Maxillary and mandibular immediately loaded implant-supported interim complete fixed dental prostheses on immediately placed dental implants with a digital approach: A clinical report

A fully digital protocol to provide a fixed interim complete denture for immediate loading for a completely edentulous patient: A dental technique

Complete arch immediate-loading implant-supported prostheses can represent a major challenge for the patient and the dental team. Obtaining stable references and an accurate occlusal record after implant placement to provide an interim prosthesis is a difficult task and can deviate from the initial treatment plan. The described technique presents a fully digital protocol to provide an immediate complete arch implant-supported fixed interim prosthesis for edentulous patients by making postoperative cone beam computed tomography and intraoral digital scans that correlate with the previous plan.

Complications related to digital technologies in treating edentulous patients with dental implants-Part II. Computer-guided surgery and prosthetic stages

This is the second part of a JPD Digital presentation focusing on commonly seen complications and solutions related to using digital technologies in treating edentulous patients during the surgical and prosthetic stages. The proper usage of the computer-aided design and computer-aided manufacturing surgical templates and immediate loading prosthesis during computer-guided surgery and accurate translation of digital planning into clinical execution are discussed. In addition, design concepts of implant-supported complete fixed dental prostheses are presented to minimize subsequent issues in their long-term clinical service. In concert with these topics, this presentation will allow clinicians to deepen their understanding of the advantages and limitations of utilizing digital technologies in implant dentistry.

Screw-Retained Surgical Guide for Implant Placement in Terminal Dentition Patients With Existing Implants

For patients with existing implants in need of additional implant placement, the use of the existing implants for guide fixation seems to be a logical alternative. Current options for the fabrication of surgical guides involve creating surgical guides that are mucosa-borne and/or retained by fixation pins. Since these existing techniques involve inherent inaccuracies, the fabrication of surgical guides that are screw-retained at the implant- or abutment-level would eliminate the introduction of those same fundamental inaccuracies. The purpose of the present technical report is to illustrate a step-by-step digitally planned guided implant placement protocol for terminal dentition patients with salvageable existing implants requiring full-arch implant rehabilitation. The advantages of this protocol include enhancing the accuracy of guided implant placement with screw-retention vs the traditional mucosa- or fixation pin support. Thus, this simplifies the transition from failing teeth to implants by ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol can also predictably reduce chairside time and adjustments at the surgical implant placement appointment. This article is protected by copyright. All rights reserved.

Open-sleeve templates for computer-assisted implant surgery at healed or extraction sockets: An in vitro comparison to closed-sleeve guided system and free-hand approach

OBJECTIVE

A buccal opening guide provides better view and better irrigation. The aim of this study was to investigate the accuracy of this open-sleeve system.

MATERIAL AND METHODS

Thirty duplicated maxillary models, each with 6 extraction sockets and 4 healed sites, were used. Based on the same digital plan, three modalities, sCAIS with open-sleeves, closed-sleeves, and free-hand approach, were used to place implants. The global, horizontal, depth, and angular deviations between the virtual and actual implant positions were measured.

RESULTS

Both sCAIS groups exhibited better accuracy than the free-hand group in two clinical scenarios. At healed sites, the closed-sleeve group showed a significantly fewer error than the open-sleeve group in global apical (0.68 ± 0.33 vs. 0.96 ± 0.49 mm), horizontal coronal (0.28±0.15 vs. 0.44±0.25 mm), horizontal apical (0.64±0.32 vs. 0.94±0.48 mm), and angular deviations (1.83 ± 0.95 vs. 2.86 ± 1.46°). For extraction sockets, the open-sleeve group exhibited fewer deviations than the closed-sleeve group in terms of global (coronal: 0.77 ± 0.29 vs. 0.91 ±0.22 mm; apical: 1.08 ± 0.49 vs. 1.37 ±0.52 mm), and horizontal (coronal: 0.60±0.24 vs. 0.86±0.20 mm; apical: 0.95±0.50 vs. 1.32±0.51mm) deviations. However, the closed-sleeve group was more accurate in the depth control (0.26 ± 0.20 vs. 0.40 ± 0.31 mm).

CONCLUSION

In this in vitro investigation, open-sleeve sCAIS proved better accuracy than free-hand surgery for both delayed and immediate implant placement. Compared with a closed-sleeve sCAIS system, open-sleeve have the potential of providing better outcomes in extraction sockets but not in healed sites.

