizing Kruskal–Wallis and Wilcoxon rank sum assessments, with P < 0.05 indicating significance.
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Desk 1 The Research Questionnaire |
Outcomes
The outcomes have been reviewed by an impartial statistician. This research included responses from 56 clinicians, a response charge of 37.3%. Baseline traits of contributors are introduced in Table 2. Though 95% of collaborating clinicians have been serious about making use of CGIS, solely 46% of them had used the know-how. Individuals within the present investigation had the next perspective towards CGIS:
- Clinicians acknowledged the benefits of CGIS over non-CGIS (Figure 1).
- Probably the most important benefits of CGIS over non-CGIS have been low stress throughout surgical procedure (P = 0.003, Spearman correlation) and the lowered degree of required surgical abilities (P = 0.04, Spearman correlation) (Figure 1).
- The benefits of a extra correct final result and a extra predictable flapless surgical procedure weren’t considerably increased with CGIS than with non-CGIS (P = 0.2 and 0.7, respectively, Spearman correlation) (Figure 1).
- Probably the most important drawback of CGIS over non-CGIS was the elevated price of therapy (P = 0.002, Spearman correlation) (Figure 1).
- Clinicians rated accessibility to CGIS as reasonable (Figure 2).
- The acknowledgement of the benefits of predictable flapless surgical procedure in affiliation with CGIS was considerably increased amongst common dentists than amongst periodontists and prosthodontists (P = 0.03, Kruskal–Wallis take a look at) (Figure 3).
- Neither their degree of expertise nor the frequency with which they used the know-how considerably influenced the contributors’ opinion about CGIS (Figures 4 and 5).
- CGIS was probably the most advisable in circumstances of full edentulism and the least advisable in treating single posterior edentulous gaps.
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Desk 2 Quantity and Proportion of Individuals In keeping with Gender, Specialty, Expertise Degree with Implant Placement in Phrases of Amount, Expertise with the Use of Laptop-Guided Implant Surgical procedure (CGIS), and Curiosity in Utilizing CGIS |
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Determine 1 Median and interquartile vary of the perspective of clinicians towards the benefits and drawbacks of computer-guided implant surgical procedure (CGIS) versus the standard non-CGIS strategy on a scale of 0 (completely disagree) to 10 (completely agree). *Statistically important distinction at P < 0.05. |
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Determine 2 Median and interquartile vary of the perspective of clinicians towards disadvantages particular to computer-guided implant surgical procedure (CGIS) on a scale of 0 (completely disagree) to 10 (completely agree). |
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Determine 3 Median and interquartile vary of the perspective of clinicians from totally different specialties in the direction of the predictability of flapless implant surgical procedure with computer-guided implant surgical procedure (CGIS) on a scale of 0 (completely disagree) to 10 (completely agree). *Statistically important distinction at P < 0.05. |
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Determine 4 Median and interquartile vary of the perspective of clinicians with totally different ranges of expertise towards the benefits and drawbacks of computer-guided implant surgical procedure (CGIS) on a scale of 0 (completely disagree) to 10 (completely agree). |
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Determine 5 Median and interquartile vary of the perspective of computer-guided implant surgical procedure (CGIS) customers and non-users towards the benefits and drawbacks of computer-guided implant surgical procedure (CGIS) on a scale of 0 (completely disagree) to 10 (completely agree). |
Dialogue
The overall statement of this research was that the contributors acknowledged the benefits of CGIS over the standard strategy. Particularly, they believed that CGIS was related to considerably decrease stress amongst clinicians and a lowered degree of required surgical abilities. Nevertheless, they didn’t take into account the accuracy of the result and the predictability of flapless surgical procedure as important benefits of CGIS. Subsequently, the principle benefits of CGIS, as seen by the contributors, have been associated to the clinician’s state of low stress quite than the affected person’s curiosity in therapy predictability.
In distinction to what contributors thought-about relating to accuracy final result within the present research, few research within the literature have reported that the accuracy of CGIS was considerably greater than that of the non-guided surgical procedure. In a current research evaluating the accuracy of implant placement between a thermoplastic surgical information and 3-D printed surgical information, a major distinction was discovered within the location of implant head place (1.3 mm and 0.51 mm, respectively) and implant apex place (1.60 mm and 0.76 mm, respectively), however not within the implant angulation (3.40 levels and a pair of.36 levels, respectively). The distinction within the accuracy final result as a result of better flexibility of the thermoplastic surgical information, resulting in elevated likelihood of defective place final result.14 One other research evaluating the distinction between the accuracy results of computer-guided surgical procedure and free-hand surgical procedure carried out by skilled dentists demonstrated a 3-times better deviation within the last place of positioned implants on the angular degree and important deviation on the lateral ranges related to the free-hand strategy.15 Nevertheless, this elevated accuracy final result will not be satisfactory in all conditions, as a result of ±2 mm imprecisions in affiliation with guided surgical procedure are to be anticipated.12
The predictability of flapless surgical procedure utilizing CGIS was acknowledged by the overall dentists on this research. A earlier research demonstrated that flapless placement of implants with out using a surgical information is an inaccurate process which will lead to bone perforation in 59.7% of the circumstances.16
Though 95% of the research contributors have been serious about utilizing CGIS, solely 46% reported utilizing the know-how. The retraction from CGIS may very well be associated to few elements. First, the excessive price of CGIS was the foremost drawback reported right here. Nevertheless, a report on the affected person’s notion on dental implant surgical procedure confirmed that 67% of sufferers would settle for the bills of guided surgical procedure if it precludes a bone grafting process.17 Second, contributors on this research reported poor accessibility to coaching programs on CGIS, planning software program, or communication with surgical information manufacturing facilities. These elements are alleged to hinder the utilization of this know-how.
On this research, the clinicians principally advisable using CGIS in full edentulous circumstances. Points relating to best positioning of a number of implants in relation to the ultimate restoration to one another and to the encompassing anatomical constructions may be handled when utilizing the computer-guided strategy.18,19 Nevertheless, in a scientific evaluation evaluating the guided surgical procedure strategy within the therapy of absolutely edentulous sufferers, problems equivalent to surgical information fracture, lowered major implant stability, and prosthesis fracture have been seen despite the excessive survival charge of 97.2%, with a imply marginal bone lack of 1.45 mm over a follow-up interval of 1–4 years.20
Shortcomings of the present survey included the small pattern measurement and the collection of a handy pattern that makes exterior generalization of the outcomes past the focused inhabitants tough. Subsequently, this survey represents the perspective of dentists training implantology in Saudi Arabia. Outcomes could fluctuate in different international locations the place the market measurement of digital implant dentistry, accessible sources, and degree of expertise with the know-how are totally different.
Conclusion
Throughout the limitations of the present investigation, the next may be concluded within the current research:
- Clinicians acknowledged the benefits of CGIS over non-CGIS.
- The numerous benefits of CGIS have been associated to the clinician’s state of low stress and lowered degree of required abilities, quite than the affected person’s curiosity in therapy predictability.
- CGIS is a beautiful strategy for many clinicians, despite the low charge of precise expertise.
Future analysis may be directed towards investigating the perspective of sufferers towards CGIS, by conducting managed scientific trials to check the result of CGIS and non-CGIS in numerous scientific conditions and to delineate scientific standards for correct case choice.
Acknowledgments
The writer wish to specific her because of all of the contributors on this research, to the biostatistician Dr.Meaad Moqaddam kind King Abdulaziz College School of Dentistry for her legitimate contribution in reviewing the present work and to Editage (www.editage.com) for English language modifying. No monetary help was obtained for this investigation.
Disclosure
The writer studies no conflicts of curiosity on this work.
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