Search Results (15)

Background and Objectives: Static Computer-Assisted Implant Surgery (sCAIS) can be performed with different drill guiding systems. This study aimed to compare the accuracy of two guiding concepts of sCAIS in partially edentulous cases. Materials and Methods: Forty polyamide models of partially edentulous maxillae with seven implantation sites were fabricated. In total, 140 replica implants were placed with keyless (KL) and drill-key (DK) guiding systems using static, full-arch, tooth-supported surgical guides. Three-dimensional crestal and apical, angular and vertical deviations from the planned implant positions were compared using Mann–Whitney U and Kruskal–Wallis H tests. Intergroup homogeneity of variance homogeneity was examined using Levene’s test to assess the precision. Results: Overall median 3D crestal and apical deviations of implants placed in the KL group were significantly higher compared to the DK group (0.86 mm [0.63–0.98] vs. 0.72 mm [0.52–0.89], p = 0.006 and 1.26 [0.98–1.52] vs. 1.13 [0.70–1.45], p = 0.012). In the subgroup analysis, implants placed with a KL system showed higher 3D crestal (p = 0.029), 3D apical (p < 0.001) and angular (p < 0.001) deviations in the extended anterior area, higher 3D crestal (p < 0.001) deviations in the proximal posterior single-tooth gap and higher vertical (p < 0.001) deviations in the distal site of free-end situation. Contrarily, the KL group showed lower 3D crestal (p = 0.007), 3D apical (p < 0.001), angular (p < 0.001) and vertical (p = 0.003) deviations in the distal posterior single-tooth gap, lower 3D apical (p = 0.007) and angular (p = 0.007) deviations in the distal site of free-end situation and lower vertical (p = 0.019) deviations in the proximal site of free-end situation. Conclusions: The deviations of both guiding concepts did not exceed the recommended safety margins. Statistically significant differences in deviations were found between two guiding concepts. Guiding concepts with superior accuracy varied across different sites of implantation. Full article

Implant-supported immediate loading full-arch rehabilitation has been documented in the literature. More recently, computed surgical guides have frequently been used since they facilitate planning and performing surgical treatment without the need to raise a flap, thus reducing trauma and morbidity. This case report describes an immediate full-arch, fixed rehabilitation with full loading placed on four commercially available 3D-printed implants, with a 24-month follow-up. The implants were placed with the help of a digitally planned 3D-printed surgical guide. The provisional fixed prosthesis installed immediately was replaced after 3 months. At the time, the soft and hard tissue around the implants appeared stable, without signs of inflammation. The same situation was observed at the 24-month follow-up. Three-dimensional-printed implants seem to be a promising choice in this case. However, further clinical studies with longer follow-up periods are necessary to confirm their efficacy. Full article

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians. Full article

Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients’ postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch. Full article

This technical note aims to present a recently developed computer-guided protocol characterized by titanium-reinforced stackable surgical guides during post-extractive implant placement and subsequent immediate loading. A full maxillary edentulism was rehabilitated with one-piece implants, starting from a pre-existing removable denture. 3D digital scans of the removable denture and upper and lower arches were performed. On this basis, a prototype with ideal esthetic and functional outcomes was realized and replicated into a custom-made radiological stent with markers. The superimposition of STL and DICOM files allowed virtual planning of one-piece implants in the ideal prosthetically driven position. The stackable guides, composed of a fixed base template and additional removable components, were then realized. The fixed template, initially secured with anchor pins to the bone, was no longer removed. The removable components, which were screwed to the base template, were used to perform implant surgery and immediate prosthetic loading. No surgical complications occurred, the implants achieved a minimum insertion torque of 35 Ncm, and immediate prosthetic loading was performed. The base template allowed for the maintenance of a fixed reference during the entire workflow, improving the transition between the digital project, the surgical procedure, and the prosthetic rehabilitation. Full article

