Research Article| Volume 58, ISSUE 9, e62-e66, November 2020

Precision of 30 guided implants in complex tumour situations


      Implant born prosthetic rehabilitation of tumour patients can be difficult to perform. Challenges in treating such patients include disrupted anatomy with limited mouth opening due to previous ablative surgery as well as free-flaps or simple bone grafts, adjuvant therapy such as radiotherapy and, in general, poorer general health. Combining classical knowledge of ideal prosthesis placement and current virtual planning possibilities the positioning and in consequence the survival of dental implants can be optimised. Since prosthetic rehabilitation has a positive effect on the patients’ quality of life and general health, we propose performing such surgeries as early as possible. All patients at our institution receiving pre-planned guided implant reconstruction and postoperative evaluation with Cone Beam Computed Tomography (CBCT) between 2015 and 2018 were evaluated for inclusion. Eight patients with a total of 30 implants met the inclusion criteria. The planned implant position was compared to the outcome position by fusing the two and deviations in entry-point position, apex-position, angular deviation and depth error were recorded. The mean (SD) discrepancy at entry-point was 2.28 (1.45) mm and 2.89 (1.53) mm at the apex, respectively. Mean (SD) angulation discrepancy was 9.5˚ (4.13˚) and the mean (SD) depth deviation was 1.52 (0.86) mm. Our results demonstrate the feasibility of pre-planned implant placement in challenging clinical situations and that only few concessions have to be made for precision.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Block M.S.
        • Emery R.W.
        • Cullum D.R.
        • et al.
        Implant placement is more accurate using dynamic navigation.
        J Oral Maxillofac Surg. 2017; 75: 1377-1386
        • Bover-Ramos F.
        • Viña-Almunia J.
        • Cervera-Ballester J.
        • et al.
        Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical, and in vitro studies.
        Int J Oral Maxillofac Implant. 2018; 33: 101-115
        • Neugebauer J.
        • Stachulla G.
        • Ritter L.
        • et al.
        Computer-aided manufacturing technologies for guided implant placement.
        Expert Rev Med Devices. 2010; 7: 113-129
        • Nickenig H.J.J.
        • Eitner S.
        • Rothamel D.
        • et al.
        Possibilities and limitations of implant placement by virtual planning data and surgical guide templates.
        Int J Comput Dent. 2012; 15 (paper in German): 9-21
        • Pozzi A.
        • Tallarico M.
        • Marchetti M.
        • et al.
        Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial.
        Eur J Oral Implantol. 2014; 7: 229-242
        • Vermeulen J.
        The accuracy of implant placement by experienced surgeons: guided vs freehand approach in a simulated plastic model.
        Int J Oral Maxillofac Implant. 2017; 32: 617-624
        • Laederach V.
        • Mukaddam K.
        • Payer M.
        • et al.
        Deviations of different systems for guided implant surgery.
        Clin Oral Implants Res. 2017; 28: 1147-1151
        • Salinas T.J.
        • Desa V.P.
        • Katsnelson A.
        • et al.
        Clinical evaluation of implants in radiated fibula flaps.
        J Oral Maxillofac Surg. 2010; 68: 524-529
        • Colella G.
        • Cannavale R.
        • Pentenero M.
        • et al.
        Oral implants in radiated patients: a systematic review.
        Int J Oral Maxillofac Implants. 2007; 22: 616-622
        • Gander T.
        • Studer S.
        • Studer G.
        • et al.
        Medium-term outcome of Astra Tech implants in head and neck oncology patients.
        Int J Oral Maxillofac Surg. 2014; 43: 1381-1385
        • Valente F.
        • Schiroli G.
        • Sbrenna A.
        Accuracy of computer-aided oral implant surgery: a clinical and radiographic study.
        Int J Oral Maxillofac Implants. 2009; 24: 234-242
        • Bredell M.
        • Rordorf T.
        • Kroiss S.
        • et al.
        Denosumab as a treatment alternative for central giant cell granuloma: a long-term retrospective cohort study.
        J Oral Maxillofac Surg. 2018; 76: 775-784
        • Lanzer M.
        • Gander T.
        • Grätz K.
        • et al.
        Scapular free vascularised bone flaps for mandibular reconstruction: are dental implants possible?.
        J Oral Maxillofac Res. 2015; 6: e4
        • Zumstein T.
        • Billström C.
        • Sennerby L.
        A 4- to 5-year retrospective clinical and radiographic study of Neoss implants placed with or without GBR procedures.
        Clin Implant Dent Relat Res. 2012; 14: 480-490