ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes.

OBJECTIVES: The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants. MATERIALS AND METHODS: Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds. RESULTS: A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants. CONCLUSIONS: Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.

Development and capture of soft tissue contours at time of implant placement.

A technique is described which will generate a customized healing abutment for a dental implant to allow the development of ideal soft tissue contours. With implant position and soft tissue contours defined at surgery, customized impression techniques can be used to capture those details and help generate the definitive implant-supported restoration. This workflow reduces the number of patient visits.

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides.

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

Deformation of stereolithographically produced surgical guides: an observational case series report.

BACKGROUND: Template-based computer-guided implant placement holds the promise of more precise and less traumatic placement of dental implants. Errors in the fabrication process of the surgical guide may lead to unfavorable clinical outcomes. PURPOSE: This report discusses the potential of unintentional volumetric deformation of stereolithographically (SLA) produced surgical guides (NobelGuide, Nobel Biocare AB, Göteborg, Sweden) compared with the original scan denture. MATERIALS AND METHODS: Three-dimensional radiographic data acquired by medical computerized tomography (CT) or cone beam CT (Newtom 3G, AFP Imaging Corporation, Elmsford, NY, USA) can be utilized in specialized software to develop treatment planning for dental implant placement. This information can then be transferred to the patient via a surgical guide. Stereolithography is a rapid prototyping process that can be used to create such a guide stent. Three cases are shown describing different levels of deformation of SLA-produced surgical guides. RESULTS: Unintentional deformation of SLA-produced surgical guides is possible. Deformation of surgical guides can create dissimilarity between the virtually planned position and the actual position of the implants. CONCLUSION: Incorrect setting of the ISO values for the segmentation of the scan denture has been found to be a factor in the deformation of SLA-produced surgical guides, although more, at this time known but also less understood, issues appear to be involved. Only one manufacturer's product is discussed; further research is warranted to determine if the discrepancies are process or product based. It might be prudent to closely evaluate the volumetric congruence of SLA-produced surgical stents before their clinical use to prevent undesired clinical outcomes.

Cast-based guided implant placement: a novel technique.

One of the most challenging aspects of implant placement is the correct spatial positioning of the dental implant in the bone. Surgical guides of various configurations have been proposed to aid implant placement. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes a combination of analog techniques, including bone sounding and periapical radiographs used to study the available bone volume. A simplified casting protocol is proposed, and the implant platform position of the implant analog is transferred to a surgical guide composed of a stiff vinyl polysiloxane material. This surgical guide is used in a conventional flapless guided implant surgery protocol. This combination of techniques allows precise placement of a dental implant, abutment, and provisional restoration in a minimally invasive manner.

An indirect immediate-load prosthetic protocol using a novel-winged analog.

UNLABELLED: Immediate loading of implants has increasingly become the preferred treatment modality for both patients and clinicians. While the concept has been accepted as the preferred method of treatment, there are various options in terms of completing the actual procedure. This article will discuss the utilization of a novel-winged analog in combination with polyvinylsiloxane-casting material. This correlation allows for the rapid chairside development of a high-precision cast. On this cast, a conversion denture is transformed into an interim fixed prosthesis. Both the conventional analog as well as the computer-guided protocols will be described herein. LEARNING OBJECTIVES: This article discusses a simplified, indirect method for placing an interim fixed prosthesis utilizing a novel-winged analog and polyvinylsiloxane casting material. Upon reading this article, the reader should: Understand the benefits attributed to the immediate loading of dental implants. Become familiar with the differences between conventional open-flap surgery and treatment protocol utilizing CAD/CAM technology.