Summary And Future Perspectives

161 Despite the rising popularity of guided surgery and immediate loading, profound scientific evidence is lacking to support this approach in dental implant treatment. Nevertheless, the possible advantages of guided surgery protocols such as flapless and minimally invasive surgery, protection of vital anatomical structures, and immediate restoration have been extensively highlighted as marketing tools in the dental implant industry. The introduction of Cone Beam CT (CBCT) scanning and the increasing availability of this technique to dental offices have made the digitalisation of implant dentistry more and more accessible. Different companies have developed software packages and technologies to deliver a digital approach to treating patients using dental implants. These software packages for guided surgery are similar and are based on comparable technology. However, the manners in which the drill guides are fabricated differ. Stereolithography, rapid prototyping, and a model-based approach using computer algorithms are among the most commonly applied technologies. On the other hand, our systematic review showed that, despite the different levels of research quality for computer-assisted implant placement, an evaluation of the evidence suggesting that computer-assisted surgery is superior to conventional procedures in terms of safety, implant precision, morbidity, and efficiency has yet to be performed. Some studies have demonstrated that the maximum observed deviations from computer-aided planned implant positions exceeded what one might call clinically acceptable levels. Thus, future long-term clinical data are necessary to evaluate its clinical success and to justify the additional CBCT-associated radiation doses, effort, and costs associated with computer-assisted implant surgery (Chapter 1). Why are there large deviations from the planned implant position? What are the possible causes of the deviations and how can we improve this technique's precision? Various hypotheses have been put into consideration to address this question:-In the treatment of edentulous jaws, lack of stable references might result in inaccuracy due to resilience of the oral mucosa and lack of stability of the scan prosthesis and the drilling template. CT image distortion and errors might cause errors in the planning software.-Failure to control and stabilise the surgical procedure and implant placement might lead to differences between planned and placed implants. Guided surgery and immediate loading. A digital approach 162 In an in vitro study (Chapter 3), we demonstrated that insertion of mini-implants as references prior to the actual implant insertion could create a permanent reference base throughout the entire treatment procedure. Calibration flags, what we refer to as screw complexes, that …