Three-Year Outcome of Full-Arch Fixed Prosthetic Rehabilitation through the All-on-4® Concept Using Dynamic 3D Navigated Surgery (X-Guided™): A Retrospective Study.

Background/Objectives: The insertion of dental implants using dynamic 3D navigated surgery while applying immediate function protocols for full-arch rehabilitations warrants further research. This study aimed to evaluate the outcomes of All-on-4® rehabilitations using 3D Dynamic navigated surgery (X-Guide™). Methods: This study included 10 patients (women: 7; men: 3; average age: 59.9 years) rehabilitated with full-arch prostheses through the All-on-4® concept, with 48 dental implants inserted using navigated surgery. The primary outcome evaluation was prosthetic/implant cumulative survival (CS), estimated using life tables. Secondary outcome evaluations were marginal bone resorption (MBR), biological complications, and mechanical complications. The evaluation parameters were measured between 1 and 3 years. Results: No patients were lost to follow-up. Two implants (4.2%) were lost in one patient (10%) with smoking habits, resulting in an implant CS rate of 95.8%. The average MBR was 0.51 mm ± 0.62 mm at the 1-year follow-up. The incidence rate of mechanical complications was 40% (n = 4 patients), all occurring in provisional prosthesis. No biological complications were registered. The patients maintained their prostheses in function throughout the follow-up of the study. Conclusions: Within the limitations of this study and based on the results, it can be concluded that the insertion of dental implants assisted by dynamic navigation for full-arch rehabilitation through the All-on-4® concept may be a valid treatment alternative in the short-term follow-up. However, more studies are necessary to validate this treatment modality.

Research progress on accuracy of intraoral digital impressions for implant-supported full-arch prostheses. / æ— ç‰™é¢Œç§æ¤ä¿®å¤å£å† æ•°å­—åŒ–å°æ¨¡å‡†ç¡®æ€§ç ”ç©¶è¿›å±•.

With the rapid development of implant techniques and digital technology, digital impressions have become a commonly used impression method in implant restoration. At present, the accuracy of intraoral digital impressions directly applied to implant-supported full-arch prostheses remains inadequate, which is due to the high accuracy requirement of full-arch implant impressions, while there are still technical challenges in intraoral digital impressions about recognition and stitching. In this regard, scholars have proposed a variety of scanning strategies to improve the accuracy of intraoral scan, including mucosal modifications, auxiliary devices and novel scan bodies. At the same time photogrammetry, as a new digital impression technique, has been developing steadily and exhibits promising accuracy. This article reviews the research progress on the accuracy of edentulous full-arch implant impressions and techniques which can improve the accuracy of intraoral digital impressions, to provide reference for clinical application.

Maxillary and mandibular overdentures retained by two unsplinted narrow-diameter titanium-zirconium implants - A clinical pilot study.

OBJECTIVES: To evaluate the survival rates and marginal bone loss of narrow-diameter titanium-zirconium implants supporting complete maxillary and mandibular overdentures up to 3 years after loading. MATERIALS AND METHODS: Ten completely edentulous patients who were dissatisfied with their complete dentures were enrolled. Two narrow-diameter implants were placed in the canine region of the maxilla and mandible. After second-stage surgery, implant-supported overdentures (palatal-free) attached by parallel alignable stud-attachments were placed. Patients were followed periodically for up to 36 months. Standardized radiographs were taken at baseline, 12 and 36 months to analyze mean marginal bone level changes around the implants. RESULTS: The Kaplan-Meier survival rates were 100% for mandibular and 68.0% (SE ± 10.9%) for maxillary implants at 36 months (p = .008). Six maxillary implants failed after loading; no mandibular implants were lost. Five implants failed due to loss of osseointegration. One implant fractured. The mean marginal bone level changes around the analyzed implants (n = 28, 9 patients) were -0.71 ± 0.82 mm in the mandible and -2.08 ± 1.52 mm in the maxilla at the 36-month follow-up. The difference in marginal bone level changes between the maxilla and mandible was significant (p = .019) at the 12- and 36-month follow-ups. CONCLUSION: Two narrow-diameter titanium-zirconium implants with stud-attachments showed a highly satisfactory outcome in the mandible. The maxillary implants showed a high failure rate and significantly more bone loss over time than the mandibular implants. The minimal concept of two implants and an overdenture should be limited to the edentulous mandible.

