Search Results (108)

Background/Objectives: Precise implant positioning is critical for successful prosthetic rehabilitation, particularly in completely edentulous patients where anatomical landmarks are lost. The aim of this study was to assess the accuracy of implant placement in the edentulous maxilla and mandible using computer-assisted planning and a bone-supported stackable surgical guide protocol. Methods: This retrospective clinical study included 15 completely edentulous patients who received a total of 60 implants. A dual-scan protocol was utilized for planning. The surgical protocol involved a base guide fixed to the bone with pins, serving as a rigid foundation for stackable components used for osteotomy and implant insertion. Postoperative CBCT scans were superimposed onto the preoperative plan to calculate angular deviations, 3D linear deviations at the implant neck and apex, and depth deviations. Results: The analysis demonstrated high accuracy with a mean angular deviation of 1.25° ± 0.80°. The mean 3D linear deviation was 0.96 ± 0.57 mm at the implant neck and 1.07 ± 0.56 mm at the apex. Depth deviation showed a mean discrepancy of 0.37 ± 0.58 mm. All measured parameters were statistically significantly lower (p < 0.05) than the pre-established clinical safety thresholds. Conclusions: Within the limitations of this study, the bone-supported stackable surgical guide protocol proved to be a highly accurate method for full-arch rehabilitation. By eliminating mucosal resilience and ensuring rigid fixation, this approach enables predictable implant placement and facilitates the passive fit of screw-retained bar-supported prostheses, representing a reliable alternative to dynamic navigation in daily clinical practice. Full article

Background/Objectives: Edentulism represents a major public health challenge, causing disorders of social, psychological and biological origin. Full-arch implant-supported restorations represent a viable alternative to mitigate this problem. This study aimed to evaluate immediate implant-supported restorations for the rehabilitation of the edentulous maxilla using four implants and distal implant tilting between 15 and 20 years. Methods: A total of 740 patients were included (women: 440; men: 300; average age: 55.3 years) rehabilitated with 740 prostheses, supported by 2960 dental implants. The primary outcome measure was prosthetic/implant cumulative survival and success (CSurR;CSucR). Secondary outcome measures included marginal bone loss (MBL), and the incidence of complications was evaluated as a secondary outcome measure. The outcomes were evaluated at 15 and 20 years. Results: In total, 287 patients (38.8%) with 1148 implants (38.8%) were lost to follow-up. A total of 170 implants (5.7%) in 101 patients (13.6%) failed, resulting in an implant CSurR and CSucR of 90.7% and 84.6%, respectively, after up to 20 years of follow-up. The prosthetic success rate was 98.1%. The average MBL was 1.07 mm ± 1.38 mm and 1.46 mm ± 1.56 mm at 15- and 20-years, respectively. Mechanical complication incidence was 78.5%, occurring in 581 patients (provisional prostheses: n = 448, 60.5%; definitive prostheses: n = 374, 50.5%). Biological complications occurred in 449 implants (15.2%) in 260 patients (35.1%). Biological complications and smoking habits were major risk indicators. Conclusions: Considering the study limitations, it can be concluded that the current rehabilitation concept is a viable treatment option in the long term, with mechanical and biological maintenance being necessary throughout the patients’ lives. Full article

Background and Clinical Significance: This case presents immediate implant placement combined with PRF (A-PRF+) and a photogrammetry-based workflow, illustrating predictable full-arch implant-supported rehabilitation. Case Presentation: Main clinical findings included compromised abutment teeth and patient dissatisfaction with aesthetics. Interventions included extractions, immediate implants, PRF socket management, and digital provisional and definitive restorations. Outcomes demonstrated stable occlusion, satisfactory aesthetics, and high patient satisfaction. Conclusions: Immediate placement with PRF and photogrammetry provides reliable outcomes in complex full-arch cases. Full article

