Comparación in vitro de la desviación angular y lineal en implantes dentales colocados a mano alzada y mediante dos flujos de cirugía guiada

Abstract

Introduction: Accurate dental implant placement is essential to achieve predictable prosthetic, functional, and biological outcomes, as well as to reduce the risk of complications associated with improper implant positioning. Objective: To compare the angular, coronal linear, and apical linear deviations of dental implants placed using the freehand technique and two guided surgery workflows, taking the initial digital planning as the reference in an in vitro experimental model. Materials and Methods: An in vitro experimental study was conducted with 24 implant placements distributed into three groups: freehand placement (FHI), guided surgery using a non-specific workflow (GS-NS), and guided surgery using a dental-specific workflow (GS-DS), with eight implants per group. CBCT scans were used for three-dimensional segmentation, virtual planning, fabrication of 3D-printed models, design of restrictive surgical guides, and implant placement. Results: The freehand technique showed the highest mean deviations for all three variables evaluated. Coronal deviation was 1.738 ± 0.342 mm for FHI, 0.375 ± 0.225 mm for GS-NS, and 0.400 ± 0.193 mm for GS-DS. Apical deviation was 1.812 ± 0.344 mm, 0.575 ± 0.249 mm, and 0.537 ± 0.220 mm, respectively. Angular deviation was 8.691 ± 1.522° for FHI, 3.038 ± 0.501° for GS-NS, and 3.100 ± 0.441° for GS-DS. Conclusions: Guided surgery reduced both linear and angular deviations compared with freehand implant placement. However, under the experimental conditions evaluated, the dental-specific workflow did not demonstrate statistically significant superiority over the non-specific workflow.