ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Fabrication of Surgical Guides for Miniscrew Implant Placement in Orthodontics is more Accurate using Cone-beam CT
Clinical Question Can the use of surgical guides, fabricated through the use of CBCT, be helpful in preventing root contact when placing miniscrew implants?
Clinical Bottom Line Miniscrew implants when used in the alveolar process must be precisely placed between the roots to avoid complications such as damage to the roots of neighboring teeth. Cone Beam CT imaging is an accurate method to facilitate the production of surgical guides to prevent this problem.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20413451Miyazawa/2010Forty-four self-drilling miniscrew implants (diameter 1.6, and length 8 mm) were placed in 18 patients mean age 23.8 years.Case Series
Key resultsCone-beam CT 3D reconstructions were used in the fabrication of surgical guides for the self-drilling miniscrew implants. Resin splints were fabricated on dental casts and a stainless steel guide tubes were used to place the miniscrew implants at the best site and the correct angle, with 52.3% (23/44) of the guide tubes requiring a change in location or angle based on CBCT evaluation. Orthodontic loading of the implants was for a mean of 20.4 months. No root contact was observed in either the upper or lower arch.
Evidence Search "Orthodontics"[Mesh] AND "Cone-Beam Computed Tomography"[Mesh] AND Clinical Trial[ptyp] ...view in PubMed
Comments on
The Evidence
The level of evidence is only a case series, a controlled clinical trail directly comparing miniscrew implant root contact when placed with or with out a surgical guide would be useful. Previous research found screw/tooth contact as high as 27.1% making monitoring of minisrew placement a necessity. This evidence suggests that the use of surgical guides and CBCT can aid in reliably in placing miniscrew implants at the correct angle and in the correct location.
Applicability In this study, over half (52.3%) of the guide tubes made on the casts needed repositioning. This approach may be particularly useful for orthodontists, oral surgeons and pediatric dentists not highly experienced in implant techniques.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords miniscrew implants, orthodontic anchorage, cone-beam CT, CBCT, surgical guide
ID# 2144
Date of submission: 10/07/2011spacer
E-mail terryg@uthscsa.edu
Author Glenn Terry
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Stephen Matteson, DDS
Faculty mentor/Co-author e-mail MATTESON@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Katherine Hoffman (San Antonio, Texas) on 11/28/2017
In a case series by Morea 2011 (PMID #21841996), retrieved in November 2017, mini-screws were made based on cone-beam computed tomography (CBCT) data. The accuracy was evaluated post intervention and supports this CAT bottom line. Researchers concluded that the surgical guides constructed, based on the CBCT data, aided clinicians for accurate mini-screw insertion without damaging nearby anatomic structures.
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