Computer-guided implant placement associated with computer-aided bone regeneration in the treatment of atrophied partially edentulous alveolar ridges: A proof-of-concept study

Abstract

Background/purpose The existing literature lacks information regarding the use of digital workflows during pre-surgical planning of implant rehabilitations in resorbed edentulous ridges. Thus, the aim was to evaluate the effectiveness of computer-guided implant placement and simultaneous computer-aided guided bone regeneration (GBR) in the treatment of atrophic posterior alveolar ridges. Materials and methods Partially edentulous patients requiring GBR simultaneously to implant insertion were enrolled. Implant positions and the augmented missing bone were planned with specific software. A stereolithographic model of the grafted jaw was produced to transfer the virtual bone augmentation to the surgical field. A tooth-supported stent was used to guide implant insertion according to the virtual project. Visual analogue scales (VASs) were used to self-register postoperative pain, swelling, bleeding, and perception of the operation. Post-operative cone-beam computed tomography scan was superimposed to the virtual project to evaluate the accuracy of implant positions. Results Overall, 10 implants were placed in 5 patients. Healing proceeded uneventfully in all except one patient that showed a dehiscence of the lingual flap as early surgical complication. Nevertheless, complete filling of the bone defects was observed clinically and radiographically in all patients. Pain scored exceptionally high with respect to the other variables. Deviations of 0.73 ± 0.21 mm, 0.59 ± 0.28 mm, and 3.05° ± 1.22° were found at implant head, apex, and long-axis respectively. Distal implants showed higher angular deviations compared to mesial implants (p = 0.008). Conclusion Computer-guided approach provided encouraging results in terms of efficacy and accuracy. Conversely, patient-centered outcomes were below the expectations.

Accuracy of implant placement with a combined use of static and dynamic computer‐assisted implant surgery in single tooth space: A randomized controlled trial

“…Although the implant type could theoretically diversely affect the outcomes in terms of accuracy, available studies investigating the effect of different implant macro designs have shown no significant difference in all parameters of accuracy (Kaewsiri et al, 2019; Schnutenhaus et al, 2021). With regard to the implant site studies on single implants have not shown any significant influence of the implant site on accuracy (Abduo & Lau, 2020; Kaewsiri et al, 2019) or the presence of bone augmentation (Kaewsiri et al, 2019; Poli et al, 2021). Nevertheless, in the case of fully edentulous patients, some authors have reported differences in the accuracy between the upper and lower jaw as well as posterior and anterior sites (Vercruyssen et al, 2014).…”

Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study

“…Among the implants in this study, 60% of the drop-out implants failed to obtain primary stability within the bony housing along with the fabricated guide. Therefore, even though guided surgery has become very predictable with the flapless approach, it cannot be applied in some patients, especially in those who have poor bone quality where primary stability cannot be obtained or requiring bone grafting due to a narrow ridge [ 37 ].…”

“…In 2021, Poli et al reported five patients for computer-guided implant placements with computer-aided guided bone regeneration using tooth-supported surgical guides stabilized by the residual dentition. They exhibited accurate results on implant position deviation of 0.73 ± 0.21 mm and 3.05 ± 1.22° at the implant head and long-axis, respectively [ 37 ]. Since that research performed bone graft after securing the primary stability of implants, however, their results was reported in areas with sufficient bone quality even if the amount of bone is insufficient.…”

Bone Augmentation for Implant Placement: Recent Advances

“…Dental implants are used in the replacement of missing teeth or provide retention and support for prostheses [ 9 , 10 ]. In particular, prosthetically guided approaches to implant insertion, fully digital, are currently a possible and recommended alternative [ 11 , 12 ]. Composition and roughness play an important role in implant-tissue interaction and osseointegration [ 13 – 15 ].…”