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22.12.

2015

AsystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebasedimplantdentistryPubMedHealth

PubMedHealth.AserviceoftheNationalLibraryofMedicine,NationalInstitutesofHealth.

DatabaseofAbstractsofReviewsofEffects(DARE):QualityassessedReviews[Internet].York(UK):CentreforReviewsandDissemination(UK)1995.

Asystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebased
implantdentistry
DSchneider,PMarquardt,MZwahlen,andREJung.
Reviewpublished:2009.

CRDsummary
Theauthorsconcludedthatsurvivalratesofimplantsplacedwithcomputerguidedtechnologywerecomparabletoconventionallyplacedimplants.A
considerablenumberoftechniquerelatedperioperativecomplicationswereobserved.Giventherelianceoncaseseriesandcohortstudiesandthelackof
reportingonstudyselectionandstudyqualityassessment,thereliabilityoftheauthors'conclusionsareunclear.

Authors'objectives
Toevaluatetheclinicalperformanceofcomputerguidedtemplatedentistry.Accuracywasalsoevaluated,butisnotreportedinthisabstract.

Searching
PubMedwassearchedfrom1966to2007.Searchtermswerereported.UnspecifiedEnglishlanguagedentaljournalsweresearchedfromJanuary2008to
February2009.Unspecifiedtopicrelateddentaljournalsandreferencelistsofselectedarticleswerehandsearched.

Studyselection
Eligiblestudieswereofanydesignwithaminimumoffivepatientsthatusedstaticsurgicaltemplatebasedcomputerguidedimplantsystems.Studiesthatused
dynamicnavigationsystems,zygomaimplants,pterygoidimplantsorminiimplantsfororthodonticpurposesofepithesesandstudiesthatexclusivelyreportedon
radiographicplanningwereexcludedfromthereview.Outcomesofinterestwere:early(twoweekspostoperatively)surgicalcomplicationsorunexpectedevents,
earlyprostheticcomplications,late(12monthsormore)implantfailuresandlateprostheticcomplications.
Agerangevariedwidelybetweenstudies.Meanpatientagewas55.3years(range18to90)wherereported.Sixdifferentsystemsofcomputerguidedimplant
surgerywereused:CADImplant,PraximNobelGuide,NobelBiocareMed3D,Med3DGmbHcoDiagnostiX,IVSSolutionsSimPlant,MaterialiseandStent
CAD,MediaLab.Moststudiesusedstereolithographicallyproducedsurgicaltemplates(rapidprototyping).Otherstudiesusedlaboratoryfabricatedsurgical
guidesforimplantplacingbasedoncomputerassistedimplantplaning.Allstudiesincludedcompletelyedentulousteethandmoststudiesincludedpartially
edentulousteeth.
Theauthorsdidnotstatehowmanyreviewersperformedstudyselection.

Assessmentofstudyquality
Theauthorsdidnotstatewhetherstudyqualitywasassessed.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028832/?report=printable

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AsystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebasedimplantdentistryPubMedHealth

Dataextraction
Dataonthenumberofpatientswhoexperiencedeachoutcomeofinterestwereextractedinordertocalculatepercentagesofpatientswhoexperiencedthe
outcome.
Tworeviewersindependentlyperformeddataextraction.Anydisagreementswereresolvedbydiscussion.

Methodsofsynthesis
Percentageofpatientswhoexperiencedeachoutcome(earlysurgicalcomplications,earlyprostheticcomplications,lateimplantfailures,lateprosthetic
complications)werepresentedintables.

