Alveolar bone remodeling in virtually planned, bone-grafted vs non-grafted guided flapless implant surgery in the anterior maxilla: a cross-sectional retrospective follow-up study

Abstract

Purpose In patients who underwent virtual planning and guided flapless implant surgery for teeth missing in the anterior maxilla, we compared buccal bone loss between those treated with and without autogenous bone augmentation. Methods Of 22 patients with teeth missing because of trauma or aplasia, 10 (18 implant sites) were reconstructed with buccally placed bone graft harvested from the mandibular ramus, and 12 were non-reconstructed (16 sites). Baseline cone-beam computed tomography allowed for implant planning using the NobelClinician® software and was performed again at 1 year after functional loading. The marginal bone level was assessed radiographically at post-implant baseline and at follow-up. Results At follow-up, buccal bone loss differed significantly between groups at the central level of the implant (p = 0.0005) but not at the coronal level (p = 0.329). The mean marginal bone level change was 0.6 mm, with no significant between-group difference (p = 0.876). The actual implant position often deviated in the vertical or sagittal plane by an average of 0.3–0.6 mm from the planned position. Conclusion Compared with non-reconstructed patients, reconstructed patients experienced significantly more buccal bone loss at the central level of implants. The groups did not differ at the coronal level or in marginal bone loss, possibly because of the more augmented bone at the central level among reconstructed patients. Differences between planned versus actual implant positions should be considered in situations of limited bone volume at the planned implant site.

Preprosthetic Surgery—Narrative Review and Current Debate

“…D'haese et al [51] and Laederach et al [52] discussed the importance of accuracy in critical anatomical situations and concluded that knowledge of implant deviation from the planned implant placement is important when using guided surgery. Åkesson et al [53] analyzed virtually planned and flapless placed implants and concluded that the actual position of the implant placement compared to the virtually planned position often differed in the sagittal or vertical dimension, which should be considered when the available alveolar bone for the implant is severely limited, e.g., in the anterior maxilla. Figure 2A-F describes a case where the aesthetic zone is repaired with titanium implants (Nobel Active NP, 11.5 mm) and Zirconia crowns using the virtual planning technique.…”