Accuracy and Complications Using Computer-Designed Stereolithographic Surgical Guides for Oral Rehabilitation by Means of Dental Implants: A Review of the Literature

Background: In the last decade several stereolithographic guided surgery systems were introduced to the market. In this context, scientific information regarding accuracy of implant placement and surgical and prosthodontical complications is highly relevant as it provides evidence to implement this surgical technique in a clinical setting. Purpose: To review data on accuracy and surgical and prosthodontical complications using stereolithographical surgical guides for implant rehabilitation. Material and Methods: PubMed database was searched using the following keywords: three dimensional imaging,image based surgery,flapless guided surgery,customized drill guides,computer assisted surgery,surgical template, and stereolithography. Only papers in English were selected. Additional references found through reading of selected papers completed the list. Results: In total 31 papers were selected. Ten reported deviations between the preoperative implant planning and the postoperative implant locations. One in vitro study reported a mean apical deviation of 1.0 mm, three ex vivo studies a mean apical deviation ranging between 0.6 and 1.2 mm. In six in vivo studies an apical deviation between 0.95 and 4.5 mm was found. Six papers reported on complications mounting to 42% of the cases when stereolithographic guided surgery was combined with immediate loading. Conclusion: Substantial deviations in three-dimensional directions are found between virtual planning and actually obtained implant position. This finding and additionally reported postsurgical complications leads to the conclusion that care should be taken whenever applying this technique on a routine basis.