Model-based guided implant insertion for solitary tooth replacement: a pilot study

Objective: The impact of the implant position on the restorative outcome could justify guided surgery even for the single implants particularly in the aesthetic zone and especially when a simplified concept is available. Material and methods: Based on a plaster model, on which the soft tissues were mimicked (according to the thickness measured on a Cone‐Beam CT), a tooth‐supported, surgical template was prepared. The latter guided all drills so that even flapless implant insertion became possible. All implants were placed by students of the master‐after‐master training program in Periodontology. Results: The prospective cohort included a total of 34 implants, all of AstraTech (Osteospeed^®) type, which were successfully inserted in 29 patients, 16 flapless, 32 onestage. The marginal bone along the integrated implants remained stable over time, with 0.13 mm loss during the first year. The aesthetic parameters were reassuring. Conclusions: This simple model‐based concept seems to be reliable for the guided placement of single implants and the pre‐operative preparation of their restorations. To cite this article:
Marcelis K, Vercruyssen M, Naert I, Teughels W, Quirynen M. Model‐based guided implant insertion for solitary tooth replacement: a pilot study. Clin. Oral Impl. Res. 23 , 2012; 999–1003
doi: 10.1111/j.1600‐0501.2011.02242.x     

Multidisciplinary rehabilitation of eosinophilic granuloma with bone graft surgery and a modified implant‐supported hybrid prosthesis: A case report with a 6‐year follow‐up

Eosinophilic granuloma is the most common form of Langerhans cell histiocytosis and corresponds with bone lesions characterized by pain, rapid growth, and high tendency of recurrence after inadequate curettage. It is a rare disease that is difficult to diagnose clinically and radiographically because it mimics other odontogenic cysts and tumors. In this report, the reconstruction of an osseous defect with an iliac graft and a modified implant‐supported hybrid prosthesis after surgical excision of an eosinophilic granuloma in the mandible of a 27‐year‐old male patient was described. The patient was satisfied with the functional and esthetic results of the implant‐supported restoration and a 6‐year follow‐up showed no sign of recurrence.     

Maxillary Sinusitis Caused by Dental Implants Extending into the Maxillary Sinus and the Nasal Cavities

This report describes the case of a patient who underwent osseointegrated dental implant placement. The implants were misplaced inside the nasal fossae and in the right maxillary sinus, causing chronic purulent sinusitis. CT scan without contrast showed signs of right maxillary sinusitis and confirmed the misplacement of four dental implants that surfaced into the nasal cavities. The imaging also revealed the presence of another implant that emerged inside the maxillary sinus. The patient underwent functional endoscopic sinus surgery with complete symptom remission at the long‐term follow‐up. We propose that sinusitis caused by protrusion of implants and by sinus floor lift procedures could share common physiopathological patterns and predisposing factors.     

手术导板对后牙区不翻瓣手术精度的影响

目的:评价后牙缺失患者手术导板辅助实施不翻瓣手术对种植体植入精度的影响。方法:选取2009年3月—2010年6月后牙缺失进行不翻瓣种植手术患者38例,其中男19例,女19例,平均年龄(45.06±11.10)岁,分为非导航手术组和导航手术组2组,非导航手术组男10例、女9例,上颌缺失牙17颗,下颌缺失牙22颗,由手术医师目测决定种植体窝洞预备轴向;导航手术组男9例、女10例,上颌缺失牙14颗,下颌缺失牙17颗,应用手术导板辅助进行种植体窝洞预备。术后CT扫描,以种植体长轴为中心重建缺牙区冠状面和矢状面图像,以角度偏差5°、距离偏差2mm为标准,对种植体植入位置满意度计数,对下后牙缺失病例是否出现尖端接触舌侧骨皮质、有无影响种植体植入长度的种植体计数。应用Stata 7.0软件计算上述指标的百分率并进行2组间χ2检验。结果:经统计学检验分析,与非导航手术组相比,导航手术组种植体颊舌向和近远中向角度误差以及下颌后牙种植体到下颌神经管距离误差满意率较高,下颌后牙种植体尖端接触舌侧骨皮质的发生率较低,并且因骨皮质阻挡、影响种植体植入长度的发生率较低。结论:与非导航手术组相比,手术导板可降低种植体植入角度误差和骨皮质阻挡植入种植体的发生率,使种植体植入位置满意率更高,并显著提高下颌后牙缺失病例的种植体植入长度。     

Comparison between computer-guided and freehand dental implant placement surgery: A systematic review and meta-analysis

The purpose of this systematic review was to compare computer-guided (fully guided) and freehand implant placement surgery in terms of marginal bone loss, complications, and implant survival. This review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42019135893). Two independent investigators performed the search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 2020 and identified 1508 references. After a detailed review, only four studies were considered eligible. These studies involved a total of 154 patients with 597 dental implants and a mean follow-up period of 2.25 years. There was no difference between computer-guided surgery and freehand surgery in terms of the marginal bone loss (mean difference ?0.11 mm, 95% confidence interval (CI) ?0.27 to 0.04 mm; P = 0.16), mechanical complications (risk ratio (RR) 0.85, 95% CI 0.36–2.04; P = 0.72), biological complications (RR 1.56, 95% CI 0.42–5.74; P = 0.51), and implant survival rate (RR 0.53, 95% CI 0.11–2.43; P = 0.41). This meta-analysis demonstrated that both computer-guided and freehand surgeries yielded similar results for marginal bone loss, mechanical and biological complications, and implant survival rate.     

Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation

Background: Computer‐aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. Methods: Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. Results: The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. Conclusions: The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer‐aided dental implant surgery still requires improvement and should be considered as in the developmental stage.     

The rehabilitation of oral defects by osseointegrated implants

Abstract. So far, preprosthetic surgery for oral defects improved prosthetic retention problems for only a limited amount of time and led to many side-effects. The alternative offered by the osseointegration technique developed by P.–I. Brånemark changed the concept of preprosthetic surgery dramatically. By means of a few permucosal titanium screws, bridges or overdentures can be retained even in cases of advanced jaw bone resorption. When the latter is extreme, an autologous free bone graft fixed by means of self-tapping titanium implants can offer the necessary support for sometimes elaborate prosthetic reconstructions. The marginal bone loss around Brånemark implants is very limited after a 1st year of bone remodelling, even when an autologous transplant has been used.     

Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery

Objective: To assess the healing process after flap or flapless surgery in immediate implant placement.
Material and Methods: This study was carried out on five Beagle dogs. Four implants were placed in the lower jaw in each dog immediately after tooth extraction. Flap surgery was performed before the extraction on one side (control), and flapless on the contrary (test). After 3 months of healing, the dogs were sacrificed and prepared for histological analysis.
Results: Ten implants were placed in each group. Two failed (one of each group). The percentage of bone–implant contact was very similar in both groups: 64.8% and 65.1% for the flap and the flapless group, respectively. The difference between the mean distance from the peri-implant mucosa margin to the first bone–implant contact at the buccal aspect was statistically significant between both groups (3.02 mm. flapless and 3.69 mm. flap group). The mean first bone–implant contact at the buccal aspect was located in relation to the sand-blasted and acid-etched level at 0.82 mm for the flapless group and 1.33 mm for the flap group. This difference was not statistically significant.
Conclusion: Flapless immediate implant surgery produces a significant reduction in the vestibular biologic width and a minor reduction in buccal bone plate resorption.     

Non‐submerged osseointegrated dental implants with ball attachments supporting overdentures in patients with mandibular alveolar ridge atrophy. A short‐term follow up.

Non‐submerged, hollow screw ITI‐Bonefit dental implants with ball attachments supporting overdentures were used as alternative treatment to combined vestibulo‐lingual‐plasty with free split‐thickness skin graft and removable dentures in 40 consecutive patients with mandibular alveolar ridge atrophy. One hundred and fifty‐six non‐submerged fixtures were installed. Ball attachments were mounted on the fixtures and implant‐supported overdentures inserted 34 months after fixture installation. The observation period after implant activation and prosthesis insertion varied from 1 to 3 years with a median observation period of 2 years. The overall success rate of individual implants was 99%(155/156). The prosthesis function rate was 100%(40/40). The 1‐year success rate of individual implants was 99%(155/156) with a prosthesis function rate of 100% 40/40. No persistent surgical, periodontic or prosthodontic complications were observed. The results indicate that non‐submerged osseointegrated ITI‐Bonefit dental implants with ball attachments supporting overdentures can be a successful alternative to combined vestibulo‐lingualplasty with free split‐thickness skin graft and removable dentures, and as successful as the use of submerged dental implants.     

Endoscopic sinus surgery for dental implant displacement into the maxillary sinus—a retrospective clinical study

The aims of this retrospective clinical study were to present our management protocol for the retrieval of impacted dental implants that have become displaced into the maxillary sinus cavity and to define the role of endoscopic sinus surgery in this setting. All 24 patients (25 implants) who underwent surgical retrieval of dental implants displaced into the maxillary sinus between 2012 and 2019 were included. Data on surgical interventions and complications were collected retrospectively. Eleven patients (46%) had chronic sinusitis associated with the migrated implant. All implants were successfully retrieved via transnasal endoscopic approach alone: 80% via a middle meatal antrostomy and 20% via a combined middle and inferior meatal antrostomy. Five patients required a concomitant transoral approach for oro-antral fistula repair. None required a transoral approach for displaced implant retrieval. All patients healed uneventfully without complications. Transnasal endoscopic sinus surgery via a middle meatal antrostomy or a combined middle and inferior antrostomy is recommended as the primary choice for dental implant retrieval from the maxillary sinus. A transoral approach should be performed simultaneously only for oro-antral fistula repair. This surgical protocol proved to be safe and efficient, and it obviated the need for osteotomies of the anterolateral maxillary wall.     

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??Digital technology plays a more and more important role in the medical field??especially in the area of dental implant. Computer-assisted preoperative diagnosis and surgical plan can realize  the visual display of  anatomical structure of the implant area??and the best implant location in the 3D space??a surgery guide and real-time intraoperative navigation technology can accurately transfer the virtual surgery plan into the real patient??achieving the effect of doing the implant accurately by the preoperative implant surgery plan??postoperative digital  technique can assess and monitor the implant effect in a short and long term??getting stable implant retention in a long term. In this paper??the application of digital technology in the implant surgery was discussed??providing a reference for the treatment of implant cases.