Depth distortion and angular deviation of a fully guided tooth-supported static surgical guide in a partially edentulous patient: A systematic review and meta-analysis

IF 3.4 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
Franciele Floriani DDS, MSc, PhD, Carlos A. Jurado DDS, MS, Alexandre J. Cabrera DDS, Wagner Duarte DDS, MSc, PhD, Thiago S. Porto DDS, MSc, PhD, Kelvin I. Afrashtehfar DDS, MSc, PhD, FDS RCS, FRCDC
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引用次数: 0

Abstract

Purpose

This systematic review and meta-analysis aimed to evaluate the depth distortion and angular deviation of fully-guided tooth-supported static surgical guides (FTSG) in partially edentulous arches compared to partially guided surgical guides or freehand.

Material and Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Open Science Framework (OSF). The formulated population, intervention, comparison, and outcome (PICO) question was: “In partially edentulous arches, what are the depth distortion and angular deviation of FTSG compared to partially guided surgical guides or freehand?” The search strategy involved four main electronic databases, and an additional manual search was completed in November 2023 by following an established search strategy. Initial inclusion was based on titles and abstracts, followed by a detailed review of selected studies, and clinical studies that evaluated the angular deviations or depth distortion in FTSG in partial arches, compared to partially guided surgical guides or freehand, were included. In FTSG, two surgical approaches were compared: open flap and flapless techniques, and two digital methods were assessed for surgical guide design with fiducial markers or dental surfaces. A qualitative analysis for clinical studies was used to assess the risk of bias. The certainty of the evidence was assessed according to the grading of recommendations, assessment, development, and evaluations (GRADE) system. In addition, a single-arm meta-analysis of proportion was performed to evaluate the angular deviation of freehand and FTSG.

Results

Ten studies, published between 2018 and 2023, met the eligibility criteria. Among them, 10 studies reported angular deviations ranging from -0.32° to 4.96° for FTSG. Regarding FTSG surgical approaches, seven studies examined the open flap technique for FTSG, reporting mean angular deviations ranging from 2.03° to 4.23°, and four studies evaluated flapless FTSG, reporting angular deviations ranging from -0.32° to 3.38°. Six studies assessed the freehand surgical approach, reporting angular deviations ranging from 1.40° to 7.36°. The mean depth distortion ranged between 0.19 mm to 2.05 mm for open flap FTSG, and between 0.15 mm to 0.45 mm for flapless FTSG. For partially guided surgical guides, two studies reported angular deviations ranging from 0.59° to 3.44°. Seven studies were eligible for meta-analysis, focusing on the FTSG in open flap technique, with high heterogeneity (I2 (95%CI) = 92.3% (88.7%–96.4%)). In contrast, heterogeneity was low in studies comparing freehand versus FTSG in open flap techniques (I2 (95%CI) = 21.3% (0.0%–67.8%)), favoring the FTSG surgical approach.

Conclusion

In partially edentulous arches, FTSG systems exhibited less angular deviation than freehand and partially guided surgical guides. Flapless surgical approaches were associated with reduced angular deviation and depth distortion, suggesting a potential preference for the FTSG method in these procedures.

Abstract Image

部分无牙颌患者使用全引导牙支持静态手术导板的深度变形和角度偏差:系统回顾和荟萃分析。
目的:本系统综述和荟萃分析旨在评估完全引导的牙支持静态手术导板(FTSG)与部分引导的手术导板或徒手手术导板相比,在部分无牙颌弓中的深度变形和角度偏差:本研究遵循系统综述和荟萃分析首选报告项目(PRISMA)指南,并在开放科学框架(OSF)中注册。制定的人群、干预、比较和结果(PICO)问题为"在部分缺牙弓中,FTSG 的深度变形和角度偏差与部分引导手术导板或徒手导板相比如何?检索策略涉及四个主要电子数据库,并于 2023 年 11 月按照既定检索策略完成了额外的人工检索。根据标题和摘要进行初步纳入,然后对所选研究进行详细审查,纳入了评估部分牙弓 FTSG 与部分引导手术导板或徒手相比的角度偏差或深度变形的临床研究。在 FTSG 中,比较了两种手术方法:开放皮瓣和无皮瓣技术,并评估了使用靶标或牙齿表面进行手术导板设计的两种数字化方法。临床研究的定性分析用于评估偏倚风险。根据建议、评估、发展和评价分级(GRADE)系统对证据的确定性进行了评估。此外,还进行了单臂比例荟萃分析,以评估徒手和FTSG的角度偏差:2018年至2023年间发表的10项研究符合资格标准。其中,10 项研究报告了 FTSG 的角度偏差从-0.32°到 4.96°不等。关于 FTSG 手术方法,7 项研究考察了 FTSG 的开放皮瓣技术,报告的平均角度偏差范围为 2.03° 至 4.23°,4 项研究评估了无皮瓣 FTSG,报告的角度偏差范围为 -0.32° 至 3.38°。有六项研究评估了徒手手术方法,报告的角度偏差从1.40°到7.36°不等。开瓣 FTSG 的平均深度变形范围在 0.19 毫米到 2.05 毫米之间,无瓣 FTSG 的平均深度变形范围在 0.15 毫米到 0.45 毫米之间。对于部分引导的手术导板,两项研究报告的角度偏差在0.59°到3.44°之间。有七项研究符合荟萃分析的条件,重点是开放皮瓣技术中的 FTSG,异质性较高(I2 (95%CI) = 92.3% (88.7%-96.4%))。相比之下,比较徒手与开放皮瓣技术中的 FTSG 的研究异质性较低(I2 (95%CI) = 21.3% (0.0%-67.8%)),有利于 FTSG 手术方法:结论:在部分无牙颌的牙弓中,FTSG系统的角度偏差小于徒手和部分引导手术导板。无瓣手术方法与角度偏差和深度变形减少有关,表明在这些手术中可能更倾向于使用 FTSG 方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.90
自引率
15.00%
发文量
171
审稿时长
6-12 weeks
期刊介绍: The Journal of Prosthodontics promotes the advanced study and practice of prosthodontics, implant, esthetic, and reconstructive dentistry. It is the official journal of the American College of Prosthodontists, the American Dental Association-recognized voice of the Specialty of Prosthodontics. The journal publishes evidence-based original scientific articles presenting information that is relevant and useful to prosthodontists. Additionally, it publishes reports of innovative techniques, new instructional methodologies, and instructive clinical reports with an interdisciplinary flair. The journal is particularly focused on promoting the study and use of cutting-edge technology and positioning prosthodontists as the early-adopters of new technology in the dental community.
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