A New Full Digital Workflow for Fixed Prosthetic Rehabilitation of Full-Arch Edentulism Using the All-on-4 Concept.

(1) Background: Recent digital workflows are being developed for full-arch rehabilitations supported by implants with immediate function. The purpose of this case series is to describe a new digital workflow for the All-on-4 concept. (2) Methods: The patients were rehabilitated using the All-on-4 concept with a digital workflow including computerized tomography scanning, intra-oral scanning, and CAD-CAM production of the temporary prosthesis, with the 3D printing of stackable guides (base guide, implant guide, and prosthetic guide). The passive fit of the prostheses and the time to perform the rehabilitations were evaluated. (3) Results: The digital workflow allowed for predictable bone reduction, the insertion of implants with immediate function, and the connection of an implant-supported prosthesis with immediate loading. The time registered to perform the full-arch rehabilitations (implant insertion, abutment connection, prosthesis connection) was below 2 hours and 30 min. No passive fit issues were noted. (4) Conclusions: within the limitation of this case series, the digital workflow applied to the All-on-4 concept using stackable base-, implant-, and prosthetic guides constitutes a potential alternative with decreased time for the procedure without prejudice of the outcome.

Assessment of bone density in edentulous maxillae using cone beam computed tomography (CBCT).

INTRODUCTION: In edentulous maxillae, the anterior maxilla is the region of interest for implant placement due to posterior bone resorption and sinus pneumatization. This study aimed to assess variations in bone density in different regions of the edentulous maxilla according to sex and age, using cone beam computed tomography (CBCT). MATERIALS AND METHODS: 69 CBCT from edentulous maxilla were analyzed. Six virtual implants were planned between the maxillary sinuses at incisor, canine, and premolar sites. Bone densities (in Hounsfield units HU) were recorded at six points on the neck, body, and apex of the buccal and lingual areas of each virtual implant. We used the two-sample t-test to compare male and female bone densities, and the Spearman correlation coefficient to analyze the correlation between mean bone density and age. One-way analysis of variance with post hoc pairwise t-tests was used to analyze the differences in density between three sites of the edentulous maxilla and the differences in density between three parts of the implant. The significance level was set at 5%. RESULTS: Mean bone density in males was significantly higher than in females. There was a significant correlation between mean bone density and age in females. Incisor sites showed the highest mean bone density, followed by canine and premolar sites. There was a significant decline in bone density from the neck to the apex. CONCLUSIONS: Bone density varied within and among edentulous maxillae. Bone density of the edentulous maxilla seemed to be influenced by age in women and by sex.

THE ACCURACY OF INTRAORAL SCAN IN OBTAINING DIGITAL IMPRESSIONS OF EDENTULOUS ARCHES: A SYSTEMATIC REVIEW.

