Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: A cohort study of consecutive patients

doi:10.1016/S0022-3913(07)60021-3

The Journal of Prosthetic Dentistry

Volume 97, Issue 6, June 2007, Pages 331-339

https://doi.org/10.1016/S0022-3913(07)60021-3 Get rights and content

Statement of problem

Data available regarding the treatment outcome for completely edentulous jaws by means of a prefabricated fixed complete denture placed immediately after flapless implant insertion using a surgical guide are only short term.

Purpose

The purpose of this study was to follow the survival of implants inserted in completely edentulous jaws using a flapless procedure and immediately loaded with prefabricated fixed complete dentures for several years. A second purpose was to investigate whether there is a difference in marginal bone remodeling in smoking (S) and nonsmoking (NS) patients.

Material and methods

During a 5-year period (mean time of follow-up 2.2 years), 30 consecutive patients, 12 women, 38–74 years of age (average 56 years) were treated for complete edentulism in 1 arch in the Department of Periodontology at the University Hospitals in Leuven. The S group included 13 and the NS group 17 patients. Descriptive statistics were used to analyze the data. Two outcome parameters were analyzed: the cumulative survival rate (CSR) of individual implants and the marginal bone remodeling for up to 5 years in the 2 groups.

Results

Nine (4.9%) implants failed. Eight of the failures occurred in 3 smoking patients. The absolute survival rate for all patients was 95%, while the cumulative survival rate (CSR) after 5 years was 91.5%. For the NS group, the CSR was 98.9%, while for the S it was 81.2%. The mean marginal bone resorption was - 2.6 and - 1.2 mm in the S and NS groups, respectively.

Conclusions

The present findings indicate that the treatment protocol described results in good implant survival rate even after several years. Smoking may eventually compromise the efficacy of this treatment concept.

Section snippets

Material and methods

All patients with at least 1 completely edentulous arch who sought rehabilitation with an implant-supported fixed complete denture were considered as possible candidates. The decision for immediate loading of implants, inserted by flapless surgery, using a prefabricated metal and acrylic resin fixed complete denture was made on the basis of medical (to interrupt anticoagulant therapy only once), psychological (fear of surgery), and social (significant scheduling constraints) considerations but

Results

Patients were followed up to a 5-year period with a mean follow-up time of 2.2 years. In 30 consecutive patients, a total of 212 implants were placed. The implant lengths varied between 8.5 and 15 mm and implant diameters were 3.75 (n= 201), 4 (n=3), or 5 mm (n=8). Four patients (29 implants) did not return for further evaluation after initial treatment completion. Thus data for the remaining 26 patients for a total of 183 implants were analyzed. However, when reached by phone all 4 patients

Discussion

Immediate loading seems to be a reasonable alternative to the classical, 2-stage, thoroughly documented protocol. In the present study, a key element to success may be the immediate and rigid connection of the implants by using an acrylic resin and metal fixed complete denture. When excess micromovement occurs, stem cells in the osseous wound differentiate to fibroblasts to form scar tissue around the implant inhibiting osseointegration.¹¹

The present study reports medium term observations in

Conclusions

The use of a prefabricated custom-fit fixed complete denture supported by implants for the completely edentulous patient over 5 years demonstrated similar results for the same implant-supported prosthetic treatment but with delayed loading. Smoking may reduce the favorable outcome but the limited series reported requires further confirmation.

Acknowledgments

The authors thank all referring dentists especially from the Department of Prosthetic Dentistry, who performed the prosthetic treatment of the patients. We also thank Dr Matts Andersson and Izidor Brajnovic of Nobel Biocare for their assistance.

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Cited by (127)