Objective: The purpose of this study was to assess the impact of photopolymer resin type, arch location, and post-processing techniques on the trueness and precision of three-dimensionally printed (3DP) full-arch surgical implant guides. Methods: Stereolithography reference images of an upper and lower surgical guide with six drill holes from a full-mouth rehabilitation clinical case were used. The files were imported into the Asiga MAX UV slicing software (Asiga Composer) where build orientation, print resolution, and support structures were added. A digital light processing 3D printer (MAX UV, Asiga Max) was used for printing the samples. The samples assessed were printed using two different, manufacturer-validated resins, DentaGuide (n = 35) and DentaClear (n = 20). The samples were subdivided and measured based on the post-processing technique used: handwashing (n = 20), sonication (n = 25), a mix of handwashing and sonication (n = 10), and post-curing using 385 nm UVA light with nitrogen (n = 50) or without nitrogen (n = 5). The diameter of each drill hole per guide was measured using a coordinate measuring machine (Absolute Arm 7-Axis, Hexagon) and compared with the reference STL to calculate each sample’s trueness (median error) and precision (interquartile range). The Mann–Whitney and Kruskal–Wallis tests were used for statistical analyses. Results: All samples demonstrated a dimensional error of <70 µm. No significant differences (p > 0.05) were observed between upper and lower arches and between post-processing techniques using nitrogen, irrespective of the use of hand- or ultrasonic washing. In contrast, DentaClear resin was significantly (p < 0.001) more accurate with a trueness of 26 µm and precision of 12 to 34 µm versus the DentaGuide at −31 µm and −54 to −17 µm, respectively. The samples post-cured without nitrogen were significantly (p < 0.05) the least accurate of all surgical guides, with a trueness of −42 µm and precision of −68 to −39 µm. Conclusion: The resin type and nitrogen post-processing are parameters that can significantly impact the accuracy of surgical guides. The tolerance of 3DP surgical guides needs to account for the dimensional changes occurring during the manufacturing process to minimise implant positioning errors. Full article

Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT^®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy. Full article

Robotic systems have emerged in dental implant surgery due to their accuracy. Autonomous robotic surgery may offer unprecedented advantages over conventional alternatives. This clinical protocol was used to show the feasibility of autonomous robotic surgery for immediately loaded implant-supported full-arch prostheses in the maxilla. This case report demonstrated the surgical protocol and outcomes in detail, highlighting the pros and cons of the autonomous robotic system. Within the limitations of this study, autonomous robotic surgery could be a feasible alternative to computer-assisted guided implant surgery. Full article

The present study aimed to evaluate the influence of manual expertise on static computer-aided implantology (s-CAI) in terms of accuracy and operative timings. After the cone-beam CT (CBCT) scanning of eleven mandibular models, a full-arch rehabilitation was planned, and two different skilled operators performed s-CAI. The distances between the virtual and actual implant positions were calculated considering the three spatial vectorial axes and the three-dimensional Euclidean value for the entry (E) and apical (A) points, along with the axis orientation differences (Ax). These values emerged from the overlapping of the pre-op CBCT to post-op CBCT data (method 1), from scanning the data from the laboratory scanner (method 2), and from the intra-oral scanner (method 3) and were correlated with the operators’ expertise and operative timings. The mean values for accuracy from the three methods were: E = 0.57 (0.8, 0.45, 0.47) mm, A = 0.6 (0.8, 0.48, 0.49) mm, and Ax 1.04 (1.05,1.03,1.05) ° for the expert operator; and E = 0.8 (0.9, 0.87, 0.77), A = 0.95 (1.02, 0.95, 0.89), and Ax =1.64 (1.78, 1.58, 1.58) for the novice. The mean value of the operative timings was statistically inferior for the expert operator (p < 0.05), with an improved accuracy over time for both operators. A significant difference (p < 0.05) emerged between method 1 and methods 2 and 3 for seven of the nine variables, without differences between the evaluations from the two scanners. The support from digital surgical guides does not eliminate the importance of manual expertise for the reliability and the shortening of the surgical procedure, and it requires a learning pathway over time. Full article

Nowadays, digital technologies have brought very important advancements in clinical prosthetic dentistry. However, a full digital workflow is still considered to be challenging in the management of full-arch implant cases with immediate prosthetic loading. The aim of this case report is to show a full-digital workflow for the fabrication of an implant-prosthetic fixed provisional prosthesis for immediate loading on seven implants in the upper maxilla. The static guided implant surgery and the OT Bridge prosthetic system were used to rehabilitate the patient. In this way, the combination of a well-known surgical technique with a peculiar prosthetic system that allows for a certain degree of tolerance resulted in it being useful for full-arch immediate loading. Future research and studies are necessary to prove the reliability of this full-digital protocol. Full article

