Prosthesis (Jul 2022)

Digital Workflow for Prosthetically Driven Implants Placement and Digital Cross Mounting: A Retrospective Case Series

  • Marco Tallarico,
  • Davide Galiffi,
  • Roberto Scrascia,
  • Maurizio Gualandri,
  • Łukasz Zadrożny,
  • Marta Czajkowska,
  • Santo Catapano,
  • Francesco Grande,
  • Edoardo Baldoni,
  • Aurea Immacolata Lumbau,
  • Silvio Mario Meloni,
  • Milena Pisano

DOI
https://doi.org/10.3390/prosthesis4030029
Journal volume & issue
Vol. 4, no. 3
pp. 353 – 368

Abstract

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Fully digital workflow in implant dentistry is ever increasing. Treatment of partial edentulous cases is well-documented; nevertheless, complete edentulous cases are still a challenge. To present several innovations in the treatment of complete edentulous patients using digital solutions, both for implant placement and restoration delivery, was the objective of this study. It was designed as a retrospective case series study, aimed to tune further research with larger sample size, and a longer follow-up. Patients requiring complete, implant-supported restoration were asked to participate in this study. Enrolled patients were treated with four implants, immediate loading and a definitive complete arch restoration. Patients were treated using computer-assisted, template-based surgery. Multi-piece surgical templates were used to accurately place the implants, to manage the bone if needed and to make immediate loading procedure quicker and easier. After osseointegration period, definitive, extra-oral, digital impressions were taken using newly developed scan analogs, connected in the patient mouth using temporary cylinders and stabilized by means of the low-shrinkage, flowable, resin composite. Outcomes were implant and prosthesis survival rate, complications, accuracy, and patient satisfaction. Radiographic evaluation performed with a preliminary, radiopaque aluminum try-in, was used to test the accuracy of the digital impressions. Overall, 20 implants were placed in five patients. All the implants osseointegrated without complications. One impression was taken a second time due to inaccuracy of the aluminum tray-in. Finally, all of the patients were completely satisfied with both surgical and prosthetic procedures. Within the limitations of this case series, multi-piece surgical templates showed promising results improving the clinician’s confidence in the case of bone reduction, post-extractive implants and immediate loading. The prosthetic template increased the trueness of the digital impression for complete edentulous patients. Finally, even if an impression was performed again, the scan-analog used for extra-oral chair-side digital impressions seemed to be a promising tool. Continuous improvements and further study are needed to confirm these preliminary results.

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