Background/Objectives: Accurate full-arch implant impressions are essential for predictable digital prosthodontics, yet the performance of different intraoral scanners (IOSs) remains variable. This in vitro study compared the trueness and precision of three widely used IOSs-Sirona Primescan, 3Shape TRIOS Core, and Medit i700-in a standardized full-arch implant model. Methods: A maxillary model with six multi-unit implants was digitized using a high-accuracy laboratory scanner to obtain the reference dataset. Each IOS was used to perform ten scans, exported as unmodified STL files. Accuracy was evaluated in Geomagic Control X through a two-step alignment and a peri-implant region-of-interest deviation analysis. Trueness (mean absolute surface deviation, µm) and precision (SD) were compared using one-way ANOVA with Tukey’s test (α = 0.05). Results: Primescan and TRIOS Core showed comparable trueness (202.76 ± 13.89 µm and 204.21 ± 2.61 µm, respectively), while Medit i700 demonstrated significantly higher deviations (221.05 ± 6.28 µm) (p < 0.05). TRIOS Core exhibited the highest reproducibility across repeated scans. Conclusions: The three scanners demonstrated measurable accuracy differences under standardized conditions. Primescan and TRIOS Core performed similarly in trueness, with TRIOS Core achieving superior precision. Medit i700 showed higher deviation values but remained consistent in its performance. These findings highlight measurable differences in accuracy and reproducibility among intraoral scanners under standardized laboratory conditions and may assist clinicians in selecting appropriate devices for full-arch digital implant workflows; however, clinical validation is required to confirm their performance in vivo. Full article

Background/Objectives: Fully digital workflows used in implant dentistry have been evolving to improve rehabilitation times and patient satisfaction. More studies are necessary for full scientific validation. The aim of this study was to evaluate the 6-month outcome of implant-supported fixed prostheses for full edentulism rehabilitation using OnX Tough 2 resin (SprintRay) and the Pro 2 (SprintRay) 3D printer following the All-on-4 concept. Methods: This study included 16 patients (10 female, 6 male) with 20 implant-supported fixed full-arch prostheses following the All-on-4 concept (10 rehabilitations for each stackable guide and photogrammetry protocols). Primary The primary outcome measure was implant and prosthetic survival. The secondary outcome measures included manufacturing issues, prosthetic passive fit, marginal bone loss (MBL), mechanical and biological complications, modified plaque and bleeding indexes, pocket depths, patient subjective evaluation, and the Oral Health Impact Profile. Results: No patients were lost to follow-up. Two prostheses failed and 2 two implants were lost, resulting in a cumulative survival rate of 90% and 97.5% at 6 months for prostheses and implants, respectively. The mean MBL was 0.31 mm ± 0.52 mm at 4 months. The mechanical complications rate was 50% at patient level. One patient (6.3%) experienced one biological complication. The grades regarding “comfort of prostheses in the mouth” and “overall chewing feeling” were 9.35 ± 1.29 and 8.79 ± 1.67 out of 10, respectively. The mean total sum of the OHIP-14 was 1.61 out of 56. Conclusions: Implant-supported full-arch rehabilitations with fixed prostheses following the All-on-4 concept, through a fully digital workflow protocol, are a viable option in the short term. Full article

Background: Accurate digital transfer of implant positions is critical for the long-term success of full-arch prosthetic rehabilitation. Photogrammetry remains the benchmark for accuracy, but its high cost and complexity limit clinical adoption. Artificial intelligence (AI)-driven intraoral scanning protocols incorporating real-time library matching and irregular, individually coded scan bodies have been proposed as accessible alternatives to improve accuracy and reproducibility. Methods: This in vitro study evaluated the trueness and precision of a full-arch implant scanning workflow using an AI-assisted real-time library matching system in combination with irregular multi-geometry titanium scan bodies. A high-accuracy structured-light scanner served as the reference standard. Six implant positions (35, 33, 31, 41, 43, 45) were scanned across 20 datasets (n = 120). Mean surface deviations were calculated against the reference STL using CloudCompare v.2.14. and a two-way ANOVA (α = 0.05) in SPSS tested the effects of implant position and scan iteration. Results: The workflow achieved a mean deviation of 13.55 ± 9.70 μm (range 0.77–43.46 μm) across all positions. Anterior sites showed the lowest deviations (e.g., position 31: 3.95 μm; 45: 5.96 μm), while posterior sites exhibited higher deviations (e.g., position 43: 26.15 μm). No mean deviation exceeded 30 μm, and no individual measurement surpassed 45 μm. Implant position significantly affected accuracy (p < 0.001), whereas scan iteration did not (p > 0.05). Conclusions: Within the limitations of this in vitro model, an AI-assisted real-time library matching workflow used in conjunction with irregular multi-geometry scan bodies achieved accuracy levels well within clinically acceptable ranges for full-arch implant impressions. Although comparable to values reported for photogrammetry under laboratory conditions, clinical equivalence should not be assumed. Further in vivo validation is required to confirm performance under routine clinical conditions. Full article

