The deviation between the planned and actual positions of immediate implants placed in the anterior maxilla using the virtual safe angle concept and a novel computer-guided drilling protocol: A prospective clinical trial.

Abstract

Anatomical complexities and socket configuration in anterior maxilla often results in challenging immediate implant placement, where implants tend to be facially positioned. Implants with facially placed shoulders exhibited three times more midfacial recession. Despite using surgical guides, osteotomy drills tend to follow the least resistance path dictated by socket anatomy. This prospective clinical trial aimed to measure the deviation from the planned implant position during immediate implant placement in the anterior maxilla and its impact on esthetic outcomes, utilizing a new computer-guided plateau drilling protocol. Twenty-six patients (7 males and 19 females, ages 20-42) with non-restorable maxillary anterior teeth participated in this study. Virtual planning was done using the Safe Angle Concept and the implants were placed with a partially guided approach. Standard tessellation language files obtained from scanned casts and initial computed tomography scans were used to plan the virtual position of the implants and surgical guides fabrication. Angular, global platform and global apex deviations from the planned implant position were measured after three-months. Bone formed labial to the implant and pink esthetic score were assessed after nine-months. The current investigation showed that the use of the new computer-guided plateau drilling protocol resulted in clinically acceptable ranges of angular, global platform, and global apex deviation 4.56 ± 3.14°, 0.91 ± 0.61 mm, 1.47 ± 0.88 mm respectively. Radiographic analysis revealed mean mm amount of bone formed labial to the implant of 2.13 ± 0.99 mm and pink esthetic score displayed a mean of 11.89 ± 1.75, with a median of 12.5 after nine months. The virtual safe angle planning concept combined with plateau drilling protocol showed promising accuracy in immediate implant placement in the anterior maxilla. The resultant deviation had no influence on the esthetic outcomes. The current trial was registered at Clinical trials.gov (ID: NCT05750004, Date: 19-February-2023).