A 4 mm-Long Implant Rehabilitation in the Posterior Maxilla with Dynamic Navigation Technology: A Case Report after a Three-Years Post-Loading Follow-Up

Abstract

The use of short (<8 mm long) and ultra-short (<6 mm long) implants allows the prosthetic rehabilitation of the posterior ridges of the jaws avoiding reconstructive procedures. Nevertheless, this approach requires vast experience to ensure the primary stability of the fixture in a correct position. Computer-aided implantology (CAI) achieves better results than the free-hand one in terms of placement accuracy, reducing the surgical risks and the operative timings. Dynamic navigation (DN) allows the surgeon to track the position and movements of the drill in real-time on the CT imaging data set. It is more versatile than the computed static system, enabling the operator to change the guidance coordinates according to the intra-operative feedbacks. A mono-edentulous upper right first molar site was rehabilitated with a four mm-long implant to avoid reconstructive techniques, drastically rejected by the patients. The case was managed within a DN protocol considering the minimal available bone and the prosthetic demands. The phases of this procedure were strictly documented up to a 3-year follow-up. No intra-operative problems occurred, and adequate primary stability of the implant was obtained. The prosthetic loading was carried out within only six weeks without any complications. No variation of the baseline clinical scenario as evidenced clinically and radiographically at the end of follow-up. No similar cases are reported in the literature.

Navigation in oral surgery: a systematic review

“…Dental elements are more and more used as anatomical fiducial markers, called dental surface calibration. Surface calibration (dental and bone), also called "trace registration" [32] are technologies about to save operative time, by avoiding to use thermoplastic brackets and to perform a 2 nd imaging for a point calibration using radiological markers [8].…”

“…This review showed that the use of navigation in implantology is prominent, representing 19 articles (55%). A total of 631 implants were placed; short implant [8], pterygoid implant [9] and zygomatic implants [10][11][12][13][14]. The indications were varied; rehabilitation of the edentulous jaw using immediate implant loading with fixed prothesis, extraction-implantation, single implant in aesthetic zone [10,11,[15][16][17], single implant with immediate loading in aesthetic zone [18] or the placement of standard minimally invasive implants (flapless) [19].…”