Background: Stackable metallic or magnetic multi-template systems translate a prosthetically (facially) driven plan into each surgical phase of full-arch rehabilitation. Our objective was to map and critically describe the clinical applications, accuracy, and short-term outcomes of stackable/sequential guides and to illustrate the operational steps with a standardized magnet-retained case. Methods: Following a prospectively registered protocol (OSF, June 2025), we performed a scoping review in accordance with and PRISMA guidance. PubMed, Scopus and Embase were searched to 26 June 2025 for primary human studies using stackable or sequential static guides to place ≥4 implants per arch with immediate (≤72 h) loading. Duplicate-independent screening and data-charting captured guide design, planning platform, surgical accuracy, implant survival, prosthetic outcomes and patient-reported measures. A single non-analytic clinical vignette was included solely to illustrate the facially driven stackable workflow. Results: Eight studies (five countries, 2021–2025) encompassing 351 implants and one additional clinical case met the inclusion criteria. Mechanical indexing predominated (7/9 protocols); only two papers, including our case, used magnetic retention. Mean coronal and angular deviations, reported in two cohorts, were 0.95 mm/2.8° and 0.87 mm/2.67°, respectively—well within accepted thresholds for full-arch guided surgery. Immediate loading was achieved in 100% of arches; cumulative implant survival was 97.1% after 3–12 months. Patient-reported satisfaction exceeded 90 mm on VAS scales when measured. Our case demonstrated 0.90 mm/2.95° accuracy, 100% implant stability ≥ 35 N cm and uneventful provisionalisation at 12 weeks. Conclusions: Early clinical reports show clinically acceptable accuracy and high short-term survival with streamlined workflow. However, evidence remains heterogeneous and short-term; prospective multi-centre studies with standardized accuracy metrics, ≥3-year follow-up, validated PROMs, and cost-effectiveness analyses are still needed. Full article

Background: This retrospective comparative clinical study aimed to evaluate the performance of digital versus conventional impression techniques in the fabrication of implant-supported prosthetic restorations. Materials and Methods: A total of 40 cases were included: 20 impressions obtained with conventional elastomeric materials (polyvinyl siloxane and polyether), and 20 impressions acquired digitally using two intraoral scanners (TRIOS 3 and Medit i700). All patients received partial fixed implant restorations and were documented across all stages of prosthetic treatment. Accuracy and passive fit were assessed using radiographic measurements and the Sheffield test. Linear distances (mm) at the implant–abutment interface, chairside time (min), and VAS scores (1–10) were analyzed. Clinical efficiency was evaluated based on procedural steps, chairside time, and adjustment frequency. Patient satisfaction was assessed through a structured 10-item Visual Analog Scale (VAS) questionnaire. Results: Results showed a lower misfit rate in the digital group (15%) compared to the conventional group (25%), with no final-stage misfits in digital cases. Digital workflows demonstrated shorter impression times, fewer procedural steps, and reduced the need for prosthetic adjustments. Patient satisfaction scores were significantly higher in the digital group across all VAS parameters (p < 0.001), particularly in comfort and esthetic satisfaction. Conclusions: These findings support the use of digital impressions as a clinically efficient and patient-preferred alternative to conventional methods for partial implant restorations. However, conventional impressions remain a viable option in settings where digital technology is not available. Further studies with larger sample sizes and long-term follow-up are recommended to assess outcomes in full-arch rehabilitation. Full article

