OBJECTIVE: To investigate the prevalence of incidental findings and need for further dental treatment and analyse the influence of size of field-of-view (FOV) and age in cone beam computed tomography (CBCT) for pre-implant planning.
METHODS: 404 CBCT scans were examined retrospectively for incidental findings and need for further dental treatment. Incidental finding-frequencies and need for further treatment were assessed for different age (< 40 years, 40-60 years, > 60 years) and FOV groups (small, medium, large). Intraexaminer and interexaminer agreements were evaluated.
RESULTS: In 82% of the scans at least one incidental finding was found, with a total of 766 overall. More incidental findings were found in scans with large FOV (98% vs. 72%, OR = 22.39 large vs. small FOV, p < 0.0001) and in scans of patients > 60 years (OR = 5.37 patient\'s age > 60 years vs. < 40 years, p = 0.0003). Further dental treatment due to incidental findings was needed in 31%. Scans with large FOV were more likely to entail further treatment (OR = 3.55 large vs. small FOV, p < 0.0001). Partial edentulism and large FOV were identified as risk factors for further treatment (p = 0.0003 and p < 0.0001). Further referral of the patient based on incidental findings was judged as indicated in 5%. Intra- and inter-examiner agreements were excellent (kappa = 0.944/0.805).
CONCLUSIONS: A considerable number of incidental findings with need for further dental treatment was found in partially edentulous patients and in patients > 60 years. In pre-implant planning of elderly patients, the selection of large FOV CBCT scans, including dentoalveolar regions not X-rayed recently, help to detect therapeutically relevant incidental findings.

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants\' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided.

OBJECTIVE: The purpose of this study was to assess the accuracy of computer-assisted implant insertion based on computed tomography and template-guided implant placement.
METHODS: A total of 246 implants were placed with the aid of 3D-based transfer templates in 181 consecutive partially edentulous patients. Five groups were formed on the basis of different implant systems, surgical protocols and guide sleeves. After virtual implant planning with the CoDiagnostiX Software, surgical guides were fabricated in a dental laboratory. After implant insertion, the actual implant position was registered intraoperatively and transferred to a model cast. Deviations between the preoperative plan and postoperative implant position were measured in a follow-up computed tomography of the patient\'s model casts and image fusion with the preoperative computed tomography.
RESULTS: The median deviation between preoperative plan and postoperative implant position was 1.0 mm at the implant shoulder and 1.4 mm at the implant apex. The median angular deviation was 3.6º. There were significantly smaller angular deviations (P=0.000) and significantly lower deviations at the apex (P=0.008) in implants placed for a single-tooth restoration than in those placed at a free-end dental arch. The location of the implant, whether in the upper or lower jaw, did not significantly affect deviations. Increasing implant length had a significant negative influence on deviations from the planned implant position. There was only one significant difference between two out of the five implant systems used.
CONCLUSIONS: The data of this clinical study demonstrate the accuracy and predictable implant placement when using laboratory-fabricated surgical guides based on computed tomography.
Zielsetzung: Ziel der vorliegenden klinischen Untersuchung war die Evaluation der klinischen Genauigkeit schablonengestützter Implantationen mit laborgefertigten Bohrschablonen auf Basis dreidimensionaler Bildgebung. Material und Methoden: Es wurden insgesamt 246 Implantate mit laborgefertigten Bohrschablonen auf Basis einer dreidimensionaler Bildgebung in 181 teilbezahnten Patienten inseriert. Die inserierten Implantate wurden in Abhängigkeit vom verwendeten Implantatsystem, dem chirurgischen Protokoll und den verwendeten Hülsen in fünf unterschiedliche Gruppen eingeteilt. Nach dreidimensionaler Implantatplanung mit der Software CoDiagnostiX wurden im zahntechnischen Labor Bohrschablonen hergestellt. Nach Implantatinsertion wurde die aktuelle Implantatposition intraoperativ registriert und auf ein Gipsmodell des Patienten übertagen. Durch die Bildfusion der präoperativen Implantatplanung mit der dreidimensionalen Bildgebung des Gipsmodells konnten die Abweichungen zwischen geplanter und erzielter Implantatposition berechnet werden.Ergebnisse: Der Median der Abweichungen zwischen geplanter und erreichter Implantatposition war 1 mm an der Implantatbasis und 1,4 mm an der Implantatspitze. Der Median der Achsenabweichung lag bei 3,6º. Implantate, welche in einer Schaltlücke gesetzt worden waren, zeigten statistisch signifikant kleinere Achsenabweichungen (P=0.000) und geringere Abweichungen an der Implantatspitze (P=0.008) im Vergleich zu Implantaten, welche in einer Freiendsituation inseriert wurden. Es zeigte sich keine Abhängigkeit der Genauigkeit von einer Implantation im Oberkiefer oder Unterkiefer. Die zunehmende Implantatlänge wirkte sich negativ auf die Genauigkeit der erreichten Implantatposition auf. In Abhängigkeit vom Implantatsystem ergab sich ein statistisch signifikanter Unterschied ausschließlich zwischen zwei Systemen. Schlussfolgerung: Die vorliegende klinische Untersuchung konnte die hohe Präzision und Verlässlichkeit einer schablonengeführten Implantatinsertion nach computerassistierter Planung belegen.