A novel guided zygomatic and pterygoid implant surgery system: a human cadaver study on accuracy

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean +/- SD): 1.69 degrees +/- 1.12 degrees and 4.15 degrees +/- 3.53 degrees for angular deviation. Linear distance deviations: 0.93 mm +/- 1.23 mm and 1.35 mm +/- 1.45 mm at platform depth, 1.35 mm +/- 0.78 mm and 1.81 mm +/- 1.47 mm at apical plane, 1.07 mm +/- 1.47 mm and 1.22 mm +/- 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.