Immediate Loading of Implants Placed by Guided Surgery in Geriatric Edentulous Mandible Patients

Abstract

The aim of this study was to show the clinical outcomes of the immediate loading of implants inserted by guided surgery in edentulous mandible patients. Edentulous mandible patients were diagnosed with oral examination, cone beam computerized tomography and diagnostic casts for intermaxillary relations and treated with 8–10 implants for rehabilitation with guided surgery and immediate loading. After flapless surgery, implants were loaded with an immediate acrylic temporary prosthesis. After a period of six months, a ceramic definitive full-arch prosthesis was placed. A total of 22 patients (12 females and 10 males) were treated with 198 implants. Eleven patients (50%) had a previous history of periodontitis. Six patients (27.3%) were smokers. The follow-up was 84.2 ± 4.9 months. Clinical outcomes showed a global success rate of 97.5% of implants. Five implants were lost during the healing phase with provisional prosthesis. Twenty-two fixed full-arch rehabilitations were placed in the patients over the 193 remaining implants. Mean marginal bone loss was 1.44 mm ± 0.45 mm. Six patients (27.3%) showed some kind of mechanical prosthodontic complication. Eighteen (9.3%) of the 193 remaining implants were associated with peri-implantitis. The antecedents of peri-implantitis are critical elements for the survival of the implants. The loss of implants was significant in patients who smoked up to 10 cigarettes, compared to non-smokers. Peri-implantitis is one of the key elements in the long-term follow-up of implants and it was more manifest in smoking patients, and in those with a history of peri-implantitis. Marginal bone loss was more significant in smokers. Full-arch rehabilitation is presented as a predictable alternative with minor fatigue problems that are easily solvable.

Implant Treatment by Guided Surgery Supporting Overdentures in Edentulous Mandible Patients

“…The aim of this study was to evaluate clinical outcomes in planning and treatment by implant-guided surgery of edentulous patients with a mandibular overdenture. The rehabilitation of edentulous mandible patients constitutes an important challenge because optimal implant planning is strongly related to a correct diagnosis to achieve a successful prosthodontic rehabilitation [14,15].…”

“…However, implant-guided surgery in the atrophic anterior mandible presents several anatomic challenges owing to the vascular and neurologic structures related to this region. The incorporation and development of CBCT have resulted in a better appreciation of the risks involved with surgery in this area [14,15].…”

“…Finally, resonance frequency analysis was used to confirm the stability of each implant immediately after removal of the guide once the implants have been placed. Adequate primary stability required an ISQ (Implant Stability Quotient) value between 55 and 85 [15]. However, an ISQ value greater than 65 was considered to perform a one-stage surgery and an early loading protocol (Table 1) [25].…”

“…Several studies have reported excellent clinical outcomes of guided implant treatment in fully edentulous patients, demonstrating that this comprehensive approach has a good implant survival and that implant-supported fixed prosthesis can be delivered to the patient [14,15]. The use of CBCT to plan the insertion of implants by surgical guides, aided by specific software, includes the use of a flapless technique with an important reduction of surgery times, postoperative pain, and better patient comfort [16,17].…”

Accuracy and Feasibility of a Zero-Setup Implant Guide System Made of a Light-Cured Composite Resin with Simultaneous Flapless Sinus Augmentation: A Pilot Study

“…The clinical use of the fully-guided surgical templates has many benefits. Apart from the obvious accuracy of implant placement [6], dangerous anatomical structures can be evaded, and an immediate provisional restoration can be delivered [7,8]. Furthermore, a previous study has revealed that the use of a fully-guided surgical template can improve the patient-reported outcome measurements and allow less experienced surgeons to place implants accurately [9,10].…”