Digital planning and bone regenerative technologies: A narrative review.

OBJECTIVES: The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry. MATERIAL AND METHODS: A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry. RESULTS: Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement. CONCLUSIONS: Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.

Simplified procedure for the immediate loading of a complete fixed prosthesis supported by four implants in the maxillary jaw: a 2-year prospective study.

PURPOSE: The aim of this study was to verify the reliability of a system for the fixed retention of complete maxillary prostheses supported by four implants with a follow-up of 2 years. MATERIAL AND METHODS: Patients were treated between September 2009 and December 2010 with four Straumann Bone Level SLActive implants supporting a complete prosthesis (CPs). The two distal implants were positioned mesially to the maxillary sinus and with a mesio-distal inclination ≤ 30° in order to reduce the distal prosthesis cantilever. An immediate loading surgical protocol was used. The CPs were planned to be fixed to multibase abutments to test their retention for a fixed rehabilitation. Clinical and radiographic parameters as probing pocket depth (PPD), bleeding score (mBI), plaque index (PI), and marginal bone loss (MBL) were assessed at a 1- and 2-year follow-up visits. Moreover, any biological and prosthodontic maintenance events were recorded. Clinical and radiographic parameters changes were analyzed. RESULTS: Twenty-one patients treated with a total of 84 implants completed the 2-year examination period. Four patients were lost to follow up. No technical complication was recorded. Also, no implant, reconstruction, or abutment failures were observed. Therefore, an implant and prosthetic survival rate of 100% were achieved after 2 years. The mean periodontal parameter scores after 2 years of function were 2.6 mm for PPD (SD 0.8 mm), 0.3 for mBI (SD 0.5 mm), and 1.2 for PI (SD 0.4 mm) indexes, respectively. In addition, the mean MBL score measured at the 2-year follow-up visit was -0.34 mm (SD of -0.45 mm). Furthermore, no peri-implant soft tissue inflammation or peri-implant infection was observed. CONCLUSIONS: It has been shown that immediate loading of four implants positioned anteriorly to the maxillary sinus could be a reliable treatment procedure to support fixed complete restorations.

A simple way to plan implant positioning: the "S-technique".

This study presents a technique for improving implant placements. As is widely known, a correct positioning is essential in restoration-driven implants, as well as in tilted implants in order to obtain satisfactory final functional and esthetic results. To this end, some authors have emphasized the importance of using a diagnostic and/or surgical guide to plan the exact implant position. In practice, one of the clinical problems faced is how to check the accuracy of the template prior to initiating the surgical phase. A simple method called the "S-Technique" is proposed in order to evaluate and to change, if necessary, the projected position of the implants by way of metal rods as radiopaque markers. This device is easy to produce and is cost-saving to the clinician and, therefore, to the patient. Furthermore, in specific patients, this method could also decrease the need for computerized tomography scans and/or radiographs, thus reducing health risks for the patient.