Digital prosthetic workflows may significantly increase the efficiency and predictability of the immediate rehabilitation of implant-supported fixed complete dentures. Advanced digital prosthetic workflows require exact and detailed virtual planning models. The direct generation of these models via direct digital impressions remains technique sensitive and demanding. This report illustrates an advanced digital workflow for accurate and efficient immediate full-arch restoration, with an aesthetically and anatomically adapted natural tooth-like prosthesis. The workflow application to fully edentulous arches, and arches with residual failing dentition, is presented. A key characteristic was efficiently integrating and interlinking the prosthetic and surgical workflows via denture replica surgical guides as landmarks for scan registration. This approach allowed for accurate implant placement and efficient and detailed anatomy-based chairside prosthetic planning, and for the manufacturing of the provisional and final restorations under detailed consideration of implant restoration, and the patient’s macro-aesthetic and soft tissue anatomy. Full article

Background: Bone regeneration procedures represent a major challenge in oral surgery. This study aimed to evaluate a composite PRF/particulate xenograft in guided bone regeneration. Methods: Edentulous patients with horizontal ridge deficiencies in the anterior maxilla and candidates to an immediate-loading full-arch rehabilitation were included. Horizontal linear measurements indicating bone gain were assessed from computer beam computer tomography (CBCT) scans obtained at pre-surgery, post-surgery, and the 12-month follow-up. Mean bone values were presented as mean ± 95% CI. Non-parametric tests were used as appropriate, and the effect size was calculated with Cohen’s d repeated measures. Results: Eighteen patients were rehabilitated with 72 implants. The mean horizontal bone width was 4.47 [4.13–4.80] mm pre-surgically, 9.25 [8.76–9.75] mm post-surgically, and 7.71 [7.28–8.14] mm 12 months after. Conclusions: PRF associated with a xenograft seems to promote an effective horizontal bone gain. Randomized clinical trials are needed to confirm the benefits of this surgical approach. Full article

Proper maxillomandibular relationship registration can be clinically challenging during a digital workflow in full-arch rehabilitations. This dental technique requires the manufacturing and use of a hybrid surgical guide custom scanning device, indicated to be used during implant placement surgery, in addition to being used to simultaneously register the maxillomandibular relationship and transfer the implants’ 3D positioning, ensuring a fully digital workflow in full-arch implant-supported prosthesis rehabilitation. The sequence of steps presented here will allow dentists and dental technicians to conduct rehabilitations from denture to the final implant-supported prosthesis using a full-digital protocol, using a minimal quantity of intraoral devices and digital tools. Full article

The transfer of information such esthetics and occlusion from the preoperative to the postoperative digital impression could reduce the time needed to build an immediately loaded full-arch not-guided rehabilitation and improve the quality of the immediate interim restoration. Based on the digital technology advances of the last years, the purpose of the present clinical report is to describe a novel digital workflow based on computer-aided design and computer-aided manufacturing aimed at fabricating an interim fixed full-arch restoration. The protocol entails recording preoperative information such as esthetics, the occlusal plane and the intermaxillary relationship in implant-supported complete rehabilitations before the surgical insertion of the fixtures. Then, the information is transferred to the postoperative impression using a digital index in the lower jaw and the palatal rugae in the upper jaw. Within the inherent limitations of a case report, the workflow was accurate, predictable, without errors from conventional protocols and was apparently characterized by low biological costs. Full article

Background: This case series describes the surgical workflow during maxillary full-arch rehabilitations in two patients through the All-on-4 concept (standard and hybrid) assisted by DTX Studio Implant Software planning and X-Guide Navigation. Results: The X-Guide Navigation enabled the drills and implants to be positioned and oriented precisely, allowing the implants to be positioned favorably under the surgical and prosthetic points of view through the avoidance of damage to the maxillary sinus and nasal cavity. Dynamic navigation-assisted surgery provided advantages, including the possibility to modify the implants’ system, length, or location perioperatively. However, it must be underlined that to achieve proficiency with this technology it is necessary to consider a necessary learning curve. Conclusion: The insertion of dental implants assisted by dynamic navigation for maxillary full-arch rehabilitations was considered a safe and predictable procedure. Nevertheless, it can be improved (such as with a simpler fiducial markers protocol), aiming to simplify the procedure. Full article