Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지

Implant stability installed with CAD-CAM assisted flapless surgery : A pilot study

CAD-CAM assisted flapless 수술법으로 식립된 임플란트의 안정성 : 기초연구

  • Park, Chan-Jin (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Kim, Dae-Gon (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Cho, Lee-Ra (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Kashiwagi, Kosuke (Department of Fixed Prosthodontics and Occlusion, Osaka Dental University) ;
  • Kawazoe, Takayoshi (Department of Fixed Prosthodontics and Occlusion, Osaka Dental University) ;
  • Tanaka, Masahiro (Department of Fixed Prosthodontics and Occlusion, Osaka Dental University)
  • 박찬진 (강릉원주대학교 치과대학 치과보철학교실) ;
  • 김대곤 (강릉원주대학교 치과대학 치과보철학교실) ;
  • 조리라 (강릉원주대학교 치과대학 치과보철학교실) ;
  • ;
  • ;
  • Received : 2011.10.20
  • Accepted : 2011.12.25
  • Published : 2011.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

It was proposed that technologies derived from CAD-CAM and computed tomography may be useful for flapless implant treatment procedures. The aims of this study were to validate the reliability of this concept in a prospective 12-month clinical study. Twelve patients with fully edentulous areas in their mandibles were included in this study. A total of 71 implants were inserted in interforaminal regions by use of a CAD/CAM drill template($NobelGuide^{TM}$), specially designed for flapless implant surgery. To assess the degree of pain and discomfort, the patients were examined at 2 days and 1 week after surgery. Patient satisfaction and implant functionality were further evaluated at follow-up intervals of 1, 3, 6, and 12 months postoperatively. One implant failed early in 1 patient. All of the other implants were in a good functional state throughout the study. The mean marginal bone loss after 1 year of follow-up was 0.3 mm (SD, 0.1) at center, 0.5 mm (SD, 0.1) at canine and 0.7 mm (SD, 0.2) at distal fixtures, respectively. Statistically, there was not significant differences among each sites(P>.05)The mean ISQ change after 1 year of follow-up was -1.05 (SD, 2.76) at center, -0.85 (SD, 2.59) at canine and -1.27 (SD, 2.18) at distal fixtures, respectively. This prospective pilot study showed that the use of CAD/CAM technology and flapless implant surgery may be considered reliable for fully edentulous mandible of patients.

CAD-CAM기법과 CT의 도움으로 무판막임플란트 치료술식이 가능하게 되었다. 본 연구의 목적은 1년간 전향적 연구를 통해 이러한 술식의 신뢰성을 검토하고자 하였다. 하악무치악상태의 연속적인 환자 12명이 포함되었다. 71개의 임플란트가 이공사이에 $NobelGuide^{TM}$법을 이용하여 식립되었고 환자는 정해진 주기에 따라 검사되었다. 한 개의 임플란트가 조기실패하였으며 나머지는 만족할 만한 기능을 보였다. 연구기간 중 평균적인 변연골흡수량은 중앙부($0.3{\pm}0.1$ mm), 견치부($0.5{\pm}0.1$ mm), 원심부($0.7{\pm}0.2$ mm)였으며 임플란트 안정성 수치의 변화량은 중앙부($-1.05{\pm}2.76$ mm), 견치부($-0.85{\pm}2.59$ mm), 원심부($-1.27{\pm}2.18$ mm)를 나타내었고 위치간 통계학적인 차이는 없었다(P>.05). 본 전향적인 기초조사연구에서 CAD-CAM기반의 무판막임플란트 치료술식은 하악무치악환자에게 신뢰성 있는 술식이 될 수 있을 것으로 사료되었다.

