Patient and Operator Centered Outcomes in Implant Dentistry: Comparison between Fully Digital and Conventional Workflow for Single Crown and Three-Unit Fixed-Bridge
Abstract:Background: Scientific information about the effects of implant therapy following a precise workflow and patient and operators’ preferences should be considered to choose which implant treatment protocol to use, and to achieve patient’s satisfaction and functional results. The aim of this study was to analyze implant rehabilitations with a fully digital workflow and compare this approach with a conventional one. Methods: This study comprises 64 patients treated with a fully digital approach and 58 patients tre… Show more
“…The rapid evolution of CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), and the advancements of its application to dentistry have heralded a series of innovations in all branches, especially in implantology and restorative dentistry, where its association with new materials presents the clinician a new treatment possibility that is both economically advantageous and clinically resilient [ 1 – 3 ].…”
The digital workflow and the application of Computer-Aided Manufacturing (CAM) to prosthodontics present the clinician with the possibility of adopting new materials that confer several advantages. Especially in the case of zirconia, these innovations have profoundly changed daily practice. This paper compares the satisfaction and perception of patients who received implant-supported single crowns (SC) and fixed partial dentures (FPD) made from zirconia, either monolithic or partially veneered, after 3 years of follow-up; the success and survival rate of these restorations were also measured. Forty patients, who had been previously treated with implant-supported SC or FPD, either monolithic or partially veneered, and submitted to a yearly maintenance program, were recalled 3 years after their treatment and requested to complete an 8-question questionnaire regarding their perceptions of the treatment. Any mechanical or biological complication that had occurred from the time of delivery was also recorded. Patients that experienced ≥1 complication were less likely to be prone to repeat the treatment. The 3-year success rate was 92.6% for monolithic restoration and 92.3% for partially veneered restoration, while the survival rate was 100% for both restorations. The 3-year follow-up found that monolithic and partially veneered zirconia restorations are both well-accepted treatment options, and patients preferred the veneered restorations (0.76,
p
<
0.05
) from an aesthetic point of view. According to our results, monolithic and veneered zirconia restorations are both reliable treatment options and are both equally accepted by patients.
“…The rapid evolution of CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), and the advancements of its application to dentistry have heralded a series of innovations in all branches, especially in implantology and restorative dentistry, where its association with new materials presents the clinician a new treatment possibility that is both economically advantageous and clinically resilient [ 1 – 3 ].…”
The digital workflow and the application of Computer-Aided Manufacturing (CAM) to prosthodontics present the clinician with the possibility of adopting new materials that confer several advantages. Especially in the case of zirconia, these innovations have profoundly changed daily practice. This paper compares the satisfaction and perception of patients who received implant-supported single crowns (SC) and fixed partial dentures (FPD) made from zirconia, either monolithic or partially veneered, after 3 years of follow-up; the success and survival rate of these restorations were also measured. Forty patients, who had been previously treated with implant-supported SC or FPD, either monolithic or partially veneered, and submitted to a yearly maintenance program, were recalled 3 years after their treatment and requested to complete an 8-question questionnaire regarding their perceptions of the treatment. Any mechanical or biological complication that had occurred from the time of delivery was also recorded. Patients that experienced ≥1 complication were less likely to be prone to repeat the treatment. The 3-year success rate was 92.6% for monolithic restoration and 92.3% for partially veneered restoration, while the survival rate was 100% for both restorations. The 3-year follow-up found that monolithic and partially veneered zirconia restorations are both well-accepted treatment options, and patients preferred the veneered restorations (0.76,
p
<
0.05
) from an aesthetic point of view. According to our results, monolithic and veneered zirconia restorations are both reliable treatment options and are both equally accepted by patients.
