by Clara Alcaraz Denia (Spain), Laura Requena Hidalgo, Jordi Caballé-Serrano, Raquel Guijarro-Martínez, Federico Hernández-Alfaro

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Objectives: In the last four decades, dental implants have become an essential part of oral rehabilitation. Successful implant placement depends directly on highly accurate treatment planning and surgical procedures. It is important to review the accuracy data for surgical and prosthodontical techniques such as guided surgery. Methods: A retrospective review was conducted for cases using an image-guidance system for the accurate placement of implants. An electronic literature search of PubMed database was conducted, combining controlled terms and keywords whenever possible. The search terms were “computer-guided design”, “image-guided surgery”, “computer-assisted manufacture”, “computed tomography” “dental implants” and “surgical guide”. Articles from January 2005 to September 2015 were screened. They were included in a qualitative assessment if they were recent papers and had references to articles related to the terms defined above. Results: Software guides may be useful for decreasing the incidence of implant-associated difficulties, as well as achieving greater precision in placement of implants, leading to better preservation of anatomic structures (especially for full-mouth rehabilitation). The most common difficulties encountered during placement are improper location, wrong angulation, and lack of primary stability. These techniques provide sufficient information about the bone anatomy to avoid these issues and the treatment plan reduces operating time and surgical trauma and increases implant success. However, these techniques require knowledge of and experience in the use of 3-D information for virtual planning and implant positioning, and there is a lack of visibility and tactile control during the procedure, thus vital anatomical structures can be damaged. The available literature on computer-aided surgical guidance has only limited data and relatively short observation periods, therefore further research should focus on clinical studies with long-term follow-up. Conclusion: Surgical implant complications are not uncommon and should be addressed immediately. Causality may be iatrogenic due to poor treatment techniques, and a successful final treatment can be possible by the use of computer-aided surgical guidance. Competent surgeons yield acceptable to excellent results and surgery is predictable using these techniques, but care should be taken when using them.
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