An additively manufactured, magnetically retained, and stackable implant surgical guide: A dental technique

Full Mouth Reconstruction with Dental Implants: Planning, Surgical, and Prosthetic Phase

Treatment of the fully edentulous or the terminal dentition patient today with the immediate load protocols has become accepted globally with predictable outcomes. Reconstruction of patients with full arch prosthesis is an advanced procedure. In order to facilitate the planning, the execution of the surgery/immediate loading as well as the fabrication of the final prosthesis, the Digital workflow is adopted by most teams. However, the treatment planning of the existing fully edentulous or the terminal dentition patient requires a comprehensive knowledge of the fundamental prosthetic as well as the surgical principles.

Accuracy of Intraoral Scanner Systems for Fabricating Inlay, Onlay, and Veneer Restorations: A Systematic Review and Meta-Analysis

PURPOSE

To evaluate the accuracy of intraoral scanners (IOSs) for fabricating inlay, onlay, and veneer restorations.

MATERIALS AND METHODS

A literature search was completed in five databases: PubMed/Medline, Scopus, Embase, Web of Science, and Cochrane. A manual search was also conducted. Two methods have been used to assess the accuracy of IOSs for fabricating inlay, onlay, and veneer restorations: accuracy of the definitive virtual casts and the marginal and internal discrepancies of inlay, onlay, and veneer restorations fabricated by using IOSs. Included articles were classified into two groups: definitive virtual casts accuracy and restoration fit. Two investigators evaluated the studies independently by applying the Joanna Briggs Institute critical appraisal. A third examiner was consulted to resolve any lack of consensus.

RESULTS

Thirty four articles were included: 17 analyzed the accuracy of definitive virtual casts and 17 assessed the marginal and internal discrepancies. Regarding the accuracy of definitive virtual casts, a trueness of 27.47 μm (p < 0.001) in the inlay subgroup and 64.15 μm (p < 0.001) in the onlay subgroup were found among the IOSs tested. For digitizing inlay preparations, a trueness of 12.29 μm (p < 0.001) in the Primescan, 69.34 μm (p < 0.001) in the Omnicam, 38.39 μm (p < 0.001) in the Trios 3, 52.96 μm (p < 0.001) in the Trios, and 28.90 μm (p < 0.001) in the CS3500 were found. A trueness of 53.00 μm (I2 = 99%, p < 0.001) in the Omnicam. Also, a precision of 19.88 μm (p < 0.001) in the inlay subgroup and 19.69 μm (p < 0.001) in the onlay subgroup was obtained. Furthermore, a nonsignificant test result for subgroup differences (p = 0.06) in the marginal discrepancy between conventional and IOS methods was found with a significant heterogeneity (I2 = 99%, p < 0.001). However, a significant test result for subgroup differences (p < 0.001) in the internal discrepancy values was found with a significant heterogeneity (I2 = 72%, p < 0.001).

CONCLUSIONS

IOSs and restoration type influenced the accuracy of the definitive virtual casts. A Better trueness and worse precision was found on the definitive virtual cast of inlay restorations when compared with those of onlay restorations. The impression method used did not impact the marginal discrepancy of inlay and onlay restorations. However, a higher internal discrepancy was found in the inlay and onlay restorations fabricated by using conventional methods, but the discrepancy was not significant. Studies are needed to assess the accuracy of definitive virtual casts for fabricating veneer restorations captured by using IOSs and to measure the fit of the veneer restorations fabricated by using IOSs.

CLINICAL SIGNIFICANCE

Intraoral scanners provide a reliable method for fabricating inlay and onlay restorations. The accuracy of IOSs for fabricating veneer restorations remains uncertain.

Implant Scanning Workflows for Fabricating Implant-Supported Prostheses Recorded by Using Intraoral Scanners With or Without Photogrammetry Technologies

OBJECTIVES

To classify complete-arch implant scanning workflows for registering implant position, tooth position, soft tissue information, and maxillomandibular relationship recorded by using intraoral scanners (IOSs) with or without photogrammetry (PG) technologies.

OVERVIEW

Implant scanning workflow has been defined as the procedures required to acquire the digital information needed to design an implant-supported prosthesis, including implant and tooth position, soft tissue information, and maxillomandibular relationship scans. As a part of the implant scanning workflow, different implant scanning techniques have been described for recording the 3-dimensional position of the implants being scanned by using IOSs. Alternatively, PG systems can also be used to record implant positions. However, dental literature lacks a classification of implant scanning workflows.