Digital Workflow in Implant Treatment Planning For Terminal Dentition Patients

Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the new orientation of the occlusal and esthetic plane as well as the change of vertical dimension of occlusion (VDO), while the fixed provisionalization using a digital workflow, still tends to be considered complex and hard to perform. This article illustrates step-by-step the utilization of a digital workflow protocol in the treatment planning for rehabilitation of terminal dentition patients, simplifying the smile design and ensuring that fixed provisionalization serves both the functional and esthetic requirements. This protocol includes facially-driven, three-dimensional (3D) digital smile design and chairside mock-up restoration workflows that enable prosthetically-driven assessment prior to implant treatment planning and 3D printing of surgical templates, which can predictably reduce chairside time and adjustments at the surgical and fixed provisionalization appointment. This article is protected by copyright. All rights reserved.

Comparison of conventional and digital workflow for dental rehabilitation with a novel patient-specific framework implant system: an experimental dataset evaluation

Purpose

This study aimed to evaluate the efficiency of a digital workflow by comparing the accuracy of prosthetic teeth positioning between virtual standard-size digitally constructed and conventional dental laboratory-fabricated prostheses.

Methods

Twenty-five computed tomography datasets with a dentate upper jaw were selected after applying inclusion criteria to 100 random datasets obtained from the institutional library, and partially edentulous maxillae were constructed virtually. Digital datasets of temporary prostheses were fabricated on these virtually constructed edentulous maxillae in two ways: one dataset comprised prostheses that were fabricated conventionally using prosthetic teeth and wax in the dental laboratory and then scanned using a model scanner, whereas the other dataset was designed virtually using standardized virtual dental arches. The digital datasets of both prostheses were compared for differences at six dental-based measurement points with the original patient dentition.

Results

Overall, the conventional design pathway was more accurate than the digital one (conventional 2.915 ± 1.388 mm, digital 3.609 ± 2.052 mm, P < 0.001). However, when all six measurement points were evaluated individually, only three points showed significant differences in the tooth positions. Compared with the original dentition, the deviations were less in the anterior teeth region than in the molar region, fulfilling the esthetic expectations of the patients. Standardized virtual dental arches were practically adequate because virtual reconstruction of every edentulous case using these virtual arches was possible without any additional modifications.

Conclusion

It is possible to fabricate clinically acceptable temporary prostheses using a comprehensive digital workflow based on standardized digital dental arches.

Prosthetic articulator-based implant rehabilitation virtual patient: A technique bridging implant surgery and reconstructive dentistry

This technique report describes a fully digital workflow to create a prosthetic articulator-based implant rehabilitation (PAIR) virtual patient for complete-arch or complete-mouth implant rehabilitation. This workflow uses a custom gothic arch tracer during the cone beam computed tomography (CBCT) scan and a 3-dimensional virtual facebow when superimposing data. The PAIR virtual patient possesses reliable centric relation and vertical dimension of occlusion and is compatible with virtual articulators. Computer-aided implant planning and a digital prosthetic design can be seamlessly integrated by using this virtual patient.

Computer-assisted implant placement and full-arch immediate loading with digitally prefabricated provisional prostheses without cast: a prospective pilot cohort study

BACKGROUND

Immediate loading of implant-supported full-arch rehabilitations has become routine practice when treating edentulous patients. The combination of static computer-aided implant surgery (s-CAIS) and digital prosthetic workflow could eliminate several treatment steps and facilitate prostheses delivery. The aim of this study is to evaluate the 1-year results of digitally prefabricated polymethyl methacrylate (PMMA) provisional prostheses without a cast for full-arch computer-assisted immediate loading.

MATERIALS AND METHODS

A digital pre-operative treatment planning was realized for all patients: dental implants and screw-retained abutments were selected in the planning software and two surgical templates were fabricated for each patient. The first template was mucosa or teeth-supported to drill the holes for fixating pins, while the second template was placed after raising a full-thickness flap and was supported by pins as well as soft or hard tissue distal support. Furthermore, based on the surgical planning, interim prostheses were digitally designed and milled of PMMA resin blocks with subsequent pink resin veneering. Osteotomies and implant placement were performed through the surgical guides and all implants were immediately loaded with prefabricated full-arch interim prostheses directly connected to titanium copings with a flowable resin.