Finite element analysis is commonly used to evaluate implant biomechanics, yet limited data exist on arch form and trabecular-surfaced implants. This study aimed to investigate the biomechanical impact of a designed trabecular surface compared with a standard implant surface in full-arch, four-implant-supported restorations, using two mandibular arch forms and four placement configurations. Finite element analyses were conducted under a 250-N oblique load applied at 30° to the posterior segment. The prosthesis was modeled as a titanium–acrylic hybrid structure. Stress distribution was evaluated in cortical and cancellous bones, implants, and prosthetic frameworks. Implants with a trabecular surface demonstrated lower stress concentrations in both bone and implant structures. The von Mises stress at the neck of the posterior implant decreased from 383.3 MPa (standard implant, hyperbolic arch, configuration 1) to 194.9 MPa (trabecular-surfaced implant, U-shaped arch, configuration 4). Similarly, the average maximum principal tensile stress in cortical bone reduced from 44.32 to 40.99 MPa with the trabecular design. Among placement strategies, Configuration 3 (all implants tilted distally) yielded the highest bone stress, whereas Configurations 2 and 4 provided more favorable load distribution. Stress concentrations were also higher in hyperbolic arches, whereas U-shaped arches exhibited a more uniform distribution. These findings emphasized the biomechanical advantage of the designed trabecular surface in reducing stress across bone and implant components, indicating that trabecular titanium may represent a more reliable and cost-effective alternative for clinical applications, potentially enhancing long-term stability. Independently, the arch form and placement strategy also significantly influenced load distribution. Despite assumptions such as isotropic, homogeneous, and linearly elastic material properties, and the use of a single oblique loading condition, this study offers valuable biomechanical insights such as the stress-reducing effect of the trabecular surface, the influence of three-dimensional arch anatomy on stress concentration sites, and the necessity of selecting implant configurations according to arch forms, which may inform future full-arch implant rehabilitations. Full article

Digital technologies have significantly advanced implant dentistry, refining diagnosis, treatment planning, surgical precision, and prosthetic rehabilitation. This review explores recent developments, emphasizing accuracy, efficiency, and clinical impact. A literature analysis identifies key innovations, such as digital planning, guided surgery, dynamic navigation, digital impressions and CAD/CAM prosthetics. Digital workflows enhance implant placement by improving precision and reducing deviations compared to freehand techniques. Dynamic navigation provides real-time guidance, offering accuracy comparable to static guides and proving benefits in complex cases. Digital impressions demonstrate high precision, which can match or, in some scenarios, surpass conventional methods, though conventional impressions remain the gold standard for full-arch cases. CAD/CAM technology optimizes prosthetic fit, aesthetics, and material selection. Artificial intelligence and machine learning contribute to treatment planning and predictive analytics, yet challenges persist, including high costs, the need for specialized training, and long-term clinical validation. This review underscores the advantages of digital approaches—improved accuracy, better communication, and minimally invasive procedures—while addressing existing limitations. Emerging technologies, such as AI, augmented reality, and 3D printing, are expected to further transform implantology. Continued research is crucial to fully integrate digital advancements and enhance patient outcomes. Full article

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article

The integration of artificial intelligence (AI) and advanced digital workflows is revolutionising full-arch implant dentistry, particularly for geriatric patients with edentulous and atrophic arches, for whom achieving both prosthetic passivity and optimal aesthetic outcomes is critical. This narrative review evaluates current challenges in intraoral scanning accuracy—such as scan distortion, angular deviation, and cross-arch misalignment—and presents how innovations like the Medit SmartX AI-guided workflow and the Scan Ladder system can significantly enhance precision in implant position registration. These technologies mitigate stitching errors by using real-time scan body recognition and auxiliary geometric references, yielding mean RMS trueness values as low as 11–13 µm, comparable to dedicated photogrammetry systems. AI-driven prosthetic design further aligns implant-supported restorations with facial symmetry and smile aesthetics, prioritising predictable midline and occlusal plane control. Early clinical data indicate that such tools can reduce prosthetic misfits to under 20 µm and lower complication rates related to passive fit, while shortening scan times by up to 30% compared to conventional workflows. This is especially valuable for elderly individuals who may not tolerate multiple lengthy adjustments. Additionally, emerging AI applications in design automation, scan validation, and patient-specific workflow adaptation continue to evolve, supporting more efficient and personalised digital prosthodontics. In summary, AI-enhanced scanning and prosthetic workflows do not merely meet functional demands but also elevate aesthetic standards in complex full-arch rehabilitations. The synergy of AI and digital dentistry presents a transformative opportunity to consistently deliver superior precision, passivity, and facial harmony for edentulous implant patients. Full article