CONCLUSIONS

There are six main implant scanning workflows based on the reference landmarks used: worflows guided by existing teeth, fiducial markers, fixation references, implant scan bodies, auxiliary devices, and interim restorations.

CLINICAL SIGNIFICANCE

Understanding different implant scanning workflows allows dental professionals to efficiently capture all the digital data information needed to design and fabricate implant-supported prostheses by using an intraoral scanner with or without a photogrammetry system.

3D virtual patient-Magnetically retained printed stackable system for implant guided placement: Case report

OBJECTIVE

The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D-printed stackable guides.

CLINICAL CONSIDERATIONS

A 3D-printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66-year-old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implant positions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2-7.3) and mean 3D discrepancies were of 0.90 mm (0.46-1.12) at the entry point and 1.68 mm (1.00-2.20) at implant apex. Case follow-up revealed stability, patient's comfort, and no intercurrences.

CONCLUSION

Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision-making and communication between the multidisciplinary team and the patient, while decreases time and costs.

CLINICAL SIGNIFICANCE

Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care.

Predictable Full Digital Workflow Using Stackable Surgical Templates for Complete Dental Arch Rehabilitation with Implant-Supported Fixed Restorations-Case Series and Proof of Concept

BACKGROUND

In recent years, advancements in digital dentistry have provided new opportunities for more predictable and efficient treatment options, particularly in patients with failing dentition. This study aimed to evaluate the effectiveness and accuracy of a fully digital workflow using stackable surgical templates for complete dental arch rehabilitation with implant-supported fixed restorations.

METHODS

Four patients, comprising two males and two females with a mean age of 66 years, were included in this case series. Each patient underwent meticulous digital planning, including CBCT and intraoral scanning, to create a virtual patient for preoperative assessment and virtual treatment planning. The assessment of the trueness of implant positioning was conducted in Geomagic Control X software (version 2017.0.3) by referencing anatomical landmarks from both the preoperative and one-year postoperative CBCT scans.

RESULTS

A total of 25 dental implants were placed in the maxilla, followed by the installation of long-term provisional restorations. The results showed minimal deviation between the planned and actual implant positions, with mean 3D coronal, apical, and angular discrepancies of 0.87 mm, 2.04 mm, and 2.67°, respectively. All implants achieved successful osseointegration, and no failures were recorded, resulting in a 100% survival rate at the one-year follow-up. Patients reported high satisfaction with both the esthetic and functional outcomes based on their subjective feedback.

CONCLUSIONS

The findings suggest that the use of a fully digital workflow with stackable surgical templates is a reliable and effective approach for immediate implant placement and prosthetic rehabilitation, enhancing treatment precision and patient comfort.

Use of an optical jaw-tracking system to record mandibular motion for treatment planning and designing interim and definitive prostheses: A dental technique

Optical jaw-tracking systems can record mandibular motion during the various treatment phases. Also, computer-aided design programs facilitate the integration of a patient's digital information, including recorded mandibular motion, into the design of interim and definitive prostheses. A technique to fabricate a complete mouth implant-supported rehabilitation by using mandibular motion captured with an optical jaw-tracking system is described. The mandibular motion recordings obtained before the treatment are combined with the interim restorations to perform a diagnostic waxing, design the computer-guided implant plan, and fabricate maxillary and mandibular screw-retained implant-supported interim and definitive prostheses. The process allows occlusal adjustments by using the patient's mandibular motion and facilitates the prosthetic design process, minimizing chair time at delivery.

A digital technique for transferring the maxillomandibular relationship for complete arch implant rehabilitation in edentulous jaws

A digital technique for transferring the maxillomandibular relationship using photogrammetry, an intraoral scanner, and a computer-aided design software program is described in a treatment involving immediate loading in a patient with mandibular edentulism. The edentulous mandible was located preoperatively in a centric occlusal relationship with a denture, and preoperative and postoperative cone beam computed tomography (CBCT) data were aligned and merged based on bone markers. This technique, which allows the transfer of the presurgical maxillomandibular relationship during the immediate loading procedure, is more objective, more straightforward, and faster than the conventional method.

