A fully digital approach for implant fixed complete dentures: A case report

Digital workflow for definitive immediately loaded complete arch CAD-CAM implant-supported prosthesis in 3 appointments without using intraoral scanning

This article presents a rapid technique for the accurate transfer of implant positions immediately after image-guided surgery to enable the immediate installation of a definitive complete arch implant-supported prosthesis with an implant biological width of 3 mm within 3 appointments. A sleeveless copy of the implant surgical guide is magnetically connected to a reference guide to ensure the accurate capture of cylindrical titanium transfer abutments. In the laboratory, the sleeveless guide with the splinted transfer abutments attached is used to generate a definitive cast to be scanned with a desktop scanner. The resulting digital definitive cast is then combined with the original meshes of the prosthetically driven virtual treatment plan to enable a definitive computer-aided design and computer-aided manufactured prosthesis to be fabricated and installed with passive fit.

Conventional and digital maxillary occlusal record for the manufacture of complete-arch implant-supported fixed prostheses: randomized controlled clinical trial

OBJECTIVES

To evaluate the trueness of the digital maxillary occlusal records in comparison with the conventional records for the fabrication of complete-arch implant-supported fixed prostheses.

MATERIALS AND METHODS

This randomized controlled clinical trial followed the recommendations of the CONSORT statement. Twenty participants who used a mandibular interim complete-arch fixed prosthesis and conventional complete maxillary dentures were included in the study. The participants were randomized into two types of maxillary occlusal records: conventional (COR) and digital (DOR) (TRIOS; Shape A/S). After fabricating the prostheses, the distribution and number of occlusal contact points, and the time taken to obtain the maxillary occlusal record and work model were evaluated. Descriptive analysis was used to evaluate the distribution of occlusal contact points. The Wilcoxon test was employed for assessing the number of occlusal contact points, while the Mann-Whitney U test was used for the time taken to obtain the working casts and the maxillary occlusal record and occlusal adjustment times (p < 0.05).

RESULTS

There was a similarity in the jaw relation recording methods regarding the distribution of occlusal contact points. There was no difference in the number of occlusal contact points between the anterior (p = 0.439) and posterior (p = 0.227) teeth. No relationship was observed between the distribution and number of occlusal contact points (COR, p = 0.288; DOR, p = 0.183). DOR required less occlusal and clinical adjustment time, on the other hand more laboratory and total workflow time than COR (p < 0.001).

CONCLUSION

The DOR may be an option for obtaining the functional space necessary for the assembly of teeth in complete-arch implant-supported fixed prostheses; however, it requires more working time.

CLINICAL RELEVANCE

The digital occlusal recording method can be used to assess the interocclusal space for the virtual tooth setup of a complete-arch implant-supported fixed prosthesis.

The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-Arch Implant Restoration

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

Influence of scanbody design and intraoral scanner on the trueness of complete arch implant digital impressions: An in vitro study

This study aimed to compare the accuracy of full-arch digital implant impressions using seven different scanbodies and four intraoral scanners. A 3D-printed maxillary model with six implants and their respective multi-unit abutments was used for this study. Seven scanbodies (SB1, SB2, SB3, SB4, SB5, SB6, and SB7) and four intraoral scanners (Primescan®, Omnican®, Trios 3®, and Trios 4®) were assessed. Each combination group was scanned ten times and a dental lab scanner (D2000, 3Shape) was used as a reference. All scans were exported as STL files, imported into Convince software (3Shape) for alignment, and later into Blender software, where their 3D positions were analyzed using a Python script. The 3D deviation, angular deviation, and linear distance between implants #3 and #14 were also measured. Accuracy was measured in terms of "trueness" (scanbody 3D deviation between intraoral scan and desktop scan). Kruskal-Wallis followed by the Bonferroni correction was used to analyze the data (⍺ = .05). The study found statistically significant differences in digital impression accuracy among the scanners and scanbodies (p<0.001). When comparing different intraoral scanners, the Primescan system showed the smallest 3D deviation (median 110.59 μm) and differed statistically from the others, while Trios 4 (median 122.35 μm) and Trios 3 (median 130.62 μm) did not differ from each other (p = .284). No differences were found in the linear distance between implants #3 and #14 between Trios 4, Primescan, and Trios 3 systems. When comparing different scanbodies, the lowest median values for 3D deviation were obtained by SB2 (72.27μm) and SB7 (93.31μm), and they did not differ from each other (p = .116). The implant scanbody and intraoral scanner influenced the accuracy of digital impressions on completely edentulous arches.

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.