Virtual Implant Planning and Surgical Guide for Single Implant Placement Fabricated from a Digital Diagnostic Cast, 2-dimensional Radiographic Imaging, and an Open-source Program: A Dental Technique.

A technique for virtually planning single implant by combining an intraoral digital scan, an opensource computer-aided design software program, bone sounding, and 2-dimensional radiographic imaging is described. The surgical implant guide is fabricated by using additive manufacturing technologies. Furthermore, the surgical implant guide positioned in the patient's mouth is used to radiographically verify the estimated mesio-distal implant angulation before proceeding with the surgical intervention and modified, if necessary. When a cone bean computed tomography scan is not available, this technique eases implant planning procedures and minimize possible surgical complications.

Novel "All in 4-4-4" Hybrid Prosthesis: Bridging the Affordability Gap.

A strong body of scientific evidence indicates that a four dental implant-supported prosthesis is well suited for a full-arch rehabilitation. Yet, countless edentulous patients who could benefit from this established concept are left untreated because of high costs. This article describes a novel workflow that enables the fabrication of a metal-resin fixed hybrid prosthesis supported on four implants, with a variable cost for parts and material of around $400 and a (laboratory) production time of approximately 4 hours. This approach allows for the possibility of delivering a final or long-term provisional restoration on the day of implant placement. Because of the relatively low cost and the feasibility of in-house production, this workflow can potentially allow more patients to access high-quality full-arch implant care.

ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes.

OBJECTIVES: The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants. MATERIALS AND METHODS: Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds. RESULTS: A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants. CONCLUSIONS: Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.

An open-source multifunctional registration device for implant-supported complete dentures.

A 3D printed registration device is described for implant-supported complete dentures that simultaneously register implant position, soft-tissue contour, anterior tooth position, occlusal vertical dimension, and centric relation. This information is captured clinically in 10 to 20 minutes and can then be transferred to the dental laboratory technician to continue the prosthetic workflow. The standard tessellation language (STL) file for the registration device is available for free download and use.

Workflow for a metal-resin-zirconia fixed complete denture: A dental technique.

The hard- and soft-tissue replacement materials in the traditional workflow for an implant fixed complete denture are acrylic resin and conventional resin denture teeth supported by a rigid substructure. A novel technique is described combining a modified digital complete denture workflow with analog components and systems, allowing the use of multicolored zirconia and 3D-printed resin. In combination with an appropriate metal substructure, a high-quality prosthesis can be fabricated with reduced effort and cost.

An Analog Intermezzo in a Digital Workflow.

Digital dental technology has revolutionized the workflows in the dental laboratory and clinical environment. Although the novelty of digital dentistry can be alluring, clinicians should bear in mind that the overall outcome is what matters most rather than the path taken to achieve that outcome. Combining analog and digital pathways can serve to amplify each one and thus enhance the result. This article presents two case examples where an analog excursion in an otherwise digital workflow saved time and reduced cost compared to a dogmatic digital approach. In one case, an alternative workflow is presented to produce implant fixed complete dentures, and in the other case composite was used to generate the pink esthetic component for a complete denture, which could be fixed or removable.

A prefabricated modular substructure for a 4-implant-supported fixed complete denture: A dental technique.

A substructure is required for an implant-supported fixed complete denture that is sufficiently strong and supportive to function reliably. A novel prefabricated modular system that allows for the analog generation of a passively fitting, supportive, titanium framework for a 4-implant fixed complete denture is described. The process allows the delivery of an immediate, definitive prosthesis on the same or the next day.

The Metal-Zirconia Implant Fixed Hybrid Full-Arch Prosthesis: An Alternative Technique for Fabrication.

The metal-resin hybrid full-arch prosthesis has been a traditionally used type of restoration for full-arch implant fixed dentures. A newer development has centered around the use of monolithic zirconia or zirconia veneered with porcelain. Being a ceramic, zirconia has the potential for fracture. This article describes a technique that utilizes a metal substructure to support a chemically and mechanically resinbonded shell of zirconia. The workflow is discussed, ranging from in-office master cast fabrication to the CAD/ CAM production of the provisional and the definitive metal-zirconia prosthesis. The article also highlights the advantages and disadvantages of various materials used for hybrid prostheses.

A Customized Healing Abutment for Immediate and Delayed Implant Cases.

Anatomically contoured healing abutments have been shown to contain and protect slow-resorbing substitution grafts, resulting in bone and soft-tissue volume augmentation. Even in healed sites customized healing abutments have demonstrated favorable outcomes compared to standard healing abutments. Through two separate cases, this article describes a technique that enables simple chairside fabrication of precisely contoured customized healing abutments and exact 3-dimensional intraoral positioning. With this technique, the soft tissues upon maturation closely resemble the natural root contour, which allows for the generation of esthetic and functional implant-supported restorations.

In-office fabrication of a definitive cast and duplication of an interim implant-supported fixed acrylic resin complete denture.

The information contained in an interim implant-supported fixed acrylic resin complete denture is a starting point for fabricating the definitive restoration. Duplicating this information in an expedient, precise, and sanitary fashion is desirable so that the interim restoration can be returned to the waiting patient. A technique is described to fabricate an accurate definitive polyvinyl siloxane cast with laboratory analogs bonded to a prepolymerized, dimensionally stable, composite resin baseplate. A screw-retained polyvinyl siloxane duplication of the interim denture is related to this cast. This combination allows for most of the relevant information of the interim denture to be communicated to the dental laboratory.

Simplified fabrication of an implant-supported framework with luted abutment cylinders.

A technique is described to generate a framework for an implant-supported fixed complete denture. The main advantage of the described technique is the low production cost of a framework that has high strength, passive fit, and distinct retentive structures for each denture tooth.

