Clinical outcomes and cost effectiveness of computer-guided versus conventional implant-retained hybrid prostheses: A long-term retrospective analysis of treatment protocols

Mouth opening limitation and influence of age and surgical location for static fully guided dental implant placement: an observational, cross-sectional clinical study

The influence of age and region of the mouth was assessed in regard to mouth opening in fully guided implant placement. Ninety patients were included in this study, 30 in each of three age groups (20-34, 35-55, and >55 years). Maximum passive mouth opening was recorded in three locations: incisal, canine, and molar. The minimum distance required to allow the bone drilling sequence through a static fully guided approach was analysed for four implant systems: Straumann, MIS Dentsply, Astra Tech Dentsply, and Dentium. The mean ± standard deviation maximum mouth opening (all 90 patients) was 46.34 ± 7.70 mm, 36.82 ± 5.92 mm, and 30.99 ± 5.40 mm in the incisal, premolar, and molar region, respectively. No significant difference in mouth opening at any of the three locations was found between the age groups (all P > 0.05). However, a correlation was found between increasing age and decreasing average mouth opening in all three mouth regions; each additional 1 year resulted in a mean reduction of 0.13 mm, 0.09 mm, and 0.08 mm in the incisal, premolar, and molar region, respectively. The minimum required mouth opening was most likely to be met for implant placement in the incisal region (98.9% of all patients) and least likely to be met for placement in the molar region, particularly for older patients (as low as 30% of patients). Mouth opening remains a major limitation in fully guided implant surgery, especially in posterior areas and in older patients. The use of some implant systems in the posterior area may be limited to only one in three patients.

Accuracy of the novel digital non-cross-arch surgical guides with integration of tooth undercut retention and screw-bone support for implant placement in mandibular free-end

BACKGROUND

Large cross-arch free-end surgical guides can obscure the visual field, compromising surgical accuracy due to insufficient stability at the free-end. This in vitro study aims to evaluate the accuracy of novel digital non-cross-arch surgical guides designed for implant placement at the mandibular free-end, incorporating tooth undercut retention and screw-bone support.

MATERIALS AND METHODS

A mandibular dental model lacking left molars was utilized to fabricate unilateral (cross-arch) tooth-supported surgical guides (GT I, n = 20). Subsequently, two additional types of surgical guides were fabricated: GT II (covering two teeth, n = 20) and GT III (covering three teeth, n = 20). These novel surgical guides were designed to utilize the undercut of the supporting teeth for retention and enhance stability with screw-bone support at the guide's free-end. Furthermore, 60 identical guiding blocks were assembled on the three types of surgical guides to facilitate the implants' insertion. On a phantom head, 120 implant replicas were placed at the Federal Dentaire Internationale (FDI) teeth positions #36 and #37 on the dental model, employing a combination of surgical guides and guiding blocks. To assess accuracy, planned and placed implant positions were compared using intraoral optical scanning. Discrepancies in angulation and linear deviations, including the coronal/apical 3D deviations, lateral deviation as well as depth deviation, were measured. Statistical analysis was performed using two-way ANOVA and Bonferroni test (α = 0.05).

RESULTS

GT I exhibited significantly largest discrepancies, including angular and linear deviations at the crest and apex at every implant site. Especially in depth, at implant site #36, the mean deviation value of GT I (0.27 ± 0.13 mm) was twice as large as GT III (0.13 ± 0.07 mm), and almost twice as large as GT II (0.14 ± 0.08 mm). However, at implant site #37, this deviation increased to almost a five-fold relationship between GT I (0.63 ± 0.12 mm) and II (0.14 ± 0.09 mm), as well as between GT I and III (0.13 ± 0.09 mm). No significant discrepancies existed between the novel surgical guides at either implant site #36 or #37.

CONCLUSION

This study provides a practical protocol for enhancing accuracy of implant placement and reducing the size of free-end surgical guides used at mandibular molar sites.

The economic and societal impact of periodontal and peri-implant diseases

Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.

