Accuracy Assessment of 3D-Printed Surgical Guide with Custom-Made Sleeve versus Freehand Technique for Zygomatic Implant Placement: A Randomized Clinical Trial

Authors

  • Abdelfattah Moawad Abdelfattah
  • Bahaa El-Din Abd Raboo
  • Mohamed Abd Elakher Mohamed

Keywords:

APH, Maternal outcomes, Fetal outcomes

Abstract

Background: Zygomatic implants offer a graftless solution for severe maxillary atrophy. However, the accuracy of computer-guided versus freehand placement remains debated. This randomized clinical trial aimed to compare accuracy of these two techniques using CT-based deviation analysis.

Methods: Eight patients requiring zygomatic implants were randomized into two equal groups: computer-guided (n = 4) and freehand placement (n = 4), with a total of 16 implants. Radiographic accuracy was assessed by comparing planned and actual implant positions using postoperative CT superimposition. Deviations were quantified in linear (mediolateral and anteroposterior) and angular dimensions. Statistical analysis was conducted using independent t-tests and Mann-Whitney U tests (significance level α = 0.05).

Results: The guided group demonstrated significantly higher radiographic accuracy compared to the freehand group. Linear deviation in the mediolateral plane was 49.66 ± 1.87 mm versus 53.47 ± 1.70 mm (p < 0.001), and in the anteroposterior plane was 49.78 ± 14.61 mm versus 21.84 ± 4.54 mm (p < 0.001). Angular deviation was significantly reduced in the guided group (5.17° ± 2.31°) compared to the freehand group (11.80° ± 8.48°, p = 0.050).

Conclusion: Computer-guided placement of zygomatic implants significantly improves the accuracy over the freehand approach. These findings support the use of guided techniques in cases requiring precise maxillary rehabilitation, particularly in anatomically complex or severely atrophic maxillae.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Migliorança R, Irschlinger A, Peñarrocha-Diago M, Fabris R, Javier A-V, Zotarelli Filho IJDOCR. History of zygomatic implants: A systematic review and meta-analysis. 2019;5(2):1-9.

Esposito M, Felice P, Worthington HVJCDoSR. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. 2014(5).

Dominguez EA, Guerrero C, Shehata E, Van Sickels JEJDC. Zygoma implants or sinus lift for the atrophic maxilla with a dentate mandible: which is the better option? 2019;63(3):499-513.

Andre A, Dym HJAotO, America MSCoN. Zygomatic implants: a review of a treatment alternative for the severely atrophic maxilla. 2021;29(2):163-72.

Bedrossian EJDC. Rescue implant concept: the expanded use of the zygoma implant in the graftless solutions. 2011;55(4):745-77.

Rosenstein J, Dym HJDCoNA. Zygomatic Implants: A Solution for the Atrophic Maxilla. 2020;64(2):401-9.

Brånemark PI, Gröndahl K, Öhrnell LO, Nilsson P, Petruson B, Svensson B, et al. Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long‐term results. 2004;38(2):70-85.

Takamaru N, Nagai H, Ohe G, Tamatani T, Sumida K, Kitamura S, et al. Measurement of the zygomatic bone and pilot hole technique for safer insertion of zygomaticus implants. 2016;45(1):104-9.

Jorba-García A, Figueiredo R, González-Barnadas A, Camps-Font O, Valmaseda-Castellón EJMo, patologia oral y cirugia bucal. Accuracy and the role of experience in dynamic computer guided dental implant surgery: An in-vitro study. 2018;24(1):e76.

Van Steenberghe D, Malevez C, Van Cleynenbreugel J, Serhal CB, Dhoore E, Schutyser F, et al. Accuracy of drilling guides for transfer from three‐dimensional CT‐based planning to placement of zygoma implants in human cadavers. 2003;14(1):131-6.

Grecchi E, Stefanelli L, Grecchi F, Grivetto F, Franchina A, Pranno NJJoD. A novel guided zygomatic implant surgery system compared to free hand: A human cadaver study on accuracy. 2022;119:103942.

Aparicio CJEJOI. A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey. 2011;4(3):269-75.

Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. 2010;340.

Cawood J, Howell RJIjoo, surgery m. A classification of the edentulous jaws. 1988;17(4):232-6.

Vercruyssen M, Cox C, Naert I, Jacobs R, Teughels W, Quirynen MJCoir. Accuracy and patient‐centered outcome variables in guided implant surgery: a RCT comparing immediate with delayed loading. 2016;27(4):427-32.

Abouzeid OEM, Gaber RM, Maergy HA, Hany HE-D, Abdelmohsen KM, Elkassaby MA, et al. A modified protocol merging two published techniques for computer guided zygomatic implants surgery: a technical note. 2024;24(1):1273.

Chrcanovic BR, Oliveira DR, Custódio ALJJoOI. Accuracy evaluation of computed tomography–derived stereolithographic surgical guides in zygomatic implant placement in human cadavers. 2010;36(5):345-55.

Vrielinck L, Politis C, Schepers S, Pauwels M, Naert IJIjoo, surgery m. Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. 2003;32(1):7-14.

Fan S, Sáenz-Ravello G, Diaz L, Wu Y, Davó R, Wang F, et al. The accuracy of zygomatic implant placement assisted by dynamic computer-aided surgery: a systematic review and meta-analysis. 2023;12(16):5418.

Stella JP, Warner MRJIJoO, Implants M. Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note. 2000;15(6).

Block MS, Emery RWJJoO, Surgery M. Static or dynamic navigation for implant placement—choosing the method of guidance. 2016;74(2):269-77.

Downloads

Published

2025-06-19

How to Cite

1.
Moawad Abdelfattah A, Abd Raboo BE-D, Elakher Mohamed MA. Accuracy Assessment of 3D-Printed Surgical Guide with Custom-Made Sleeve versus Freehand Technique for Zygomatic Implant Placement: A Randomized Clinical Trial. J Neonatal Surg [Internet]. 2025Jun.19 [cited 2025Jul.19];14(32S):871-82. Available from: https://jneonatalsurg.com/index.php/jns/article/view/7479

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.