Computer-Aided Crown Design Using Digital Scanning Technology for Immediate Postextraction Single-Implant Restorations Supported by Conical Indexed Abutments.

Conical retention with antirotational features (Acuris abutment) has been recently proposed for restorations of healed single implants. The conometric abutments use the retentive force of the coping-abutment system to retain the prosthetic crown without the use of cement or screws. This retentive force must be overcome to obtain detachment of the relined provisional crown in immediate restorations. The present article describes the use of digital scanning technology to virtually plan computer-guided implant placement and restoration with conical indexed abutments in postextraction sites. Importing the scan data of both matrix and patrix abutments that are seated on the definitive cast into the computer-aided design software provides a workflow to preoperatively mill a crown that perfectly fits the abutment into the postextraction site. This technique simplifies the provisional crown relining onto the conometric indexed abutment and reduces the intraoperative time.

Guided-welded approach planning using digital scanning technology for combined screw- and conometric-retained implant-supported maxillary prosthesis.

AIM: The goal of this case series was to evaluate the clinical outcome at the 2-year follow-up of immediately loaded combined screw- and conometric-retained implant-supported full-arch restorations virtually planned using digital scanning technology. MATERIALS AND METHODS: This series included 12 patients presenting hopeless teeth in the maxilla treated with computer-guided flapless implant placement. A total of 72 implants were inserted. All implants were immediately loaded with a complete-arch restoration supported by an intraorally welded framework. Digital scanning technology was used to virtually plan a combined screw and conometric retention of the frameworks. Clinical parameters were assessed at 1 week and at 1, 3, 6, 12, and 24 months follow-up. RESULTS: The survival rate after 2 years was 98.6%, as one implant failed during the osseointegration period. No major prosthetic complications were observed such as issues with mobility, unscrewed abutments, disconnected conometric copings, and prosthetic fracture. Only one patient registered the chipping of a prosthesis. CONCLUSION: Based on the results of the present study, the use of combined screw and conometric retention for fixed immediate restorations properly planned using digital scanning technology seems to be a viable treatment alternative to screw or conometric retention alone for immediately loaded rehabilitations.

Guided-welded approach planning using a computer-aided designed prosthetic shell for immediately loaded complete-arch rehabilitations supported by conometric abutments.

In guided surgery, implants can be planned from radiographic guide information according to a restoratively driven treatment plan. Unfortunately, the palatal or lingual surface of teeth cannot be easily identified. The present article describes the use of a digitally designed prosthetic shell to improve the accuracy of guided-welded approach planning for immediate restorations supported by conometric abutments. Importing the virtual shell into the planning software provides an effective protocol for using the definitive prosthetic space information to plan the framework shape and position predictably. This method increases the accuracy of virtual planning and reduces the time needed to reline the prosthetic shell.

Accuracy of Computer-Guided Flapless Implant Surgery in Fully Edentulous Arches and in Edentulous Arches With Fresh Extraction Sockets.

PURPOSE: The aim of this study was to evaluate the accuracy of computer-guided flapless implant (CGFI) surgery in edentulous jaws with fresh extraction sockets and compare it to CGFI in fully edentulous jaws. MATERIALS AND METHODS: Ten patients with a completely edentulous arch (group A) and ten patients presenting natural teeth with a hopeless prognosis in the upper or lower jaw (group B) were consecutively treated with CGFI. A multipiece radiographic guide was fabricated for group B patients. The accuracy was assessed by matching the planning cone-beam computed tomography (CBCT) with a postoperative CBCT. Global coronal, global apical, angular deviation, and depth deviation were registered. RESULTS: The mean global coronal deviation for group A was 1.12 ± 0.5 mm, the mean global apical deviation was 1.36 ± 0.7 mm, the mean angular deviation was 3.16 ± 1.8 degrees, and the mean depth deviation was 0.51 ± 0.7 mm. The mean global coronal deviation for group B was 1.28 ± 0.6 mm, the mean global apical deviation was 1.65 ± 0.7 mm, the mean angular deviation was 3.42 ± 1.5 degrees, and the mean depth deviation was 0.53 ± 0.9 mm. Global apical deviation was significantly higher in the group B (P = 0.007). CONCLUSION: CGFI surgery in edentulous arches with fresh extraction sockets may be accurate. However, clinicians should be aware that higher apical deviation may occur in this setting.

