Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, Augusta University, Augusta, Georgia, USA.
International Center Oral rehabilitation, Rome, Italy.
J Esthet Restor Dent. 2021 Jan;33(1):224-236. doi: 10.1111/jerd.12710. Epub 2021 Jan 19.
To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete-arch prosthesis.
This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48-75) requiring at least one complete-arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes).
Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete-arch FDPs immediately loaded (mean follow-up 16.2 ± 1.7 months, 14-18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65-78). The mean MBL was -0.53 ± 0.28 mm (-0.22 to -1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively.
Within the limitations of this proof-of-concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete-arch FDP was facilitated, resulting in high implant and prosthetic success rates.
The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete-arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health.
评估整合动态引导手术的新型数字化工作流程在简化种植体植入、软组织和骨组织雕刻以及即刻交付导航引导全颌义齿方面的临床和影像学性能。
这是一项前瞻性单队列研究，纳入了 2019 年 1 月至 8 月期间需要在上下颌中至少植入一颗全颌固定义齿（FDP）的 10 名连续患者（3 名男性，7 名女性；平均年龄 62.5 ± 8.9 岁；年龄范围 48-75 岁）。主要结局是种植体和修复体的成功率、手术和修复体的并发症。次要结局是边缘骨丧失（MBL）、种植体稳定性指数（ISQ）、牙周参数（菌斑和出血指数）。
共植入 60 颗种植体（32 颗 NobelParallel TiUltra 和 28 颗 NobelActive TiUltra，Nobel Biocare），并即刻加载 14 颗全颌 FDP（平均随访 16.2 ± 1.7 个月，14-18 个月）。有 1 颗种植体失败并立即更换。无其他手术或生物学并发症发生，累积成功率为 98.3%。无修复体并发症发生，修复体成功率为 100%。种植体植入时的平均 ISQ 为 71 ± 2.8（65-78）。平均 MBL 为-0.53 ± 0.28mm（-0.22 至-1.12mm）。菌斑和出血评分分别为 14.4 ± 8.18 和 7.15 ± 4.4。
在本概念验证研究的限制范围内，动态导航可有效地将种植体和修复体按计划坐标植入，并引导骨和软组织雕刻。数字化预制的美学驱动的全颌 FDP 即刻负载变得更加容易，从而获得高的种植体和修复体成功率。
本研究中整合动态导航的数字化工作流程可以克服数字化预制全颌 FDP 即刻定位和加载的困难。导航引导的软组织和骨组织雕刻，结合异种胶原基质移植，是一种可预测的技术，可实现数字化计划的界面，重建保护下方骨组织所需的黏膜维度，同时保持组织健康。
