Internally Irrigated and Externally Irrigated Surgical Guide Design for Placement of Dental Endosseous Implants

Hams Hamed Abdelrahman14 enrolled

Overview

Background: Patient specific surgical guides (PSG) have been widely used to achieve a precise 3D implant position. However, they prevent external cooling systems from reaching the osteotomy site sufficiently. So, heat generated during guided implant surgery is greater than free hand technique. Adding internal irrigation channel to the conventional surgical guides allows better diffusion of irrigation to the osteotomy site and reduces heat generation. Aim of the study: Is to introduce a patient specific surgical guide design with internal irrigation system and compare it to the conventional surgical guide with external irrigation clinically through bone temperature, implant stability and radiographically by CBCT through crestal bone loss and bone density.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Dental Implant

Interventions

* Virtual surgical plan will be completed in the implant planning software (BlueSky plan, BlueSky Bio, USA), and the implant type, position, and sleeve height will be adjusted. * The entry point of the surgical drill into the alveolar bone will be identified. * An irrigation channel will be added, directed toward the entry point of the drill and adjusted to have the same diameter as the irrigation system tube.

Conventional implant surgical guide with external irrigationOTHER

Virtual surgical plan will be completed in the implant planning software (BlueSky plan, BlueSky Bio, USA), and the implant type, position, and sleeve height will be adjusted. Conventional guide will be printed

Eligibility

Sex: ALLMin age: 20 YearsMax age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient with missing mandibular posterior premolar or molar teeth. * Tooth extraction at the implant sites was performed at least 4 months before the surgery. * Residual alveolar bone height more than 10 mm. * With minimum alveolar bucco-lingual dimension of 6 mm. * Free from any systemic disease or local pathological lesions that may affect bone healing or contraindicate implant placement. Exclusion Criteria: * Severe atrophic alveolar ridge (height less than 10mm, width less than 6mm). * Bad oral hygiene ( Silness-Löe index (score 2-3). * Heavy smoker (smoke greater than or equal 25 cigarettes per day). * Presence of acute infections or periapical lesions in adjacent teeth. * Parafunctional habits. * Pregnant females.

Outcomes

Primary Outcomes

change in implant stability

Osstell will be used to objectively and non-invasively determine implant stability and to assess the progress of osseointegration without jeopardizing the healing process. This method is based on determining whether or not an implant is stable enough. The result is presented as an ISQ value of 1-100. The higher the ISQ, the more stable the implant

Time frame: Baseline and 4 months

change in postoperative oedema

This will be measured as follows: None (no inflammation). Mild (intraoral swelling confined to the surgical field). Moderate (extraoral swelling in the surgical zone). Severe (extraoral swelling spreading beyond the surgical zone).

Time frame: 2nd day, 1 week and 2 weeks

Secondary Outcomes

Presence of intra or postoperative complications

Bone overheating. Bone fenestration. Wound dehiscence. Peri-implantitis.

Time frame: 4 months

change in crestal bone loss

A CBCT was obtained immediately post operatively T1 and after 4 months T2 and evaluated using (BlueSky plan, BlueSky Bio, USA) to asses Crestal bone loss.

Time frame: baseline and 4 months

change in bone density

A CBCT was obtained immediately post operatively T1 and after 4 months T2 and evaluated using (BlueSky plan, BlueSky Bio, USA) to asses Bone density using Hounsfield Unit (HU).