RESULTS

A total of 55 dental implants were placed in ten patients. In all cases, interim prostheses allowed the insertion of titanium copings without the need of access hole enlargement or adaptation. All the prostheses had 1 year of functional loading to simulate the long provisional phase. No screw loosening occurred at the first removal of the prostheses after implant osseointegration. No fracture occurred during the whole period. After 1 year, the mean marginal bone loss level was 0.37 ± 0.06 mm, while the implant survival rate was 98.18% (n=54/55), with just one implant failing but not affecting final prosthesis delivery to the patient.

CONCLUSIONS

Within the limitations of the present study, the authors concluded that digitally prefabricated provisional prostheses for full-arch immediate loading with s-CAIS could be a valid alternative treatment modality. Milled PMMA restorations proved to be durable enough during the long provisional phase, without prosthetic complications.

Esthetic treatment planning with digital animation of the smile dynamics: A technique to create a 4-dimensional virtual patient

A method is presented for obtaining a virtual 4-dimensional patient that replicates the intended esthetic treatment. The process involves facial and intraoral scanning to acquire records and software manipulation to enable a virtual waxing of the smile. Once the digital design is complete, patient information can be merged to generate an animated video of the projected rehabilitation, displaying movement and smile dynamics. This strategy provides a noninvasive and reliable diagnostic tool for predicting clinical outcomes.

Use of a digitally guided triple technique for bone reduction, implant placement, and immediate interim prostheses in complete-arch implant surgery

A digitally guided triple technique for bone reduction, implant placement, and immediate interim prostheses in complete-arch implant surgery is presented. This technique integrates bone reduction and implant placement information into a dual-function surgical template and introduces a digital approach to fabricating immediate interim implant-supported fixed dental prostheses with the same occlusal relationship as the one evaluated with diagnostic removable prostheses.

Immediately loaded interim complete-arch implant-supported fixed dental prostheses fabricated with a completely digital workflow: A clinical technique

A digital method for delivering an immediately loaded interim complete-arch implant-supported prosthesis is described. Reference pins were used to accurately superimpose a postoperative scan with the scan bodies in place on a preoperative scan with the framework design, including the interocclusal relationship and the occlusal scheme. A prefabricated auxiliary device was used after surgery to record the position of the implants and after scanning to obtain an accurate transfer of the implant positions by means of a free software program, allowing an excellent fit of the fabricated prosthesis. This technique can help in the fabrication of an interim prosthesis with better fit and comfort and reduced chair time than conventional techniques.

Digital workflow for predictable immediate loading in the mandible by using a shape memory dental implant abutment system: A clinical report

Digital surgical planning for immediately loaded dental implants can be a predictable and accurate procedure, with the interim prosthesis also designed digitally. If the planning and execution are meticulous, chairside adjustments can be minimized because the outcome should be closely matched to the proposed digital plan. A novel dental implant abutment system made from a shape memory metal could be an answer to the cement versus screw controversy as it uses neither. This new system can provide patients with better esthetics and is biologically favorable.

Polyetherketoneketone (PEKK), a framework material for complete fixed and removable dental prostheses: A clinical report

This clinical report demonstrates the use of polyetherketoneketone (PEKK) as a framework material with individually luted heat-pressed lithium disilicate glass-ceramic crowns for an implant-supported complete fixed dental prosthesis (ICFDP) and a conventional complete removable dental prosthesis (CRDP). This prosthesis design provides a non-computer-aided design and computer-aided manufacturing (CAD-CAM) option for the fabrication of ICFDPs and CRDPs with individualized ceramic crowns for optimal esthetics. The performance of PEKK as a framework material needs to be assessed in clinical trials.

Use of a CAD-CAM poly(methyl methacrylate) interim prosthesis for direct intraoral splinting

This article describes a technique where an interim computer-aided design and computer-aided manufacturing (CAD-CAM) prosthesis is milled from a poly(methyl methacrylate) blank to confirm esthetics, occlusion, function, phonetics, and accessibility for oral hygiene. The interim prosthesis is then sectioned and reconnected intraorally with autopolymerizing acrylic resin. This interim prosthesis is used to fabricate the definitive stone cast. The interim prosthesis is then scanned with a laboratory scanner. By applying this technique, the implant positioning can be related to the occlusal plane, the contours of the teeth, and the flange. The clinician can more effectively design the definitive prosthesis because the location of the implants and the exact contours of the teeth are all captured in a single digital file.