Dynamic navigation guided surgery and prosthetics for immediate loading of complete‐arch restoration

Abstract

Objective To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete‐arch prosthesis. Materials and Methods This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48–75) requiring at least one complete‐arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes). Results Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete‐arch FDPs immediately loaded (mean follow‐up 16.2 ± 1.7 months, 14–18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65–78). The mean MBL was −0.53 ± 0.28 mm (−0.22 to −1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively. Conclusion Within the limitations of this proof‐of‐concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete‐arch FDP was facilitated, resulting in high implant and prosthetic success rates. Clinical Significance The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete‐arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health.

Can computer‐assisted implant surgery improve clinical outcomes and reduce the frequency and intensity of complications in implant dentistry? A critical review

“…Schnutenhaus et al 21 compared mean ISQ values between implants placed with s‐CAIS and alveolar ridge preservation (63 ± 8.75) and nonaugmented sites (64.12 ± 7.88). Other prospective and retrospective studies with s‐CAIS have only reported that all implants displayed values above the clinically acceptable thresholds of ITV 25 Ncm, RT 20 Ncm, or ISQ of 55 13,14,22–25 . With regards to d‐CAIS, Pozzi et al, 24 in a case series with 10 fully edentulous patients/60 implants, reported a mean ISQ of 71 ± 2.8.…”

Accuracy of Computer-Assisted Flapless Implant Placement by Means of Mucosa-Supported Templates in Complete-Arch Restorations: A Systematic Review

“…The surgical templates were realized in order to fully guide the implant placement through metal sleeves that rigidly guide the dedicated drills. The clinicians were not allowed to change the pathway of the drills unless a freehand implant positioning was performed [7]. It is crucial to stabilize the surgical templates before the start of the bone drilling [8].…”

“…positioning was performed [7]. It is crucial to stabilize the surgical templates before the start of the bone drilling [8].…”

Navigation guided socket‐shield technique for implant and pontic sites in the esthetic zone: A proof‐of‐concept 1‐year prospective study with immediate implant placement and loading

“…The pontic‐NSS technique was executed following the same surgical protocol, carving, and tinning the root‐shield as described above. The fresh alveolar sockets at the pontic sites were filled with a xenogeneic adsorbable bone substitute material (Bio‐Oss or Bio‐Oss Collagen, Geistlich Pharma), leaving at least 2.5 mm of space to the gingival margin to allocate the collagen matrix (Fibrogide, Geistlich Pharma) 45–48 . A horizontal mattress suture was used to keep in position the xenogeneic collagen matrix at the pontic site without compressing the gingival margins, just underneath the prosthetic contour to enhance the soft tissue regeneration, avoiding bone exposure.…”