OBJECTIVES: Accuracy is a crucial factor when assessing the quality of digital impressions. This systematic review aims to assess the accuracy of intraoral scan (IOS) in obtaining digital impressions of edentulous jaws. METHODS: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022382983). A thorough retrieval of 7 electronic databases was undertaken, encompassing MEDLINE (PubMed), Web of Science, EMBASE, Scopus, Cochrane Library, Virtual Health Library, and Open gray, through September 11, 2023. A snowball search was performed by tracing the reference lists of the included studies. The Population, Intervention, Comparison, and Outcome (PICO) question of this systematic review was: "What is the accuracy of intraoral scan in obtaining digital impressions of edentulous arches?" The Modified Methodological Index for Nonrandomized Studies (MINORS) was employed to assess the risk of bias. RESULTS: Among the studies retrieved from databases and manual search, a total of 25 studies were selected for inclusion in this systematic review, including 9 in vivo and 16 in vitro studies. Twenty-one of the included studies utilized the 3D deviation analysis method, while 4 studies employed the linear or angular deviation analysis method. The accuracy results of in vitro studies indicated a trueness range of 20-600 µm and a precision range of 2-700 µm. Results of in vivo studies indicated a trueness range of 40-1380 µm, while the precision results were not reported. CONCLUSION: According to the results of this study, direct digital impressions by IOS cannot replace the conventional impressions of completely edentulous arches in vivo. Edentulous digital impressions by IOS demonstrated poor accuracy in peripheral areas with mobile tissues, such as the soft palate, vestibular sulcus, and sublingual area.

Dynamic navigation-assisted bone ring technique for partially edentulous patients with severe vertical ridge defects.

The autogenous bone ring technique is among the approaches for vertical alveolar ridge augmentation, and this technique can enable simultaneous implantation. However, the outcomes can be compromised due to donor site morbidity, shifting of the bone ring graft positioning, and inaccurate implant placement. In recent decades, dynamic navigation systems have been introduced into the field of implantology, allowing the accuracy of outcomes to be improved. This Technical Note describes the use of dynamic navigation to guide bone ring surgery, which is expected to enable more precise and predictable bone augmentation and implantation procedures, reduce the risk of injuries to the adjacent anatomical structures, and achieve better treatment outcomes.

Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review.

(1) Background: The aim was to perform a literature review on customized subperiosteal implants (CSIs) and provide clinical guidelines based on the results of an expert consensus meeting held in 2023. (2) Methods: A literature search was performed in Pubmed (MEDLINE) in July 2023, including case series and cohort studies with a minimum follow-up of 6 months that analyzed totally or partially edentulous patients treated with CSIs. Previously, an expert consensus meeting had been held in May 2023 to establish the most relevant clinical guidelines. (3) Results: Six papers (four case series and two retrospective cohort studies) were finally included in the review. Biological and mechanical complication rates ranged from 5.7% to 43.8% and from 6.3% to 20%, respectively. Thorough digital planning to ensure the passive fit of the CSI is mandatory to avoid implant failure. (4) Conclusions: CSIs are a promising treatment option for rehabilitating edentulous patients with atrophic jaws; they seem to have an excellent short-term survival rate, a low incidence of major complications, and less morbidity in comparison with complex bone grafting procedures. As the available data on the use of CSIs are very scarce, it is not possible to establish clinical recommendations based on scientific evidence.

Effect of bar designs on peri implant tissues health in implant-supported removable prostheses: a systematic review.

Different characteristics of bars (cross-sectional shape, diameter, distal extension etc.) lead to different biomechanical behavior (retention and stress) with implants and peri-implant tissues.Aim: To evaluate the impact of implant-supported removable prostheses bar designs in fully edentulous arch (in the maxilla and/or mandibula), with 4 implants or more, on the peri-implant soft and hard tissues.Two reviewers searched for observational studies, RCT and in vitro studies, published on five main databases and three from the grey literature, without restrictions on November 2023.Of the 3049 selected articles, four met the inclusion criteria. Four RCT evaluated peri-implant health tissues in full edentulous arches with 4 or 6 implants rehabilitated with implant bar overdentures. One prospective study with 5 years follow-up evaluated the success/survival rate of implants and implant bar overdentures. Overall, 261 subjects were enrolled in our systematic review with 1176 implants. Overdentures' survival rate was 100%. There was a trend that plaque indices and gingival indices were low in all of the studies, however no statistical analysis was done due to the lack of information.Due to the lack of information in the included studies, we cannot confirm if bar characteristics affect the peri-implant tissues health.