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
2024, Journal of Prosthetic Dentistry
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.
An overview of the advances in the 3D printing technology
2022, 3D Printing Technology for Water Treatment Applications
In the past decades, 3D printing technology or additive manufacturing has evolved to mold prototypes as physical objects by precisely depositing material (e.g., plastic, resin, biomaterials, metals) layer by layer according to the geometrical representations by computer-aided design (CAD). Since its advent, it has found its use in education, health, engineering, architecture, and irrigation, to name a few. The idea dates back to the 1970s until the prototype was accepted in the 1980s which made tremendous use of stereolithography. Over time it has evolved to use various technologies like Selective Laser Sintering and Fused Deposition Modeling, which have gained colossal recognition worldwide. Persistent advancements in the CAD tools and materials used have co-occurred to provide more robust, economic, and effective means for 3D printing, an account of which this chapter describes.
Accuracy evaluation of computer-guided implant surgery associated with prototyped surgical guides
2021, Journal of Prosthetic Dentistry
Correct implant placement by means of a pretreatment planning software program is still subject to deviations between the planned and achieved implant positions. Inaccuracy at this level may have drastic consequences, including neurovascular trauma. Further data are therefore needed to evaluate the accuracy of such computer-guided implant planning software programs.
The purpose of this clinical study was to evaluate the accuracy of computer-guided implant surgery associated with prototyped surgical guides.
Cone beam computed tomography (CBCT) scans were made of the participants with a tomographic guide to merge anatomic and prosthetic data. This allowed virtual planning with a prosthetically guided approach respecting the anatomy of the participant. A prototyped surgical guide was then fabricated from the virtual plan, determining the intrasurgical position of the implants. Flapless guided implant surgery was carried out according to the manufacturer’s instructions. A second CBCT was made 30 days after the surgery, to enable overlapping of the data from before and after the implant placement. The angular, coronal, central, and apical deviations of the placed implants were measured and compared with those virtually planned. The data were submitted to descriptive statistic and intraclass correlation coefficient (ICC), analysis of variance, and the Student t test (α=.05).
A total of 61 implants were analyzed. The mean angular deviation was 2.04 degrees. The mean coronal, central, and apical linear deviations were 0.68 mm, 0.72 mm, and 0.82 mm, respectively. No statistically significant difference was found between the virtual and the real position of the implants inserted. A tendency toward a greater absolute error was observed in the mandible than in the maxilla in terms of angular (P=.047), central (P=.043), and coronal error (P=.031).
Flapless computer-guided implant surgery with virtual planning had some angular and linear deviations; nevertheless, this technique should be acceptably safe and accurate.
Five-year survival rates for implants placed using digitally-designed static surgical guides: a systematic review
2020, British Journal of Oral and Maxillofacial Surgery
Digitally-designed static surgical guides provide an acceptable level of accuracy and predictability for the placement of dental implants. However, to our knowledge, few published studies have compared the long-term survival of implants placed in this way with those placed using other methods. A systematic search of electronic databases using a population, intervention, comparison, and outcome (PICO) framework was conducted of Medline and EMBASE, as well as grey literature and hand searches, to obtain all relevant work pertaining to the survival of dental implants placed by guided surgery. The studies were required to have at least 10 patients with a follow up of at least five years. A total of 621 titles were screened. Four studies met the inclusion criteria for quantitative analysis, and they all reported the exclusive use of Nobel Biocare implants and the NobelGuide system (Nobel Biocare Services). Cumulative survival rates ranged from 94.5% to 100% over five years. The survival rates of implants placed using digitally-designed static surgical guides are comparable to the estimated overall survival rate (95.6% over five years), despite the complex nature of the treatments done with guided surgery. Clinicians who do these operations should, however, have the experience and ability to revert to conventional freehand techniques if complications arise.
The influence of prosthetic material on implant and prosthetic survival of implant-supported fixed complete dentures: a systematic review and meta-analysis
2019, Journal of Prosthodontic Research
Evaluating the impact of the prosthetic material on implant- and prosthetic survival of implant-supported fixed complete dentures.
Electronic and hand searches were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify clinical studies including at least 10 patients restored with implant-supported dentures. The primary outcome was to evaluate the implant survival rate according to the applied restorative materials. The prosthetic survival rate was evaluated as secondary outcomes.
Forty-one of 2254 studies were ﬁnally selected. A statistically significant difference (p = 0.0337) was found between implant survival rates in the main restorative groups (metal-ceramic:97%(95%CI [0.96;0.98]), all-ceramic:99%(95%CI [0.98;1.00]), metal-resin:97%(95%CI [0.96;0.98])). Prosthetic survival rates were: (metal-ceramic:95%(95%CI [0.89;0.97]), all-ceramic:97%(95%CI [0.92;0.99]), metal-resin:97%(95%CI [0.95;0.98]), with no statistically significant difference (p = 0.3796) between the groups. Chipping incidence rates were as follows: metal-ceramic:8%(95%CI[0.03;0.20]), all-ceramic:15%(95%CI [0.06;0.32]), and metal-resin:22%(95%CI [0.13;0.33]).
Five types of exact restorative materials were identified (porcelain-fused-to-non-precious alloy, porcelain-fused-to-zirconia, precious-metal-acrylic-resin, non-precious-metal-acrylic resin, and PMMA). Again, implant survival rates were statistically significantly influenced by the applied restorative materials (p = 0.0126), whereas, no significant differences were reported regarding prosthetic survival rate.
Prosthetic material selection seems to have no clinically relevant influence on implant- and prosthetic survival rate in implant-supported fixed complete dentures. Due to the high chipping rate, quantifying prosthetic survival alone does not seem to be a reliable tool for evaluating the outcome of the restorations and providing recommendations. These results, along with the obvious lack of evidence, suggest that clinicians must exercise caution whenever porcelain-fused-to-zirconia or metal-resin restorations are considered.
A randomized controlled clinical trial comparing guided with nonguided implant placement: A 3-year follow-up of implant-centered outcomes
2019, Journal of Prosthetic Dentistry
Implant-based prosthetic solutions can be time consuming. If implants can be placed successfully with a guide, surgery time can be reduced.
The purpose of this randomized controlled clinical trial was to assess implant outcomes, both clinical and radiological, comparing guided with nonguided implant placement after 3 years of follow-up.
A total of 314 implants were placed in 72 jaws (60 participants). The jaws were randomly assigned to 1 of the 6 treatment groups: Materialise Universal/mucosa (Mat Mu), Materialise Universal/bone (Mat Bo), Facilitate/mucosa (Fac Mu), Facilitate/bone (Fac Bo), freehand navigation (Freehand), and a pilot-drill template (Templ). Radiographic and clinical parameters (bone loss, pocket probing depth, bleeding on probing, and plaque scores) were recorded at the time of implant placement, prosthesis installment (baseline), and 1-year, 2-year, and 3-year follow-up. Analysis was performed using a linear mixed model, and correction for simultaneous hypothesis was made according to Sidak (α=.05).
Three participants left the study before the 3-year follow-up; hence, 302 implants in 69 jaws were included in this study. None of the implants failed. The mean marginal bone loss after the third year of loading was 0.7 ±1.3 mm for the guided surgery group and 0.5 ±0.6 mm for the control group. No significant intergroup or follow-up period differences were observed (P>.05). In the guided surgery groups, the mean number of surfaces with bleeding on probing and plaque at 3-year follow-up was 1.7 ±1.5 and 1.7 ±1.7, respectively; for the control groups, this was 1.6 ±1.4 and 1.6 ±1.6, respectively. The mean pocket probing depth was 3.0 ±1.3 mm for the guided group and 2.6 ±1.0 mm for the control group. No significant differences were found (P>.1).
Within the limitation of this study, no statistically significant differences could be found between the guided group and the control group at the 3-year follow-up.