Development and capture of soft tissue contours at time of implant placement.

A technique is described which will generate a customized healing abutment for a dental implant to allow the development of ideal soft tissue contours. With implant position and soft tissue contours defined at surgery, customized impression techniques can be used to capture those details and help generate the definitive implant-supported restoration. This workflow reduces the number of patient visits.

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides.

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

An adjustable, cast based, fully restrictive surgical guide.

The 3D Click Guide is a fully restrictive cast-based surgical guide for the placement of dental implants. This in-office system consists of prefabricated parts that are assembled onto a carrier. The 3-dimensional data are derived from a dental cast in combination with a periapical radiograph or cone-beam computed tomography data.

A simple, safe and affordable cast-based guided implant placement system.

A fully restrictive surgical guide allows controlled execution of a preoperatively planned osteotomy and subsequent implant placement. There are two fabrication modes. One is a digital path, where these guides can be fabricated based on data from a cone beam CT source. Alternatively, 3-D data can be derived from a dental cast and periapical radiographs. The 3D Click Guide is a cast-based, fully restrictive surgical guide that can be generated in the dental office.

Congruency of stereo lithographically produced surgical guide bases made from the same CBCT file: a pilot study.

PURPOSE: This is a pilot study evaluating the effect of the algorithms and production processes of four commercial manufacturers of stereolithographically produced surgical guide. MATERIALS AND METHODS: A singular Dicom file was used to produce six distinct duplicate dentures, which function as the base for surgical guides. The duplicate dentures were repeatedly fitted (n = 10) into an impression of the occlusal surface of the original scan appliance. The gaps between the incisal edge of teeth #8 and #9 and the corresponding imprints in the vinyl polysiloxane impression were photographed, digitally recorded, and measured in a blinded fashion. RESULTS: Nobel Biocare mean was 0.56 mm (range 0.49-0.65), I-dent mean was 0.57 mm (range 0.31-0.74), Materialise II mean was 1.12 mm (range 0.90-1.40), Blue Sky Bio II mean was 1.13 mm (range 0.93-1.35), Materialise I mean was 1.43 mm (range 1.21-1.86), and Blue Sky Bio I mean was 2.17 mm (range 2.06-2.34). The difference between the fit of the Nobel Biocare and the I-dent guide bases and the guide bases from Materialise and Blue Sky Bio is statistically significant (p < .05). CONCLUSION: The algorithms and production processes of the different manufactures do influence the congruency outcome of the produced surgical guide bases. Within the limits of this study, we were unable to produce a perfect fit, although some duplicate dentures showed minimal errors. The implications of the discrepancies need further study.

Deformation of stereolithographically produced surgical guides: an observational case series report.

BACKGROUND: Template-based computer-guided implant placement holds the promise of more precise and less traumatic placement of dental implants. Errors in the fabrication process of the surgical guide may lead to unfavorable clinical outcomes. PURPOSE: This report discusses the potential of unintentional volumetric deformation of stereolithographically (SLA) produced surgical guides (NobelGuide, Nobel Biocare AB, Göteborg, Sweden) compared with the original scan denture. MATERIALS AND METHODS: Three-dimensional radiographic data acquired by medical computerized tomography (CT) or cone beam CT (Newtom 3G, AFP Imaging Corporation, Elmsford, NY, USA) can be utilized in specialized software to develop treatment planning for dental implant placement. This information can then be transferred to the patient via a surgical guide. Stereolithography is a rapid prototyping process that can be used to create such a guide stent. Three cases are shown describing different levels of deformation of SLA-produced surgical guides. RESULTS: Unintentional deformation of SLA-produced surgical guides is possible. Deformation of surgical guides can create dissimilarity between the virtually planned position and the actual position of the implants. CONCLUSION: Incorrect setting of the ISO values for the segmentation of the scan denture has been found to be a factor in the deformation of SLA-produced surgical guides, although more, at this time known but also less understood, issues appear to be involved. Only one manufacturer's product is discussed; further research is warranted to determine if the discrepancies are process or product based. It might be prudent to closely evaluate the volumetric congruence of SLA-produced surgical stents before their clinical use to prevent undesired clinical outcomes.

Cast-based guided implant placement: a novel technique.

One of the most challenging aspects of implant placement is the correct spatial positioning of the dental implant in the bone. Surgical guides of various configurations have been proposed to aid implant placement. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes a combination of analog techniques, including bone sounding and periapical radiographs used to study the available bone volume. A simplified casting protocol is proposed, and the implant platform position of the implant analog is transferred to a surgical guide composed of a stiff vinyl polysiloxane material. This surgical guide is used in a conventional flapless guided implant surgery protocol. This combination of techniques allows precise placement of a dental implant, abutment, and provisional restoration in a minimally invasive manner.

An indirect immediate-load prosthetic protocol using a novel-winged analog.

UNLABELLED: Immediate loading of implants has increasingly become the preferred treatment modality for both patients and clinicians. While the concept has been accepted as the preferred method of treatment, there are various options in terms of completing the actual procedure. This article will discuss the utilization of a novel-winged analog in combination with polyvinylsiloxane-casting material. This correlation allows for the rapid chairside development of a high-precision cast. On this cast, a conversion denture is transformed into an interim fixed prosthesis. Both the conventional analog as well as the computer-guided protocols will be described herein. LEARNING OBJECTIVES: This article discusses a simplified, indirect method for placing an interim fixed prosthesis utilizing a novel-winged analog and polyvinylsiloxane casting material. Upon reading this article, the reader should: Understand the benefits attributed to the immediate loading of dental implants. Become familiar with the differences between conventional open-flap surgery and treatment protocol utilizing CAD/CAM technology.