Accuracy of the Yakebot dental implant robotic system versus fully guided static computer-assisted implant surgery template in edentulous jaw implantation: A preliminary clinical study.

AIMS: To compare the accuracy of the Yakebot dental implant robotic system with that of fully guided static computer-assisted implant surgery (CAIS) template in edentulous implantation. MATERIALS AND METHODS: Thirteen patients with edentulous were recruited and divided into two groups: the Yake robotic system group (experimental) (n = 5) and the CAIS group (control) (n = 8). Postoperative cone-beam computed tomography (CBCT) was performed immediately, and the 3-dimensional positions of implants were obtained and compared with that in the preoperative design. The comparison showed platform, apical, depth, and angular deviations. A value of p < 0.05 was considered statistically significant. RESULTS: A total of 84 implants (36 in the robotic group and 48 in the CAIS group) were placed. The mean deviation at the implant platform, apex, depth, and angle in the CAIS group was 1.37 ± 0.72 mm, 1.28 ± 0.68 mm, 0.88 ± 0.47 mm, and 3.47 ± 2.02°, respectively. However, the mean deviation at the implant platform, apex, depth, and angle in the robotic group was 0.65 ± 0.25 mm, 0.65 ± 0.22 mm, 0.49 ± 0.24 mm, and 1.43 ± 1.18°, respectively. Significant differences in the four types of deviation (p < 0.05) between the two groups were observed. CONCLUSION: The accuracy of robotic system in edentulous implant placement was superior to that of the CAIS template, suggesting that robotic system is more accurate, safe, and flexible, can be considered a promising treatment in clinical practice.

Preprosthetic Surgery-Narrative Review and Current Debate.

This review describes the role of modern preprosthetic surgery. The atrophic edentulous jaw can cause severe functional impairment for patients, leading to inadequate denture retention, reduced quality of life, and significant health problems. The aim of preprosthetic surgery is to restore function and form due to tooth loss arising from congenital deformity, trauma, or ablative surgery. Alveolar bone loss is due to disuse atrophy following tooth loss. The advent of dental implants and their ability to preserve bone heralded the modern version of preprosthetic surgery. Their ability to mimic natural teeth has overcome the age-old problem of edentulism and consequent jaw atrophy. Controversies with preprosthetic surgery are discussed: soft tissue versus hard tissue augmentation in the aesthetic zone, bone regeneration versus prosthetic tissue replacement in the anterior maxilla, sinus floor augmentation versus short implants in the posterior maxilla-interpositional bone grafting versus onlay grafts for vertical bone augmentation. Best results for rehabilitation are achieved by the team approach of surgeons, maxillofacial prosthodontists/general dentists, and importantly, informing patients about the available preprosthetic surgical options.

Estimation of L-carnitine levels in diabetic completely edentulous patients for implant diagnosis: A cross-sectional study.

Background: Carnitine is effective in preventing the accumulation of end products related to lipid peroxidation due to its anti-inflammatory and antioxidant effects. Carnitine also exerts a significant anti-inflammatory role through the downregulation of the nuclear factor kappa beta pathway, which leads to a decrease in the expression of pro-inflammatory cytokines.The aim of the study was to estimate the L-carnitine (L-C) levels in diabetic completely edentulous patients. Materials and Methods: A cross-sectional study was conducted after the selection of 60 samples based on the inclusion and exclusion criteria. The collected saliva samples were utilized to measure the levels of L-C using the sandwich enzyme-linked immunosorbent assay (ELISA) method. One hundred microliters of sample was applied to a particular row of wells and incubated for an hour as part of the sandwich ELISA procedure. After the wells had been cleaned, a second batch of monoclonal L-C was added, and they were once more incubated for an hour. The horseradish peroxidase substrate was then applied after washing the second batch as well. To allow the blue-to-yellow color transition, the wells were kept steady. Following the observation of the color shift, the OD was measured, and the concentration was determined using the sandwich ELISA kit's standard curve as an intercept. The data were statistically analyzed using the independent t-test (significant level P < 0.05) and were tabulated. Results: The L-C levels have higher levels in nondiabetic patients than in diabetic patients. The difference in the baseline mean value between the groups was statistically significant (P = 0.00). Although it is statistically significant (P = 0.00), the mean value for diabetic individuals is 0.19 as opposed to 0.29 for nondiabetic patients. Conclusion: Based on the findings, it can be concluded that L-C improves insulin sensitivity and glucose disposal in diabetic completely edentulous patients.

Cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata / Virtual guided surgery for implantsupported rehabilitation of the edentulous maxilla with immediate loading

Objetivo: Presentar el relato de un caso clínico de cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata. Relato del caso: Paciente, edéntulo total en ambos maxilares, expresó su deseo de cambiar la prótesis total superior removible por una prótesis total fija sobre implantes. Durante la evaluación clínica, se observaron condiciones biológicas favorables al tratamiento como, adecuada faja de tejido queratinizado y leve reabsorción ósea. Como tratamiento se le sugiere al paciente, una planificación inversa, asistida por cirugía virtual guiada, utilizando un prototipo de guía quirúrgica para la colocación de seis implantes dentales en el maxilar y la instalación de una prótesis protocolo de carga inmediata. Conclusiones: Los resultados nos permiten concluir que la cirugía virtual guiada por computadora para rehabilitación protésica implantosoportada de maxilar edéntulo, con carga inmediata, proporciona precisión en los procedimientos quirúrgicos, es fundamental para la confección de prótesis inmediatas, representa una alternativa mínimamente invasiva y el resultado complace a los pacientes.

Objective: present the report of a clinical case of a virtual guided surgery for implant-supported rehabilitation of the edentulous maxilla with immediate loading. Case report: Patient, bi-maxillary edentulous expressed the desire to replace the removable upper total prothesis for a total fixed prothesis on implants. During the clinical evaluation, favorable biological conditions for treatment were observed, such as adequate keratinized tissue band and mild bone resorption. As part of the treatment, the patient was recommended a reverse planning approach, assisted by virtual guided surgery. This involved a prototype surgical guide for the fixation of six dental implants in the maxilla and the installation of an immediate loading protocol prosthesis. Conclusions: The results lead us to conclude that computer-guided virtual surgery for implant-supported prosthetic rehabilitation of the edentulous maxilla with immediate loading, provides a high precision in surgical procedures. It is essential to fabrication of immediate prostheses, represents a minimally invasive alternative, and results in patient satisfaction.

Effect of the level of alveolar atrophy on implant placement accuracy in guided surgery for full-arch restorations supported by four implants: an in vitro study.

BACKGROUND: A fixed screw-retained full-arch restoration supported by four implants is a popular treatment option for edentulous arches. Optimal alignment of implants is quite challenging in extremely atrophied edentulous cases, and a small amount of deviation is expected during guided surgery. This study aimed to compare implant accuracy among edentulous jaws with various levels of atrophy. METHODS: Five separate copies of each Cawood and Howell model (III-V) were produced for the maxilla and mandible. A total of 120 implants (30 models). The implant accuracy was assessed based on angular deviations at the base (angle, 3D offset, distal, vestibular, and apical) and tip (3D offset, distal, vestibular, and apical). RESULTS: The atrophy level of the jaws had a statistically significant effect on deviation; implants showed greater deviation from the planned location as the atrophy level increased. CONCLUSION: Given that implant deviation increased with the degree of atrophy, a greater safety margin from important anatomical structures is recommended when planning implant location for guided surgery in Cawood and Howell V cases.

Fracture treatment in atrophic mandible.