Resultsofthereview
Tenprospectivestudies(caseseriesandcohortdesign,numbernotreported)(468patientsand1,793implants)wereincludedinthereview.Followupranged
fromzeroto60months.
Earlysurgicalcomplications:Eightstudies(428patients,1,581implants)reportedonearlysurgicalcomplications.Thirtyninepatients(9.1%)experiencedan
earlysurgicalcomplication.Themostcommoncomplicationwaslimitedaccessinposteriorareas(10patients,2.3%).Othercommonearlysurgical
complicationsincludedprimaryboneaugmentationnecessary(eightpatients,1.9%),unexpectedbonydehiscence(threepatients,0.7%),fractureoftemplate
(threepatients,0.7%)andinfectionatdrillsitepins(threepatients,0.7%)
Earlyprostheticcomplications:Threestudies(69patients,438implants)reportedonearlyprostheticcomplications.Thirteenpatients(18.8%)experiencedan
earlyprostheticcomplication.Themostcommonearlyprostheticcomplicationwasmisfitofabutmenttobridge(fivepatients,7.2%ofpatients).Othercommon
earlyprostheticcomplicationsincludedextensiveadjustmentsoftheocclusion(threepatients,4.3%)andincompleteseatingofprosthesis(twopatients,2.9%).
Lateimplantfailures:Sixstudies(138patients,721implants)reportedonimplantfailuresafteraminimumof12months.Infourofthesestudies(101patients,
537implants),37implants(6.9%)failedduringthefollowupperiod.Theimplantfailureratewasreportedtobehigherinopenflapsurgerywithdelayedloading
comparedtoflaplesssurgerywithimmediateloadingprocedures.Twostudies(37patients,atleast184implants)hadnoimplantfailures.
Lateprostheticcomplications:Fivestudies(108patients)reportedonlateprostheticcomplications.Twostudies(39patients,atleast71implants)hadno
prostheticcomplications.Inthreestudies(69patients,438implants),allofwhichusedaflaplessprocedurewithimmediateloading,13patients(12%)
experiencedcomplications.

Authors'conclusions
Survivalratesofimplantsplacedwithcomputerguidedtechnologywerecomparabletoconventionallyplacedimplants.Aconsiderablenumberoftechnique
relatedperioperativecomplicationswereobserved.

CRDcommentary
Theinclusioncriteriawerebroad.Thesearchstrategywaslimitedtoonedatabaseanditappearedthatnoattemptsweremadetolocateunpublishedmaterial,so
relevantstudiesmayhavebeenmissed.Theauthorsdidnotstatehowmanyreviewerswereinvolvedstudyselection,soitwasunclearwhetherthisreviewprocess
wassubjecttoreviewererrororbias.Dataextractionwasperformedbytworeviewers,whichreducedtheriskofreviewererror.Therewasnoassessmentofstudy
quality,sothereliabilityofdatafromtheincludedstudiescouldnotbeassessed.Theauthorsacknowledgedthattheobservationperiodofthestudieswasshort
andthatlittlevarietyofcomputerguidedtemplatebasedimplantsystemswasused.Giventherelianceoncaseseriesandcohortstudies,ableitthebestevidence
available,andthelackofreportingonstudyselectionandstudyqualityassessment,thereliabilityoftheauthors'conclusionsareunclear.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028832/?report=printable

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AsystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebasedimplantdentistryPubMedHealth

Implicationsofthereviewforpracticeandresearch
Practice:Theauthorsdidnotstateanyimplicationsforpractice.
Research:Theauthorsstatedthatfurtherresearchshouldinvolveclinicalstudieswithlongtermfollowupandstriveforimprovementofthesystemsand
proceduresregardingaccuracy,predictabilityandreproducibilityofimplantplacementaswellassurgicalandprostheticoutcomes.

Funding
Notstated.

Bibliographicdetails
SchneiderD,MarquardtP,ZwahlenM,JungRE.Asystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebasedimplant
dentistry.ClinicalOralImplantsResearch200920(Supplement4):7386.[PubMed:19663953]

OriginalPaperURL
http://onlinelibrary.wiley.com/doi/10.1111/j.16000501.2009.01788.x/abstract

IndexingStatus
SubjectindexingassignedbyNLM

MeSH
AnimalsDentalImplantation,Endosseous/adverseeffects/methodsDentalImplantsDentalRestorationFailureHumansJaw,Edentulous/radiography
MedicalErrorsModels,AnatomicSurgery,ComputerAssistedTreatmentOutcomeVerticalDimension

AccessionNumber
12009109872

Databaseentrydate
22/09/2010

RecordStatus
ThisisacriticalabstractofasystematicreviewthatmeetsthecriteriaforinclusiononDARE.Eachcriticalabstractcontainsabriefsummaryofthereview
methods,resultsandconclusionsfollowedbyadetailedcriticalassessmentonthereliabilityofthereviewandtheconclusionsdrawn.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028832/?report=printable

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AsystematicreviewontheaccuracyandtheclinicaloutcomeofcomputerguidedtemplatebasedimplantdentistryPubMedHealth

CRDhasdeterminedthatthisarticlemeetstheDAREscientificqualitycriteriaforasystematicreview.
Copyright2014UniversityofYork.
PMID:19663953

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