Implementation of computer-guided implant planning using digital scanning technology for restorations supported by conical abutments: A dental technique.

Conometric retention has recently been proposed as an alternative to cement- or screw-retention for fixed restorations. Conometric copings can only compensate for slightly nonparallel placement without interfering with retention. This article describes a method of using digital scanning technology to facilitate computer-guided implant planning when an immediate restoration supported by conical abutments is planned with a guided-welded approach. The procedure involves importing the scan data of the conometric coping and of the definitive cast obtained from the surgical template into the implant planning software. This approach increases the accuracy of computer-guided implant planning and reduces the time needed for the surgery.

Use of Intraoral Welding to Increase the Predictability of Immediately Loaded Computer-Guided Implants.

Inaccuracy of computer-guided implant placement may lead to complications when combined with an immediately loaded prefabricated prosthesis. The aim of this case series was to describe the use of an intraoral welding technique to increase the predictability of immediately loaded implants supporting a fixed full-arch prosthesis after computer-guided flapless implant placement. A total of 60 Ankylos plus implants (Dentsply) with a width of 3.5 mm and a length of 8 to 14 mm were placed consecutively in 10 patients. The implants were functionally loaded using the intraoral welding technique on the day of surgery. The accuracy of guided implant placement was assessed by matching the planning cone beam computed tomography (CBCT) scans with postoperative CBCT scans. No mechanical or biologic complications were registered at the 1-year follow-up. The global coronal deviation of implant placement from the guide plan ranged from 0.25 to 2.84 mm (SD: 0.6 mm), with a mean of 1.28 mm. Average angle deviation was 3.42 degrees (range 0.38-7.82 degrees; SD: 1.52 degrees). The global apical deviation ranged between 0.36 and 3.85 mm (SD: 0.71 mm), with a mean of 1.65 mm. Despite the inaccuracy registered, this guided-welded approach allowed successful achievement of a passive fit of the full-arch prosthesis on the inserted implants the same day of the surgery and provided a high implant and prosthetic survival rate at the 1-year follow-up.

Computer-assisted surgery and intraoral welding technique for immediate implant-supported rehabilitation of the edentulous maxilla: case report and technical description.

BACKGROUND: Complications are frequently reported when combining computer assisted flapless surgery with an immediate loaded prefabricated prosthesis. The authors have combined computer-assisted surgery with the intraoral welding technique to obtain a precise passive fit of the immediate loading prosthesis. METHODS: An edentulous maxilla was rehabilitated with four computer assisted implants welded together intraorally and immediately loaded with a provisional restoration. RESULTS: A perfect passive fit of the metal framework was obtained that enabled proper osseointegration of implants. Computer assisted preoperative planning has been shown to be effective in reducing the intraoperative time of the intraoral welding technique. No complications were observed at 1 year follow-up. CONCLUSIONS: This guided-welded approach is useful to achieve a passive fit of the provisional prosthesis on the inserted implants the same day as the surgery, reducing intraoperative time with respect to the traditional intraoral welding technique. Copyright © 2015 John Wiley & Sons, Ltd.

Immediately Loaded Intraorally Welded Complete-Arch Maxillary Provisional Prosthesis.

Guided implant surgery is not completely accurate when using computer-designed stereolithographic surgical guides. Complications are frequently reported when combining computer-guided flapless surgery with an immediately loaded prefabricated prosthesis. Achieving passive fit of a prefabricated prosthesis on the inserted implants the same day of the surgery can be difficult. The aim of this report is to show a new treatment approach to immediately loaded implants inserted with computer-guided surgery using an intraoral welded full-arch provisional prosthesis.

Buccal plate regeneration with immediate postextraction implant placement and restoration: case reports.

The loss of the buccal alveolar plate following tooth extraction in the maxillary anterior region is an especially challenging condition for the clinician. Immediate implant placement with a flapless approach has been suggested in order to reduce postextraction bone loss. In the presence of a significant vertical gap in the buccal plate after tooth extraction, most authors still recommend a bone augmentation procedure before implant placement. In these reports, buccal bone plate regeneration was obtained through a flapless approach and immediate postextraction implant placement with a cancellous bone and collagen graft in the buccal gap.