Guided coronally advanced flap to treat gingival recession: Digital workflow and case report

BACKGROUND

The inherently technique-sensitive nature of periodontal plastic procedures demands a significant level of skill and expertise. The incorporation of three-dimensional (3D) printing technologies emerges as a potential strategy to optimize and simplify surgical procedures. This case report describes the digital workflow and presents the clinical outcomes achieved using a guided coronally advanced flap for the treatment of a single gingival recession (GR).

METHODS AND RESULTS

A female patient with a gingival recession type 1 (RT1 B-) defect on the mandibular second left premolar underwent successful treatment using a guided coronally advanced flap (g-CAF) and de-epithelized connective tissue graft (CTG). The digital planning included intraoral scanning of the mandible and hard palate using an intraoral scanner, with resulting polygon format (PLY) files exported for virtual model creation. The CAF guide was meticulously designed to orient horizontal and vertical incisions at the papillae base adjacent to the GR defect. For the donor site, a guide was specifically created, positioning the graft area 2 mm apically to the premolars' gingival margins. The delineation of this area involved two horizontal and vertical incisions, meticulously based on the dimensions of the GR. The digitally designed guides were then 3D-printed using a surgical guide-specific resin, contributing to the precise execution of the innovative surgical approach. Complete root coverage was achieved.

CONCLUSION

This case report demonstrates that g-CAF can be a promising approach for the treatment of single GR.

HIGHLIGHTS

Why is this case new information? To the best of the authors' knowledge, this is the first manuscript to report a guided procedure for the treatment of gingival recession. This report provides the digital workflow for the fabrication of a guide to perform the coronally advanced flap for single recession defects. What are the keys to successfully manage this case? It is necessary to adequately scan the recession defect area and palate. Properly not only design the guide using specific software but also print it. The guide has to be stable when in position for the surgical procedure. What are the primary limitations of this technique? This guide was designed to help surgeons during the incisions. However, it does not provide aid to split and release the flap and suture.

Alveolar ridge preservation: Complications and cost-effectiveness

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.

The Use of Zirconia for Implant-Supported Fixed Complete Dental Prostheses: A Narrative Review

The success of implant-supported fixed complete dental prostheses (ISFCDPs) depends on multiple factors: some are related to the fixtures, such as fixture material, surface characteristics, positioning, and type of connection to prosthetic components; others are related to the prostheses, such as design and materials used. Zirconia is a material widely used in fixed prosthodontics, whether on natural teeth or on implants, with excellent results over time. Regarding the use of zirconia for ISFCDPs, the 2018 ITI Consensus Report stated that "implant-supported monolithic zirconia prostheses may be a future option with more supporting evidence". Since CAD/CAM technology and zirconia are being continuously innovated to achieve better results and performances over time, a narrative review of the literature seems necessary to focus research efforts towards effective and durable solutions for implant-supported, full-arch rehabilitations. The objective of the present narrative review was to search the literature for studies regarding the clinical performance of zirconia-based ISFCDPs. According to the results of this review, the use of zirconia for ISFCDPs showed good clinical outcomes, with high survival rates ranging from 88% to 100% and prosthetic complications that were restorable by the clinicians in most cases.

How to Avoid Errors When Using Navigation to Place Implants - A Narrative Review

PURPOSE

Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation.

METHODS

Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer-reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic.

RESULTS

The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°.

CONCLUSION

The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.

Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.

Conventional free-hand, dynamic navigation and static guided implant surgery produce similar short-term patient-reported outcome measures and experiences

