The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has been extensively examined; however, more information is required to justify the application of fully digital planning protocol. The purpose of this study was to investigate the clinical accuracy of sGIS with a fully digital planning workflow. Twenty-one partially edentulous patients were enrolled in this prospective study. Cone-beam computed tomography (CBCT) and intraoral scans were taken and superimposed by matching the dental surface images directly (surface registration protocol) or by matching fiducial markers on a stereolithographic (SLA) radiographic template fabricated from the digital data of the intraoral scan (fiducial marker registration protocol). Virtual implant treatment plans were then determined, and tooth-supported SLA surgical guides were fabricated according to the plans. Twenty-six implant surgeries were performed via the surgical guide by one surgeon. Pre- and post-operative CBCT images were superimposed, and the positional and angular deviations between placed and planned implants were measured with metrology software. A total of 43 fully guided implants were placed, in which 25 implants were planned with the surface registration protocol. Implants planned based on the surface registration protocol had a larger mean angular deviation than the fiducial marker registration protocol. No significant differences were found for any deviations of the examined variables. Within the limits of this study, we concluded that the clinical accuracy of the sGIS planned with a fully digital workflow was consistent with the conventional workflow for partially edentulous patients.

A distal free-end situation could result in insufficient stability of the surgical guide, and could reduce accuracy of the static guided implant surgery (sGIS). The purpose of this study was to investigate the accuracy of sGIS using a combination tooth-and-bone supported stereolithographic (SLA) surgical guide in distal extension situation. Thirty dentists, each placed three implants at the Federal Dentaire Internationale (FDI) teeth positions #46, #47 (a distal extension situation), and #36 (a single tooth gap) via the surgical guide on a model fixed to a manikin. Pre- and post-operative computed tomography (CT) images of the models were superimposed, and the positional and angular deviations of the implants were measured with metrology software. An analysis of variance (ANOVA) test was performed to evaluate the intergroup differences. No significant differences were found for all the positional and angular deviations among the three implant sites, except the bucco-lingual deviation at the implant platform in the #47 position (0.43 ± 0.19 mm) that was significantly larger than the #46 (0.21 ± 0.14 mm) and #36 (0.24 ± 0.25 mm) positions (p < 0.0001). Within the limits of this study, we conclude that, in distal extension situation of missing mandibular molars, adding a bone-supported strut in the distal part of the surgical guide can be beneficial to the accuracy of the sGIS.

This study compared the accuracy of static computer-assisted implant surgery (sCAIS) planned through dental surface image registration and fiducial marker registration. Stone models of 30 patients were converted into digital dental casts by using a desktop scanner. Cone-beam computed tomography (CBCT) was performed and superimposed to the digital dental casts with two methods: matching the dental surface images or matching the fiducial markers on a stereolithographic radiographic template. Following the implant planning, stereolithographic surgical guides were fabricated, and 56 fully guided implants were inserted by the same doctor. Deviations between planned and inserted implants were measured and compared using postoperative CBCT images. After adjustment for other potential influencing factors, compared with the fiducial marker registration group, significantly larger mean lateral deviations were noted in the dental surface registration group at both the implant platform and apex (p = 0.0188 and 0.0371, respectively). However, the mean lateral deviations for the dental surface registration (0.83 ± 0.51 mm at implant platform and 1.24 ± 0.68 mm at implant apex) were comparable to the literature. In conclusion, our findings indicate that although sCAIS planned using dental surface image registration was not statistically as accurate as that using fiducial marker registration, its accuracy was satisfactory for clinical use.

Studies examining the effect of operator experience on the accuracy of static guided implant surgery have used postoperative computed tomography (CT) images to measure the error, with inconsistent results. The purpose of this study was to try to clarify this issue by using a measurement method based on the postoperative optical scan. Thirty dentists were divided into an experienced group and an inexperienced group. On a partially edentulous mandibular model in the manikin head, each dentist placed three implants via the stereolithographic (SLA) surgical guide. The implant positions were identified by a desktop scanner and compared with the planned positions using a metrology software program. No statistically significant differences were observed for any of the measured positional and angular deviations of the three implant sites between experienced and inexperienced operators (p > 0.01). All the mean values of deviations of the inexperienced group, except the depth deviation, were less than the experienced group. Implants inserted by dentists under 40 years old had significantly better accuracy than senior doctors in the global deviation at implant apex (p = 0.006). Within the limits of this study, we concluded that operator experience is not a critical factor in achieving the accuracy of guided implant surgery via the tooth-supported SLA surgical guide. Large deviations could occur even with the aid of the SLA surgical guide, and care must be taken to avoid errors for both experienced and inexperienced operators.

The performance of intraoral scanners (IOSs) relies on the operator's skills. However, whether operator experience influences IOS accuracy remains unclear. This study investigated the effect of operator experience on the trueness accuracy and time-based efficiency of IOSs. Thirty operators were equally divided into two groups on the basis of their IOS-handling experience. Each operator performed simulation scans of a maxillary model in a training dummy by using three IOSs: CEREC Omnicam, Primescan, and Aoralscan 3. A total of 90 scans were generated, and the scan time for image acquisition and the render time required for an IOS to generate a three-dimensional image were recorded. The trueness of each scan was calculated by comparing with a reference scan obtained from an industrial high-precision scanner. The t test and the ANOVA followed by the Tukey post hoc test were used to determine statistical differences. Significance was set at P < 0.01. For the three IOSs, no significant difference was noted in trueness accuracy, scan time, or render time between inexperienced and experienced operators. For both inexperienced and experienced operators, Omnicam had significantly less accuracy and longer scan time than did the other IOSs; the render time was significantly shorter for Aoralscan 3 than for the other IOSs. Operator experience does not substantially influence the trueness accuracy and time-based efficiency of IOSs; these factors vary across IOS types. The render time for obtaining three-dimensional images is a significant feature for improving the time-based efficiency of IOSs.

Polyetheretherketone (PEEK) is widely used in dentistry owing to its exceptional properties, including its natural appearance; however, existing surface treatment methods for bonding PEEK have limitations. Autofocus laser cutters, known for their precise engraving and cutting capabilities, offer potential for surface treatment of PEEK; thus, the objective of this study was to investigate the creation of laser groove structures on PEEK to enhance its bonding capability with dental resin cement. A dental computer-aided design and manufacturing system was used to fabricate PEEK samples, and three groove patterns (circle, line, and grid) were generated on PEEK surfaces, with air-abrasion used as the control group. The surface characteristics, cell viability, and bond strength were evaluated, and the data were statistically analyzed using one-way analysis of variance and post hoc Tukey’s tests (α = 0.05). Laser-treated PEEK exhibited a uniform texture with a groove depth of approximately 39.4 µm, hydrophobic properties with a contact angle exceeding 90°, a surface roughness of 7.3–12.4 µm, consistent topography, and comparable cell viability compared with untreated PEEK. Despite a decrease in bond strength after thermal cycling, no significant intergroup differences were observed, except for the line-shaped laser pattern. These findings indicate that the autofocus laser cutter effectively enhances the surface characteristics of PEEK by creating a uniform texture and grooves, showing promise in improving bonding properties, even considering the impact of thermal cycling effects.