Computer-assisted prosthetic planning and implant design with integrated digital bite registration: a treatment protocol.

The aim of this clinical study is to present an integrated digital project through the description of a clinical case, made entirely in digitized form, taking advantage of the opportunity offered by instrumental diagnostic software. A case report participant is a 65-year-old female patient presents with loss of diffuse bone support, caused by periodontal disease. After a sign of an informed consent and an explication of a plan of treatment, technical intraoral and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Smile Lynx Software and the scanner stereolithographic (STL) file was matched into the CAD Lynx to obtain a virtual previsualization of teeth and smile design, and to mill the provisional and the definitive crowns. The digital prosthetic design allows the evaluation of the dental parameters in relation to the parameters of the patient's face for the new prosthetic project and the radiological examination using CBCT guides the insertion of the fixtures for the rehabilitation phase. The surgical and prosthetic design are subsequently integrated. The evaluation of the bone bases is carried out with a radiological diagnostic software for CT (Real Guide 5.0-3Diemme, Cantù-Italy) which can virtually design the implant insertion. The functional examination of the patient is carried out through an occlusion-postural examination that uses digital electromyographic assessments. The integrated digital protocol proposal inserts in the rehabilitation path the digital recording of the free mandibular movement, as well as the scan of the patient's face, data that will be integrated into the CAD software for the design of temporary and definitive prosthetic artifacts, made using the CAM method. This study showed guided implant placement and the application of fixed implant-supported prosthetic restorations carried out with a fully digital workflow, dependent on the functional digital evaluation of the patient's occlusion. The proposed protocol described the correct use of digitalization of clinical, surgical, and prosthetic procedures, and the matching of the data into a computerized environment, to improve team communication and to take advantage of the combination of collected data to not lose information using classic manual steps.

Minimally invasive digital implant-prosthetic procedure in "all on 4" rehabilitation in patients with special needs: a three-year follow-up.

The present study describes an innovative procedure for resolving implant-prosthetic cases in patients with edentulous special needs. In 2017 a 56-year-old female patient came to the Department of Dentistry of Vita-Salute San Raffaele Hospital, Milan, Italy, requiring implant-prosthetic rehabilitation of the dental arches given the difficulty in wearing removable prostheses. The first level radiological examinations were evaluated, two technical photographs were taken with specific reference, the 2D Digital Smile Design (Smile Design) was then carried out, the provisional prosthesis was performed and the CBCT requested with repere and provisional prostheses to realize the computerized implant project and an atraumatic flapless guided surgery. Professional oral hygiene sessions were performed quarterly, and the 3-year follow-up revealed no complications affecting the prosthetic or implant component. We can therefore conclude that the proposed method, exploiting digital technologies and flows and minimally invasive flapless surgical methods, can be considered elective in the treatment of patients with special needs.

Accuracy of Edentulous Computer-Aided Implant Surgery as Compared to Virtual Planning: A Retrospective Multicenter Study.

PURPOSE: To evaluate the accuracy of computer-aided dental implant positions obtained with mucosal-supported templates as compared to Three-Dimensional (3D) planning. MATERIALS AND METHODS: One-hundred implants were inserted into 14 edentulous patients using the All-on-4/6 protocol after surgical virtual planning with RealGUIDE, 3DIEMME, and Geomagic software. After 6 months, three-dimensional neck (V) and apex (S) spatial coordinates of implants and angle inclination displacements as compared to virtual plans were evaluated. RESULTS: The S maxilla coordinates revealed a significant discrepancy between clinical and virtual implant positions (p-value = 0.091). The V coordinates showed no significant differences (p-value = 0.71). The S (p-value = 0.017) and V (p-value = 0.038) mandible coordinates showed significant discrepancies between the clinical and virtual positions of the screws. Implant evaluation showed a 1-mm of the horizontal deviation in the V point and a 1.6-mm deviation in the S point. A mean 5° angular global deviation was detected. The multivariate permutation test of the S (p-value = 0.02) confirmed the difference. Greater errors in the mandible were detected as compared to the maxilla, and a higher S discrepancy was found in the posterior jaw compared to the anterior section of both the mandible and maxilla. CONCLUSIONS: Computer-aided surgery with mucosal-supported templates is a predictable procedure for implant placement. Data showed a discrepancy between the actual dental implant position as compared to the virtual plan, but this was not statistically significant. However, the horizontal and angle deviations detected indicated that flap surgery should be used to prevent implant positioning errors due to poor sensitivity and accuracy in cases of severe jaw atrophy.