Digital workflow for complete arch immediate loading with a prefabricated interim prosthesis using autonomous robotic surgery: A dental technique

A fully digital workflow incorporating autonomous robotic surgery is described. A prefabricated interim prosthesis offers the potential to streamline the process and reduce chairside time. Adopting this digital workflow can simplify the treatment procedure and help minimize the overall time required for the provision of implant-supported prostheses.

Two-piece magnet-retained shell manufactured by using milled and vat-polymerized methods for direct interim restorations

The shell technique has been described for fabricating direct interim restorations by using conventional and computer-aided design and computer-aided manufacturing (CAD-CAM) methods. However, the positioning of the shell over the tooth preparations can be challenging. In the present manuscript, the clinical and laboratory steps for manufacturing a 2-piece magnet-retained shell for direct interim restoration fabrication are described. The 2-piece shell was produced by combining milling and additive manufacturing procedures. The described technique aims to simplify the correct positioning of the shell and facilitate direct interim restoration fabrication.

Utilization of Digital Periodontal and Restorative Dentistry in Full Mouth Reconstruction: A Case Report

CT-guided surgery has demonstrated superior accuracy over traditional methods in the dental literature. However, inherent errors such as discrepancies between jaw dimensions in scans and reality can challenge the fabrication of screw-retained provisional restorations. These discrepancies can impede final restoration fabrication. Traditional immediate loading of edentulous jaws using temporary cylinders in existing dentures often requires time-consuming abutment positioning and drilling. Many articles addressed these issues through minimally invasive implant placement with immediate loading, achieved through careful preoperative planning and exact prosthetic techniques. CT-guided surgery facilitates minimally invasive procedures and immediate restoration of edentulous jaws, resulting in reduced morbidity and quicker, more precise outcomes. This case report illustrates how digital dentistry enhances implant placement precision and reliability. It involves using a lock object system between the surgical guide and provisional restoration, streamlining the process. A 59-year-old male with significant periodontal issues and non-restorable teeth was treated with implant-supported fixed prostheses using digital planning and computer-fabricated surgical guides. The plan included immediate loading with mechanical and magnetic locks for optimal outcomes. The patient received complete fixed provisional restorations on both arches through minimally invasive procedures. Digital dentistry facilitated precise implant placement and restoration, improving function, esthetics, and patient satisfaction. Digital technologies streamlined the process, reducing time and enhancing predictability and reproducibility. In conclusion, integrating digital dentistry into implant treatment planning and execution offers enhanced accuracy, efficiency, and patient outcomes. By utilizing digital technologies and innovative methods, clinicians can attain consistent and reliable outcomes, thereby enhancing the quality of care for patients undergoing implant therapy.

Cone-wedge anchored surgical templates for stackable metal guide: a novel technique

OBJECTIVE

To address the instability in implant surgical guides, this technique proposes an alternative anchoring mechanism in the stackable metal surgical guides utilizing cone-wedge anchors for improved stability.

METHODS

Postoperative implant position superimposed onto the preoperatively planned design using Mimics Medical 21.0 and Materialise Magics 24.0 to assess 3D coronal implant deviation, 3D apical implant deviation, and implant angular deviation.

RESULTS

Postoperative cone-beam computed tomography (CBCT) revealed a high level of precision in the implant placement, with an average 0.97 mm deviation at implant coronal region, 1.56 mm at implant apexes, and 2.95° angular deviation.

CONCLUSION

This technique introduces a novel cone-wedge anchoring mechanism to enhance the stability of stackable metal surgical guide templates, addressing inherent instability issues. The utilization of this approach significantly improves the accuracy of implant placement procedures.

Current knowledge about stackable guides: a scoping review

PURPOSE

The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of the temporary prosthesis at the time of implant placement. This scoping review aimed to assess the current knowledge available on stackable guides.

METHODS

The review focused on fully edentulous or requiring total edentulism patients. The procedure studied was the use of stackable guides for edentulous patients in order to place immediate temporary prostheses. The clinical endpoint was immediate placement of the provisional prosthesis after surgery combined with a prior bone reduction using a stackable guide.

RESULTS

12 case reports or case series articles met inclusion criteria, which did not allow an analysis by a systematic review. The included studies were case reports or case series. Most of the articles showed a base stabilized by 3 or 4 bone-pins, anchored in buccal or lingual part. Regarding the accuracy of bone reduction (ranged from 0.0248 mm to 1.98 mm) and implant placement when compared to planned, only 4 articles reported quantitative data. 11 articles showed an immediate loading with the transitional prosthesis after implant placement.