“…The use of digital workflow in oral and maxillofacial surgery is expanding in the areas of performing osteotomies, zygomatic implants, bone regeneration, orthognathic surgeries where greater surgical precision and accuracy is essential [ 4 ]. To satisfy the high expectations of patients and to ensure an adequate and predictable long-term outcome, implant treatment requires prosthodontically guided, three-dimensional assessment and planning [ 5 ]. DWF can optimize the process, as they provide valuable diagnostic information and facilitate backward planning to improve safety and efficiency, which contribute to a more predictable outcome.…”
Section: Introductionmentioning
confidence: 99%
“…Optimal positioning ensures adequate bone volume surrounding the implant with correct load distribution. Whilst freehand (FH) implant placement has been the standard approach [ 5 , 6 ], the surgical accuracy of this method can be limited. Despite the use of anatomical landmarks or stents, FH surgery relies on good three-dimensional (3D) spatial awareness and high levels of surgical experience to place the dental implant correctly within the limited volume of residual bone [ 7 , 8 ].…”
An increase in the number of implants placed has led to a corresponding increase in the number of complications reported. The complications can vary from restorative complications due to poor placement to damage to collateral structures such as nerves and adjacent teeth. A large majority of these complications can be avoided if the implant has been placed accurately in the optimal position. Therefore, the aim of this in vitro pilot study was to investigate the effect of freehand (FH) and fully guided (FG) surgery on the accuracy of implants placed in close proximity to vital structures such as the inferior alveolar nerve (IAN). Cone-beam computed tomography (CBCT) and intraoral scans of six patients who have had previous dental implants in the posterior mandible were used in this study. The ideal implant position was planned. FG surgical guides were manufactured for each case. In this study, the three-dimensional 3D printed resin models of each of the cases were produced and the implants placed using FG and FH methods on the respective models. The outcome variables of the study, angular deviations were calculated and the distance to the IAN was measured. The mean deviations for the planned position observed were 1.10 mm coronally, 1.88 mm apically with up to 6.3 degrees’ angular deviation for FH surgery. For FG surgical technique the mean deviation was found to be at 0.35 mm coronally, 0.43 mm apically with 0.78 degrees angularly respectively. The maximum deviation from the planned position for the apex of the implant to the IAN was 2.55 mm using FH and 0.63 mm FG. This bench study, within its limitations, demonstrated surgically acceptable accuracy for both FH and FG techniques that would allow safe placement of implants to vital structures such as the IAN when a safety zone of 3 mm is allowed. Nevertheless, a better margin of error was observed for FG surgery with respect to the angular deviation and controlling the distance of the implant to the IAN using R2 Gate® system.
“…Of the 14 selected studies, 6 studies showed data on guided and non‐guided implant surgery (Arısan et al, 2010; Fortin et al, 2006; Nkenke et al, 2007; Pozzi et al, 2014; Vercruyssen et al, 2014; Youk et al, 2014), 7 studies reported on implant impressions (De Angelis et al, 2020; Delize et al, 2019; Guo et al, 2019; Joda & Bragger, 2016; Mangano & Veronesi, 2018; Schepke et al, 2015; Wismeijer et al, 2014) and 3 studies compared conventional and digital fabrication of veneered and monolithic restorations (Delize et al, 2019; Joda, Ferrari, et al, 2018; Mangano & Veronesi, 2018). In two studies, outcomes of both impressions and final restorations were evaluated (Delize et al, 2019; Mangano & Veronesi, 2018).…”
Section: Resultsmentioning
confidence: 99%
“…In addition, the same clinicians followed strictly all surgical and prosthetic steps and an external assistant performed all evaluations directly after the impression procedure to avoid the possibility of the procedure effect being erased from the patient's memory. However, the results of this study have to be interpreted with caution, due to the retrospective nature of the study and the small and strictly selected sample (De Angelis et al, 2020). Joda et al also used the VAS scale to evaluate patient's opinion on optical impressions compared with conventional ones.…”
Objectives
To summarize the existing evidence on patient‐reported outcome measures (PROMs) of implant‐supported restorations fabricated using a digital workflow in comparison to conventional manufacturing procedures.
Methods
A PICO strategy was executed using an electronic and manual search focusing on clinical studies evaluating PROMs of implant‐supported restorations. Only clinical trials assessing conventional versus digital workflows for implant‐supported restorations were included. PROMS on implant impression procedures and fabrication of final restorations were evaluated using random and fixed effects meta‐analyses, while implant planning/placement was reported descriptively.
Results
Among 1062 titles identified, 14 studies were finally included, and only seven studies were eligible for meta‐analysis. For implant planning and placement, only a qualitative analysis was possible due to heterogeneity between the studies. For impression procedures, the random effects model revealed statistically significant differences in taste, anxiety, nausea, pain, shortness of breath, and discomfort in favor of optical impressions. No significant difference in the subjective perception of the duration of an impression could be reported. For the final fabrication of restorations, no significant difference between veneered and monolithic posterior restorations was found in terms of esthetic, function, and general satisfaction.
Conclusion
Most of the studies reporting about PROMs were published during the last ten years and limited to implant‐supported single crowns in the posterior region. Based on PROMs, no scientifically proven recommendation for guided implant placement could be given at this time. Patients showed high preference for optical impressions, whereas no differences between veneered and monolithic restorations could be reported.
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