BACKGROUND: Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts. Besides, the Luhr classification serves as a guide to select the type of treatment. OBJECTIVE: To show the treatment of fractures in atrophic mandible with plates and screws, and the potential indications of bone graft in this type of fractures. METHOD: We presented a serie of 17 patients with atrophic mandible treated with plates and screws, some of them no blocked system and other with locked screws. For patients in luhr classes II and III cancellous bone grafts were used, looking for best osteogenic response, harvesting for the proximal third of the tibia. RESULTS: Postoperative progress was generally uneventful. Oral intake with purees was resumed 24 hours after surgery, as well as ambulation. Fracture healing at 6 months was seen in 17 patients. One patient died before the 6-month time point as the result of a stroke. Delayed union was diagnosed 3 months after surgery in another patient, who refused secondary treatment. CONCLUSIONS: Treatment of fractures in atrophic mandibles with plates and screws is a reliable procedure. Luhr classification provide useful guidance regarding the use of bone grafts for best osteogenic response in the fracture. This treatment allows a quick restart of the feeding by mouth and movilization of the patients.

ANTECEDENTES: Las fracturas en mandíbula atrófica han sido tratadas desde con fijación intermaxilar hasta con osteosíntesis. Pueden requerir injertos óseos. La clasificación de Luhr es una guía para orientar el tratamiento. OBJETIVO: Mostrar el tratamiento de fracturas en mandíbula atrófica con placas y tornillos y las posibles indicaciones de uso de injerto óseo en este tipo de fracturas. MÉTODO: Se presenta una serie de 17 pacientes con mandíbula atrófica fracturada tratada con placas y tornillos, algunas con sistemas no bloqueados y otros bloqueados. En las de clase II and III se aplicó injerto óseo esponjoso para mejorar la capacidad osteogénica. El injerto se tomó del tercio proximal de la tibia, previa evaluación radiológica. RESULTADOS: La evolución en general fue satisfactoria. Se inició la vía oral con papillas y los pacientes deambularon a las 24 h de posoperatorio. Se observó consolidación en 17 pacientes. Hubo una defunción por enfermedad vascular cerebral antes de 6 meses. Una paciente tuvo retardo de consolidación diagnosticado al tercer mes, pero no aceptó tratamiento secundario. CONCLUSIONES: El tratamiento de las fracturas mandibulares atróficas con placa y tornillos bajo concepto de carga absorbida es un procedimiento confiable. La clasificación de Luhr es útil para orientar la utilización de injerto óseo, buscando mejorar la capacidad osteogénica en la fractura. Este tratamiento permite un pronto reinicio de la vía oral, así como la movilización de los pacientes.

Effect of the number and distribution of fiducial markers on the accuracy of robot-guided implant surgery in edentulous mandibular arches: An in vitro study.

OBJECTIVES: Robot-guided implant placement based on the screw marker-assisted registration technique has been applied in dentistry. This study aimed to identify the optimal number and distribution of fiducial markers for robot-guided implant placement in edentulous mandibular phantoms. METHODS: Four implants were digitally planned and placed in edentulous mandibular phantoms under robotic guidance. Different numbers of fiducial markers (3, 4, 5, or 6) and distribution patterns (dispersed or localized) were used to register the robotic system. Platform, apex, and angular deviations were measured between the planned and actual implant positions using different numbers and distributions of fiducial markers. RESULTS: Inserting six fiducial markers resulted in optimal implant position accuracy at the platform (0.53 ± 0.19 mm) and apex (0.59 ± 0.2 mm) deviations. However, the angular deviation did not differ significantly between different numbers of fiducial markers. Furthermore, the implant position accuracy did not differ significantly between the dispersed and localized distributions of fiducial markers. CONCLUSION: In robot-guided implant placement for edentulous mandibular arches, the insertion of six fiducial markers significantly increases the implant placement accuracy. CLINICAL SIGNIFICANCE: The findings of this in vitro study may serve as a reference for clinicians to determine the optimal placement of fiducial markers and to facilitate the clinical application of robot-guided systems for implant placement in edentulous patients. Further clinical studies are necessary to confirm these findings.