Design A randomised controlled trial study comparing patient-reported outcome measures (PROMs) and experiences (PREs) using conventional brain-guided (free-hand), dynamic computer-assisted implant surgery (dCAIS) and static computer-assisted implant surgery (sCAIS) for dental implant placement.Case selection Ninety subjects who met the inclusion criteria (that is, at least 20 years of age interested in dental implant treatment) accepted to participate in the trial and were randomly allocated to three groups between August 2019 and October 2020, according to the dental implant placement protocol, by means of block randomisation. The included subjects were required to undertake several self-administered questionnaires concerning: 1) pre-operative expectations (that is, five items evaluating patients' perceptions using a 5-point Likert scale and six items about patients' expectations concerning the planned surgery); 2) post-operative healing complications or events during the immediate post-operative week (that is, pain intensity assessment on a continuous visual analogue scale [VAS] 0-10, oedema or swelling evaluation on four grades ranging from no oedema [Grade 1] to extraoral oedema reaching beyond the surgical zone [Grade 4] and analgesic drugs intake); and 3) post-operative PROMs at a two-week follow-up (six items evaluating the post-operative symptoms experience and eight items measuring overall patient satisfaction using a 5-point Likert scale).Data analysis Kolmogorov-Smirnov test determined a non-normal distribution. Consequently, Wilcoxon signed-rank test assessed the intra-group differences and Kruskal-Wallis test was applied for inter-group comparison using the Statistical Package for the Social Sciences (IBM SPSS version 24; Chicago, IL). Spearman's correlation test evaluated the relation of patients' or implant procedures' characteristics with the maximum mean pain score, analgesic intake and oedema grade. The significance level alpha was set to 0.05. Lastly, Cronbach's alpha was used to evaluate the internal consistency for perceptions (0.53), expectations (0.76) and satisfaction (0.85).Results Only two subjects were excluded for missing the two-week follow-up visit. Both subjects belonged to the dCAIS group. Hence, 88 participants (mean age = 57.7 years) corresponding to 179 implants placed were evaluated. Sex was the only subjects' characteristic with a significant difference as more women were included (60%; p = 0.020). Most of the subjects had one (38%) and two (45%) dental implants at anterior (11%) and posterior sites (80%) with full-thickness flap operation (95%) but without simultaneous guided bone regeneration (57%). In terms of the surgical duration, sCAIS took the longest (89.70 ± 45.75 min), followed by dCAIS (70.95 ± 42.48 min) and brain-guided protocol (70.30 ± 47.08 min). Nevertheless, there was no significant inter-group surgical time difference (p = 0.076). Concerning the pre-operative patients' perspectives on dental implant intervention, most participants believed that implants would permit chew (93%), sound (88%) and appearance (91%) to be as close as with natural dentition. Interestingly, 32% believed that osseointegrated implants require less maintenance than natural dentition and 73% stated that implants last a lifetime. There was a significant difference between the groups regarding the both the amount of time they expected to be in pain postoperatively (p=.035) and the amount of post operative swelling they expected (p=0.006)There was no significant inter-group difference in magnitude of post-operative pain, oedema and analgesic intake. The dCAIS group expected longer to adapt to speaking (p = 0.030). The inter-group analysis of expected chewing difficulties evidenced significant differences (p = 0.040). Regarding the PREs, significant inter-group differences were displayed in duration of post-operative pain (p = 0.010), phonetic limitations (p = 0.038) and impact on routine activities (p = 0.046). After one week, the conventional and the sCAIS groups still had the highest (1.40 ± 2.43) and lowest (0.77 ± 1.85) pain scores. Concerning the self-reported post-operative oedema grading, it peaked on day two and most participants referred intraoral oedema (Grade 2) to extraoral oedema (Grade 3). Again, no significant inter-group difference was detected in the six measured time points regarding pain, oedema or analgesic intake. The highest post-operative oedema at day two was significantly correlated with flap operation (p = 0.030). During the first post-operative week, there was a low mean analgesic intake (5.13 ± 5.52). The first post-operative day had the highest consumption of analgesic drugs and the highest group consumption was by the conventional group. The post-operative healing experience and functional limitations were considered acceptable by most participants. Oedema had the lowest acceptable proportion (59%), followed by oral hygiene care difficulty (64%) and chewing (65%). The only intra-group difference in patients' acceptance was evidenced in the post-operative speaking difficulties of the sCAIS group (p = 0.015). Ninety-two percent of participants were satisfied with the clinical service (median = 5.0) and 89% were satisfied with the overall implant surgery (median = 4.0).Conclusions Placing dental implants with conventional brain-guided, sCAIS or dCAIS protocols obtained a similar post-operative level of patient satisfaction, analgesic intake, oedema and pain. Patients reported the dental implant post-operative symptoms to be acceptable even though they expected a shorter inflammation duration. The highest level of pain and oedema were experienced six hours and two days post-operative, respectively, regardless of the surgical protocol.

