Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-09-20, 16:58:27 | version 1.38.0
Journal of Oral Science & Rehabilitation Volume 2 | Issue 3/2016 51 I m m e d i a t e l o a d i n g u s i n g g u i d e d s u r g e r y Introduction Transitioning from a failing dentition to complete- arch implant rehabilitation may involve tempo- rarily rendering the patient edentulous.1 In such cases, interim complete removable dental pros- theses have been used after extraction of the hopeless teeth and during the osseointegration period. However, manypatients objectto a com- pleteremovabledentalprosthesisforpsycholog- ical, functional or esthetic reasons, and request fixed provisionalization throughout all phases of the rehabilitation process.2, 3 In orderto avoidthe useofaremovableprosthesis,immediateimplant placement and immediate loading with a fixed interim prosthesis have been proposed for the rehabilitation of hopeless dentition.4 Indeed, im- mediately loaded implants placed into post- extraction sockets have recently been demon- strated to provide a reliable option for replacing failing residualteeth.5 Although immediate load- ing may place implants at a higher risk of com- plications,6 comparable survival rates have been reported forthe two loading protocols.7 Further- more, immediate loading combinedwith implant placement in post-extraction sites may result in improved esthetic outcomes owing to preserva- tion of osseous and gingival architecture, offer reduced treatment time, and provide the patient with the convenience of an immediate tooth re- placement.8 The risk of implant failure can be minimized by proper patient selection, well- trained operators, high primary implant stability and lack of micromovements.9 Computer-aided design (CAD) technology al- lows for the transfer of patient data to a 3-D im- plant planning programforvirtualimplant place- ment.10 The virtual planning is then used to generateacustom-madesurgicaltemplate(com- puter-aided manufacturing—CAM) with metallic sleevestopreciselyguideeachdentalimplantinto the position planned virtually. In addition, im- plant-supportedfixedacrylicresinprosthesescan be fabricated in advance and immediately deli- vered to the patient. These aspects of minimally invasive and simplified surgery, along with redu- cing the treatment time and postoperative dis- comfort, are beneficial to the patient.11 Favorable clinical results of computer-assisted templa- te-guided surgery have been shown in several studies;12–15 however, deviations in 3-D position betweenvirtualplanningandactualfinalposition ofthe implant inthe patient’s jawandtechnique- related perioperative complications have to be taken into account.16–20 In2009,CantoniandPolizzidescribedastep-by- step technique involving a specially designed two-piece radiographic stent that allows the patient to retain hopeless teeth until the day of the surgery, making easier the transition from failing dentition to implant-supported prosthe- ses.21 The present study aimed to retrospective- ly assess the survival rate of variable-thread expanding tapered-body implants (NobelActive, Nobel Biocare, Zurich, Switzerland) placed into maxillary post-extraction or healed sites using template-guided surgery in combination with a specially designed radiographic stent.21 This study followed the Strengthening the Reporting of Observational Studies in Epidemiology guide- lines.22 Materials and methods This retrospective studyevaluated data collected from 27 consecutive patients of both sexes (19 females,8males),aged18yearsorolder(rangeof 38–84; mean of 60.6), presenting with failing maxillary dentition, confirmed by clinical and radiographic examination, and with a preference foracomplete-archimplant-supportedfixedden- tal prosthesis or an intolerance to a complete re- movabledentalprosthesis.Alloftheimplantswere placed without elevation of a flap in maxillary post-extractionsocketsorhealedsitesusingcom- puter-assisted template-guided surgery (Nobel- Guide, Nobel Biocare) between September 2009 and October 2012. The patients were clinically followedforaminimumoftwoyears(rangeoftwo to five years; mean of 29 months). All of the pa- tients were treated in a single specialized implant rehabilitation center.Two clinicians performed all ofthesurgical(GP)andprosthetic(TC)procedures, and two dental laboratories manufactured all of the restorations. One independent examiner (EP) conductedaretrospectivechartanalysisofthe27 consecutively implanted patients with compro- mised dentition in the maxilla. Patientswereinformedabouttheclinicalpro- cedures, materials to be used, benefits, potential risks and complications, as well as follow-up evaluations requiredforthe clinicaltrial, and gave theirwritten consenttotake part inthis study.All of the procedures were conducted in accordance with the Declaration of Helsinki of 1975 for bio- medical research involving human subjects, as amendedin2008.Thepatientswerenotadmitted to the study if any of the following exclusion cri- teria were present: general contraindications to Volume 2 | Issue 3/201651