CONCLUSIONS

There are as yet no prospective or comparative studies on the efficiency of this technique. In a reliable way, stackable guides seem to be able to guide the practitioner from the flap elevation to the placement of the temporary screw-retained implant supported prosthesis. Given the lack of studies in this specific field of guided surgery, further studies are needed to confirm the clinical relevance of this technique.

A Fully Guided Sequential Template Immediate Loading Protocol for Dual-Arch Implant Surgery

A method is described for designing, fabricating and implementing sequential template immediate loading protocols for dual arch implant therapy. A 41-year-old medically-free patient with terminal dentition was treated following stackable guide loading protocols for maxillary and mandibular arches. Implants were placed following extractions and immediately loaded with full arch fixed prostheses. Healing was uneventful and all implants integrated successfully. Special consideration was given to the design and clinical challenges when implementing stackable guide protocols for dual arch implant therapy.

A New Full Digital Workflow for Fixed Prosthetic Rehabilitation of Full-Arch Edentulism Using the All-on-4 Concept

(1) Background: Recent digital workflows are being developed for full-arch rehabilitations supported by implants with immediate function. The purpose of this case series is to describe a new digital workflow for the All-on-4 concept. (2) Methods: The patients were rehabilitated using the All-on-4 concept with a digital workflow including computerized tomography scanning, intra-oral scanning, and CAD-CAM production of the temporary prosthesis, with the 3D printing of stackable guides (base guide, implant guide, and prosthetic guide). The passive fit of the prostheses and the time to perform the rehabilitations were evaluated. (3) Results: The digital workflow allowed for predictable bone reduction, the insertion of implants with immediate function, and the connection of an implant-supported prosthesis with immediate loading. The time registered to perform the full-arch rehabilitations (implant insertion, abutment connection, prosthesis connection) was below 2 hours and 30 min. No passive fit issues were noted. (4) Conclusions: within the limitation of this case series, the digital workflow applied to the All-on-4 concept using stackable base-, implant-, and prosthetic guides constitutes a potential alternative with decreased time for the procedure without prejudice of the outcome.

Computer Aided Full Arch Restoration by Means of One-Piece Implants and Stackable Guide: A Technical Note

This technical note aims to present a recently developed computer-guided protocol characterized by titanium-reinforced stackable surgical guides during post-extractive implant placement and subsequent immediate loading. A full maxillary edentulism was rehabilitated with one-piece implants, starting from a pre-existing removable denture. 3D digital scans of the removable denture and upper and lower arches were performed. On this basis, a prototype with ideal esthetic and functional outcomes was realized and replicated into a custom-made radiological stent with markers. The superimposition of STL and DICOM files allowed virtual planning of one-piece implants in the ideal prosthetically driven position. The stackable guides, composed of a fixed base template and additional removable components, were then realized. The fixed template, initially secured with anchor pins to the bone, was no longer removed. The removable components, which were screwed to the base template, were used to perform implant surgery and immediate prosthetic loading. No surgical complications occurred, the implants achieved a minimum insertion torque of 35 Ncm, and immediate prosthetic loading was performed. The base template allowed for the maintenance of a fixed reference during the entire workflow, improving the transition between the digital project, the surgical procedure, and the prosthetic rehabilitation.

Prevention of peri-implant disease in edentulous patients with fixed implant rehabilitations

OBJECTIVES

To provide an overview about the current approaches to prevent peri-implant diseases in edentulous patients with complete-arch implant-supported prostheses, and to review the clinical applications of the latest digital technologies for implant prosthodontics.

METHODS

A review of the guidelines to prevent peri-implant diseases in patient's receiving complete-arch implant-supported prostheses including facially driven treatment planning procedures using either conventional or digital methods, computer-aided implant planning procedures, and prosthodontic design variables including the optimal number and distribution of dental implants, implant to abutment connection type, implant or abutment level design, screw- or cement-retained alternatives, prostheses contours, and material selection is provided. Furthermore, an outline of the current therapeutic management approaches to address peri-implant diseases is reviewed.

CONCLUSIONS

Clinicians should understand and know different planning and design-related variables that can affect biological and mechanical complication rates of complete-arch implant-supported prostheses. Maintenance protocols are fundamental for minimizing biological and mechanical complications.