Clinical factors influencing implant positioning by guided surgery using a nonmetal sleeve template in the partially edentulous ridge: Multiple regression analysis of a prospective cohort

Objective: To determine the positional accuracy of implants placed with a three-dimensionally printed template having nonmetal sleeves and to determine the contributing factors to observed deviations. Materials and Methods: One hundred and eighty-seven implants placed in 72 patients were analyzed. Presurgical intraoral scans and cone-beam computed tomography images obtained before and after surgery were superimposed, and vertical, angular, platform, and apex deviations were measured between the virtually planned and actually placed positions. A multiple linear regression model was designed for identifying the contributing factors. Statistical significance was set at p <.05, with Bonferroni correction if necessary (p <.0167). Results: A total of 187 implants demonstrated deviations of 0.65 [0.56, 0.75] mm (mean [95% confidence interval]) vertically, 3.59° [3.30°, 3.89°] angularly, 1.16 [1.04, 1.28] mm at platform, and 1.50 [1.36, 1.65] mm at apex. Implants placed in the mandible showed larger angular, platform, and apex deviations compared with those in the maxilla (p =.049, p =.014 and p =.003, respectively). Implants placed at the third or fourth nearest sites from the most-distal tooth had larger deviations than those placed at the first or second nearest sites, in vertical, platform, and apical aspects (p =.015, p =.011 and p =.018, respectively). This was only applicable to free-ending-supported templates (p <.0167), and anchor pin-supported free-ending templates (p <.0167). Conclusion: Using a three-dimensionally printed surgical template with a nonmetal sleeve in the partial edentulous ridge resulted in larger deviations in implants placed in the mandible or distal free-end third or fourth nearest site.