Guided Insertion of Temporary Anchorage Device in Form of Orthodontic Titanium Miniscrews with Customized 3D Templates—A Systematic Review with Meta-Analysis of Clinical Studies

(1) Background: Miniscrew insertion, using a surgical guide, aims to avoid possible adverse effects or complications. With the higher availability of both 3D imaging and printing, 3D surgical guides have been used more frequently in orthodontics. The aim of the present systematic review was to find scientific clinical evidence concerning the precision of the 3D guided insertion of miniscrews for temporary orthodontic anchorage. (2) Methods: Literature searches were performed in the following five search engines: Pubmed (Medline), Pubmed Central, Scopus, Web of Science and Embase on 10 September 2021 (articles from 1950 to 10 September 2021). A meta-analysis was performed using the random-effect model, with Standardized Mean Differences (SMD) and 95% confidence intervals (95% CI) calculated as effect estimates. The heterogeneity was assessed quantitatively. (3) Results: The search strategy identified 671 potential articles. After the removal of duplicates, 530 articles were analyzed. Subsequently, 487 papers were excluded, because they were not associated with the subject of the study. Of the remaining 43 papers, 34 were excluded because they did not meet the methodological criteria. Finally, only nine papers were subjected to a qualitative analysis. (4) Conclusions: The current literature concerning guided miniscrew insertion reveals, for the most part, a low methodological level. High-quality clinical trials are in the minority. The use of surgical guides increases insertion accuracy, stability and reduces the failure rate of orthodontic miniscrews. Tooth-borne insertion guides supported on the edges of the teeth ensure a higher insertion precision compared to mucosa-borne ones. The study protocol was registered in PROSPERO under the number CRD42021267248.

Time and costs related to computer-assisted versus non-computer-assisted implant planning and surgery. A systematic review

Aim

To study the time and costs involved with computer‐assisted versus non‐computer‐assisted implant planning and placement.

Material and methods

Based on the PICO question, “In patients receiving dental implants, is computer‐assisted implant planning and surgery (CAIPS) compared to non‐computer‐assisted implant planning and surgery (non‐CAIPS) beneficial in terms of treatment related costs and time involved?”, a search path was created to perform an electronic search in the databases PubMed, PubMed Central, EMBASE, and Cochrane. The publication period of eligible publications extended from 01.01.2005 to 04.05.2020. Four independent reviewers reviewed the literature to identify studies that met the eligibility inclusion criteria. A further manual search of articles was performed, and gray literature was excluded. Corresponding authors of potentially eligible manuscripts were contacted for further information.

Results

Of the 1354 retrieved titles after the search were screened. Thirty‐one articles have been identified to read the full text, resulting in four articles to be analyzed for the present review all of which were RCTs. In total, 182 partially and completely edentulous patients were treated with 416 implants following either non‐computer‐assisted or computer‐assisted implant planning and surgery to determine the duration of the single working steps and the financial aspects of the different procedures.

Conclusions

When evaluating the time and costs involved with the diagnostic and planning procedures in computer‐assisted implant planning and surgery workflow protocols, one can summarize that these are higher than in the non‐computer‐assisted workflow protocols. The time involved with the procedures appears to be the driving factor when it comes to economic considerations. On the basis of the conclusions, also the time for the prosthetic restoration should be taken into account.

Failure rates associated with guided versus non-guided dental implant placement: a systematic review and meta-analysis

Objective

The purpose of the systematic review and meta-analysis was to evaluate implant failure rates and their association with guided and free-hand implant placement techniques.

Materials and methods

A literature search was conducted across PubMed, Medline via Ovid, Cochrane database, and Google Scholar. The search was completed in September 2020. Series of meta-analyses were conducted to compare implant failure rates with guided and free-hand techniques.

Results

A total of 3387 articles were identified from the electronic search. After applying the inclusion criteria, eight articles were selected for qualitative assessment and four for quantitative synthesis (meta-analysis). The included studies had a risk ratio of 0.29 (95% CI: 0.15, 0.58), P < 0.001 for the use of guided implant placement. Implant failure rates were affected by the different placement techniques indicated by the test for overall effect (Z = 3.53, P = 0.0004). The incidence of implant failure in guided surgery versus free-hand surgery was found to be 2.25% and 6.42%, respectively.

