Surgical guides for flapless dental implant placement and immediate definitive prosthesis installation by using selective laser melting and sintering for 3D metal and polymer printing: A clinical report.

Integration between the phases of computer-based guided dental implant surgery can be used to optimize oral rehabilitation. Two new surgical guides prepared by using the 3D metal and polymer printing technology are presented for immediate implant loading and definitive fixed prosthesis construction in flapless dental implant surgery. Nine implants and 2 fixed prostheses were installed in 2 completely edentulous adult patients by using a metallopolymer surgical guide with a metal central bar attached to a polymer seal or a metal guide. Virtual planning was used to design the 3D-printed surgical guides, which were then constructed by using selective laser sintering (SLM) and selective laser melting (SLS). The 3D-printed surgical guides oriented the surgical placement of the implants and were welded to the abutments and attached to the denture framework. The technique allowed implants and prostheses to be installed on the same day.

A selective laser sintering prototype guide used to fabricate immediate interim fixed complete arch prostheses in flapless dental implant surgery: Technique description and clinical results.

STATEMENT OF PROBLEM: Extensive occlusal adjustments and misfit of the prosthesis to prosthetic components are frequent problems related to fixed interim prosthesis fabrication with immediate dental implant loading. PURPOSE: The purpose of this clinical trial was to evaluate a prosthetic guide made with a rapid prototype model based on virtual surgical planning. This prosthetic guide was used to fabricate fixed interim prostheses that would allow immediate implant loading after computer-guided implant installation. MATERIAL AND METHODS: Nine interim prostheses were made for 9 participants with complete maxillary or mandibular edentulism. The virtual prosthetic guide was planned using computer-assisted design (CAD) software and was fabricated with rapid prototyping equipment (selective laser sintering). The prosthetic guide had 3 portions: the occlusal portion, which had occlusal registration; the connection portion, which had the information of the position and angulation of the abutment/implant projection; and the mucosa portion, which had the registration of the alveolar mucosa architecture. The prosthetic guide was used by a dental technician to fabricate prostheses. A single trained examiner evaluated the passive fit of the interim prostheses, the average time required for installing the interim prosthesis and for occlusal adjustments, the satisfaction of the patient with the prosthesis; and the screws, torque, occlusion, and prosthesis status. RESULTS: Passive fit was achieved between the prosthetic components and prostheses in 7 participants. The average time required for installing the fixed interim prostheses was 64.44 minutes. All participants reported being more pleased with the fixed interim prosthesis than with the prosthesis worn before implant placement. Prosthesis fractures were observed in 3 participants (2 in the maxilla and 1 in the mandible); all fractures occurred 3 months or more after delivery. No further complication was observed during 6 months of follow-up. CONCLUSIONS: The prosthetic guide enabled fabrication of interim immediate prostheses that were easily seated and adjusted to accommodate any shifts in implant position occurring during computer-guided surgery. Immediate implant loading could be achieved in a reasonable operative time.