View all citing articles on Scopus

: This research was partially financed by Nobel Biocare.

View full text

Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: A cohort study of consecutive patients

Statement of problem

Purpose

Material and methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Acknowledgments

A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study

Clin Implant Dent Relat Res

A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss

Clin Oral Implants Res

Clinical evaluation of mandibular overdentures supported by multiple-bar fabrication: a follow-up study of two implant systems

Int J Oral Maxillo-fac Implants

Outcomes and their measurement in clinical trials of endos-seous oral implants

Ann Periodontol

Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study

Clin Implant Dent Relat Res

Prospective multicenter study on immediate rehabilitation of edentulous lower jaws according to the Branemark Novum protocol

Clin Implant Dent Relat Res

Immediate loading of implants in partially and fully edentulous jaws: a series of 27 case reports

J Periodontol

Immediate loading of Branemark System TiUnite and machined-surface implants in the posterior mandible: a randomized open-ended clinical trial

Clin Implant Dent Relat Res

Bone formation at titanium implants prepared with iso- and anisotropic surfaces of similar roughness: an in vivo study

Clin Implant Dent Relat Res

Does loading time affect implant survival? A meta-analysis of 1,266 implants

J Periodontol

Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature

J Biomed Mater Res

Interventions for replacing missing teeth: different times for loading dental implants

Cochrane Database Syst Rev