This in vitro study aims to compare the trueness of digital impressions obtained using two intraoral scanners (IOS) and one photogrammetry device for full-arch implant-supported rehabilitations. According to the Caramês Classification I, three models were produced with Straumann implants arranged in different spatial distributions: Option A with six implants and Options B and C with four implants each. The three models were scanned using a 12-megapixel scanner to create digital master casts. For each reference model, 30 digital impressions were acquired: 10 with the 3Shape Trios 3 intraoral scanner, 10 with the Medit i500 intraoral scanner, and 10 with the PIC Dental photogrammetry device. Trueness was assessed through best-fit superimpositions between the digital master casts and the corresponding virtual models. The Shapiro–Wilk test was applied to assess the normality of the data distribution, and Levene’s test was used to evaluate the homogeneity of variances. The non-parametric Kruskal–Wallis test was employed to compare group differences, with post hoc adjustments made using the Bonferroni correction. A significance threshold of p = 0.05 was adopted for all statistical tests. Statistically significant differences were observed in the root mean square values among the three devices. The Medit i500 demonstrated the highest trueness, with a median (interquartile range) deviation of 24.45 (18.18) µm, whereas the PIC Dental exhibited the lowest trueness, with a median deviation of 49.45 (9.17) µm. Among the implant distribution, the Option C showed the best trueness, with a median deviation of 19.00 (27.83). Considering the results of this in vitro study, intraoral scanners demonstrated comparable trueness, whereas the photogrammetry-based system exhibited lower trueness values. Additionally, a smaller number of implants and reduced inter-implant distances were associated with improved trueness in digital impressions for full-arch implant rehabilitation. Full article

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. Data were collected on demographics, medical status, type and location of prostheses, implant type, abutments, method of fixation, and complications. Statistical analysis included Fisher’s exact test, the Mann–Whitney U test, and chi-squared tests, with a significance level set at p < 0.05. Results: Mechanical complications occurred in 41.4% of patients (29 out of 70), with framework fractures reported in eight cases (27.6%), ceramic chipping in six cases (20.7%), and resin discoloration in four cases (13.8%). The prostheses were fabricated using monolithic zirconia, metal–ceramic crowns, zirconia on titanium bars, and hybrid resin/PMMA on cobalt–chromium frameworks. Gingival inflammation was also noted in 41.4% of cases (n = 29), predominantly in posterior implant regions. Younger patients and those without systemic diseases showed a significantly higher incidence of mechanical complications. Conclusions: Two years post-treatment, mechanical and biological complications appear to be independent phenomena, not significantly associated with most prosthetic variables. Patient-specific factors, particularly age and general health status, may have greater predictive value than prosthetic design. Limitations of the study include its retrospective design and the lack of radiographic data to assess peri-implant bone changes. Full article

Background. Digital dentistry continues to evolve, offering improved accuracy, efficiency, and patient experience across various prosthodontic procedures. Many previous reviews have focused on digital applications in prosthodontics. But the use of a fully digital workflow for full-arch implant-supported prostheses in edentulous patients remains an emerging and underexplored area in the literature. Objective. This article presents a comprehensive methodological review of the digital workflow in full-arch implant-supported rehabilitation. It follows a structured literature exploration and synthesizes relevant technological processes from patient assessment to prosthetic delivery. Methods. The relevant literature was retrieved from the PubMed database on 20 June 2024, to identify the most recent and relevant studies. A total of 22 articles met the eligibility criteria and were included in the review. The majority included case and technical reports. Results. The review illustrates the integration and application of digital tools in implant dentistry, including cone-beam computed tomography (CBCT) exposure, intraoral scanning, digital smile design, virtual patients, guided surgery, and digital scanning. The key findings demonstrate multiple advantages of a fully digital workflow, such as reduced treatment time and cost, increased patient satisfaction, and improved interdisciplinary communication. Conclusions. Despite these benefits, limitations persist due to the low level of evidence, technological challenges, and the lack of standardized protocols. Further randomized controlled trials and long-term clinical evaluations are essential to validate the effectiveness and feasibility of a fully digital workflow for full-arch implant-supported rehabilitation. Full article