Keywords

References

  1. Becker W, Goldstein M, Becker BE. Minimally invasive flapless implant surgery: A prospective multicenter study. Clin Implant Dent Relat Res 2005;7:1. https://doi.org/10.1111/j.1708-8208.2005.tb00040.x
  2. Hahn J: Single-stage, immediate loading, and flapless surgery. J Oral Implantol 2000;26:193. https://doi.org/10.1563/1548-1336(2000)026<0193:SILAFS>2.3.CO;2
  3. Kan JYK, Rungcharassaeng K, Ojano M. Flapless anterior implant surgery: A surgical and prosthodontic rationale. Pract Periodont Aesthet Dent 2000;12:467.
  4. Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: A retrospective 3-year clinical study. Clin Implant Dent Relat Res 2003;5:29.
  5. Rocci A, Martignoni M, Gottlow J. Immediate loading of Brånemark System TiUnite and machined-surface implants in the posterior mandible: A randomized open-ended clinical trial. Clin Implant Dent Relat Res 2003;5:57.
  6. Azari A, Nikzad S, Kabiri A. Using computer-guided implantology in flapless implant surgery of a maxilla: A clinical report. J Oral Rehabil 2008;35:690. https://doi.org/10.1111/j.1365-2842.2007.01836.x
  7. Rocci A, Gottlow J. Esthetic outcome of immediately loaded scalloped implants placed in extraction sites using flapless surgery. A 6-month report of 4 cases. Appl Osseointegration Res 2004;4:55.
  8. Wendelhag I, van Steenberghe D, Blombork U. Immediate function in edentulous maxillae with flapless surgery including a 3-D CT-scan based treatment planning procedure. Clin Oral Implants Res 2004;15:1. https://doi.org/10.1111/j.1600-0501.2004.00982.x
  9. Azari A, Nikzad S. Flapless implant surgery: Review of the literature and report of 2 cases with computer-guided surgical approach. J Oral Maxillofac Surg 2008;66:1015. https://doi.org/10.1016/j.joms.2007.12.010
  10. Marchack CB. An immediately loaded CAD/CAM- guided definitive prosthesis: A clinical report. J Prosthet Dent 2005;93:8. https://doi.org/10.1016/j.prosdent.2004.10.012
  11. Campelo LD, Camara JR. Flapless implant surgery: A 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants 2002;17:271.
  12. Schiroli G. Immediate tooth extraction, placement of a Tapered Screw-Vent implant, and provisionalization in the esthetic zone: A case report. Implant Dent 2003;12:123. https://doi.org/10.1097/01.ID.0000055822.98106.94
  13. Dula K, Mini R, van der Stelt P. The radiographic assessment of implant patients: Decision-making criteria. Int J Oral Maxillofac Implants 2001;16:80.
  14. Sclar AG. Guidelines for flapless surgery. J Oral Maxillofac Surg 2007;65:20.
  15. Ganz SD. Presurgical planning with CT-derived fabrication of surgical guides. J Oral Maxillofac Surg 2005;63:59
  16. van Steenberghe D, Glauser R, Blomb U. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae. A prospective multicenter study. Clin Implant Dent Relat Res 2005;7:111. https://doi.org/10.1111/j.1708-8208.2005.tb00083.x
  17. Wittwer G, Adeyemo WL, Wagner A. Computer- guided flapless placement and immediate loading of four conical screw-type implants in the edentulous mandible. Clin Implant Dent Relat Res 2007;18:534.
  18. Rosenfeld AA, Mandelaris GA, Tardieu PB. Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes. Part 1: Diagnostics, imaging, and collaborative accountability. Int J Periodontics Restorative Dent 2006;26:215.
  19. Jeong SM, Choi BH, Li J. Flapless implant surgery: An experimental study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:24. https://doi.org/10.1016/j.tripleo.2006.11.034
  20. Fortin T, Bosson JL, Isidori M, et al: Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants 2006;21:298.
  21. Sertgoz A, Güvener S. Finite element analysis of the effect of can- tilever and implant length on stress distribution in an implant- supported fixed prosthesis. J Prosthet Dent 1997;76:165-9.
  22. Romeo E, Lops D, Margutti E, Ghisolfi M, Chiapasco M, Vogel G. Implant-supported fixed cantilever prostheses in partially edentulous arches. A seven-year prospective study. Clin Oral Impl Res 2003;14: 303-11. https://doi.org/10.1034/j.1600-0501.2003.120905.x
  23. McAlarney ME, Sc DE, Stavropoulos DN. Theoretical cantilever lengths versus clinical variables in fifty-five clinical cases. J Prosthet Dent 2000;83:332-43. https://doi.org/10.1016/S0022-3913(00)70137-5
  24. Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow- up study of mandibular fixed prostheses supported by osseointegrat ed implants. Clinical results and marginal bone loss. Clin Oral Impl Res 1996;7:329-36. https://doi.org/10.1034/j.1600-0501.1996.070405.x
  25. Jeffcoat MK, Reddy MS, Webber RL, Williams RC, Ruttimann UE. Extraoral control of geometry for digital subtraction radiography. J Periodont Res 1987;22:396-402. https://doi.org/10.1111/j.1600-0765.1987.tb01605.x
  26. Meijer HJA, Steen WHA, Bosman F. Standardized radiographs of alveolar crest around implants in the mandible. J Prosthet Dent 1992;68:318-21. https://doi.org/10.1016/0022-3913(92)90337-A
  27. O'Sullivan D, Sennerby L, Meredith N. Measurements comparing the initial stability of fie designs of dental implants. A human cadaver study. Clin Oral Den Rel Res 2000;2(2):85-92 https://doi.org/10.1111/j.1708-8208.2000.tb00110.x
  28. O'Sullivan D, Sennerby L, Meredith N. Influence of implant taper on the primary and secondary stability of osseointegrated titanium implants. Clin Oral Impl Res 2004;15:474-80. https://doi.org/10.1111/j.1600-0501.2004.01041.x
  29. Glauser R, Sennerby L, Meredith N, Ree A, Lundgre A, Gottlow J, Hämmerle CHF. Resonance frequency analysis of implant subjected to immediate or early functional occlusal loading. Successful vs failing implants. Clin Oral Impl Res 2004;15:428-34. https://doi.org/10.1111/j.1600-0501.2004.01036.x
  30. Huang HM, Chiu CL, Yeh CY, Lin CT, Lin LH, Lee SY. Early detection of implant healing process using resonance frequency analysis. Clin Oral Impl Res 2003;14:437-43. https://doi.org/10.1034/j.1600-0501.2003.00818.x
  31. Schneider D, Marquatdt P, Zwahlen M, Jung R. A systematic review on the accuracy and the clinical outcome of computerguided template-based implant dentistry. Clin Oral Impl Res 2009;20:73-86 https://doi.org/10.1111/j.1600-0501.2009.01788.x