"All-on-4" and "All-on-6" treatment concept applied using computer-guided surgery in a patient: Case report with a 2-year follow-up.

This case aimed to assess the clinical and radiographic outcomes of the All-on-4 and the All-on-6 concept using three-dimensional computer-assisted treatment planning, and computer-guided surgery. Two years after the treatment, the "All-on-4" and "All-on-6" concepts provided effective treatment for immediate restoration and showed predictable outcomes in a completely edentulous patient.

Comparison of the accuracy of implant position among freehand implant placement, static and dynamic computer-assisted implant surgery in fully edentulous patients: a non-randomized prospective study.

The optimal implant position is a critical factor for long-term success in fully edentulous patients. Implants can be placed through conventional freehand, static computer-assisted implant surgery (CAIS), or dynamic CAIS protocols, but at present there is very limited clinical evidence on their accuracy in fully edentulous patients. This study was performed to evaluate the accuracy of implant placement using three protocols in fully edentulous patients. Thirteen patients received 60 implants with the freehand (n = 20), static CAIS (n = 20), or dynamic CAIS (n = 20) protocol. Postoperative cone beam computed tomography was utilized to evaluate the accuracy of implant placement in relation to the planned optimal position. The data were analysed by ANCOVA followed by Bonferroni analysis. The mean angular deviation (standard deviation) in the freehand, static CAIS, and dynamic CAIS groups was 10.09° (4.64°), 4.98° (2.16°), and 5.75° (2.09°), respectively. The mean three-dimensional deviation (standard deviation) at the implant platform in the freehand, static CAIS, and dynamic CAIS groups was 3.48 (2.00) mm, 1.40 (0.72) mm, and 1.73 (0.43) mm, while at the implant apex it was 3.60 (2.11) mm, 1.66 (0.61) mm, and 1.86 (0.82) mm, respectively. No difference in terms of accuracy was found between static and dynamic CAIS; both demonstrated significantly higher accuracy when compared to the freehand protocol in fully edentulous patients.

6 mm short versus 11 mm long inter-foraminal implants in the full-arch rehabilitation of edentulous non-atrophic mandibles: 5-year results from a multicenter randomized controlled trial.

OBJECTIVE: The aim of this multicenter parallel-group randomized controlled trial is to compare, in the same clinical scenario, 6 mm short with 11 mm long implants for the rehabilitation of completely edentulous non-atrophic mandibles. MATERIALS AND METHODS: Thirty patients in three study centers received a fixed full-arch mandibular rehabilitation supported by five inter-foraminal implants, with no need for bone augmentation procedures. Patients were randomly allocated (1:1 ratio), at the time of surgery, to test (6 mm implants) or control group (11 mm implants). After 3 months, a screw-retained full-arch prosthesis was positioned (baseline). Peri-implant marginal bone level change (MBLc, primary outcome) together with implant and prosthesis survival rate, and biological/technical complications (secondary outcomes) were evaluated up to 5 years. RESULTS: Twenty seven patients were controlled at 5 years (3 drop-outs). No implant or prosthesis loss occurred. No significant intergroup difference for biological/technical complications (p > .05, Fisher's exact test) and no significant intragroup and intergroup difference in the MBLc values were registered (test -0.03 ± 0.17 mm and control -0.13 ± 0.32 mm at 5-years; p > .025, one-sided Mann-Whitney U-test). CONCLUSIONS: When used in comparable anatomic, surgical, and prosthetic conditions, no difference in the clinical and radiographic outcomes between 6-mm and 11-mm implants was observed at 5 years of follow-up. Short implants showed to be a reliable option for the rehabilitation of completely edentulous non-atrophic mandibles. There is growing clinical evidence supporting the use of short implants, even in the case of non-atrophic sites.

Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes.

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) - 0.13, 95% confidence interval (CI) - 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD -2.32, 95% CI -5.20 to 0.55, P = 0.113; late postoperative: MD -0.01, 95% CI -0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28-100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.