Conclusion

Both guided and free-hand implant placement techniques resulted in a high implant survival rate. However, implant failure rates were almost three times higher in the free-hand implant placement category. A guided implant placement approach is recommended for a successful outcome.

The Impact of Surgical Guide Fixation and Implant Location on Accuracy of Static Computer-Assisted Implant Surgery

PURPOSE

To evaluate the accuracy of static computer-assisted implant surgery (sCAIS) for tooth-supported free-end dental implantation with the aid/and without the aid of fixation pins to secure the surgical template through comparison between planned, 3D printed guide position and placement implant position.

MATERIALS AND METHODS

Thirty-two duplicated maxillary resin models were used in the present in vitro study. Digital planning was performed and fabrication of a surgical template that allowed implant placement on the distal extension edentulous site of the model (maxillary left side). A first optical scan was performed after fitting the surgical template on the model to assess the deviation at the surgical guide level. After placing implants in the model using the surgical guide, scan bodies were attached to the implants, and a second scan was performed to record the position of placed implants. The digital representations were later superimposed to the pre-operative scan and measurements of implant deviations were performed. Global (coronal and apical), horizontal (coronal and apical), depth and angular deviations were recorded between planned implant position, guide position, and placement implant position. Three-way ANOVA was used to compare implant location (#13, 14, and 15), fixation pin (with or without pin), and guide comparison (planned, guided, and placement).

RESULTS

Final implant placement based on the digital plan and based on the 3D printed guide were very similar except for depth deviation. Use of fixation pin had a statistically significant effect on the depth and angular deviation. Overall, without fixation pins and based on guide versus placement, mean global coronal (0.88 ± 0.36 mm), horizontal coronal (0.55 ± 0.32 mm), and apical (1.44 ± 0.75 mm), and angular deviations (4.28 ± 2.01°) were similar to deviations with fixation pins: mean global coronal (0.88 ± 0.36 mm); horizontal coronal (0.67 ± 0.22 mm) and apical (1.60 ± 0.69 mm); and angular deviations (4.53 ± 2.04°). Horizontal apical without pins (1.63 ± 0.69 mm) and with fixation pins (1.72 ± 0.70 mm) was statistically significant (p = 0.044). Depth deviation without pins (-0.5 ± 0.5 mm) and with fixation pins (-0.16 ± 0.62 mm) was also statistically significant (p = 0.005). Further analysis demonstrated that the final sleeve position on the 3D printed guide was on average 0.5 mm more coronal than the digital plan.

CONCLUSIONS

The use of surgical guides with or without fixation pins can provide clinically acceptable outcomes in terms of accuracy in implant position. There was a statistically significant difference in the accuracy of implant position when utilizing fixation pins only for horizontal apical and depth deviation. Additionally, a statistically significant difference between the planned and the 3D printed surgical guide when considering the sleeve position was detected.

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

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.

Static computer-aided, partially guided, and free-handed implant placement: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To analyze the outcomes of static computer-aided implant placement (sCAIP) compared to partially guided (PGIP) and free-handed (FHIP) implant placement.

MATERIAL AND METHODS

This study was registered in PROSPERO (CRD42019131397). A comprehensive literature search was performed by two independent examiners. Only randomized controlled trials (RCTs) were selected. Treatment modalities included sCAIP, PGIP, and FHIP. Data pertaining to the outcomes of interest were extracted. Random-effects meta-analyses were feasible for a subset of outcomes.

RESULTS

From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta-analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post-loading was high (>98%) and comparable between treatments (low-quality evidence). No tangible differences in terms of patient perception of intra- or postoperative discomfort were observed (low-quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41°, 95% CI 3.99-4.83, p < .00001), coronal (MD = 0.65 mm, 95% CI 0.50-0.79, p < .00001), and apical (MD = 1.13 mm, 95% CI 0.92-1.34, p < .00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high-quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11°, 95% CI 1.06-3.16, p < .00001).

CONCLUSIONS

sCAIP is associated with superior accuracy compared to PGIP and FHIP.