Masticatory function in edentulous patients wearing implant overdentures after graftless maxillary sinus membrane elevation.

BACKGROUND: Graftless sinus floor augmentation shows good results in bone gain, radiology and implant survival. Clinically, this technique can be recommended as an alternative to conventional procedures using augmentation materials. OBJECTIVES: This study aims to assess masticatory performance, masticatory ability and patient satisfaction after graftless sinus floor augmentation. METHODS: The study group consisted of patients who had received a graftless sinus lift procedure in a split-mouth design and was compared to patients with maxillary implant-supported overdentures without augmentation and a natural dentition group. To assess objective masticatory performance, the mixing ability test was performed. Three questionnaires were used to assess patient reported outcomes related to mastication and patient satisfaction. RESULTS: Each group included ten patients. Both the graftless sinus lift group and the edentulous control group had a worse masticatory performance compared to the natural dentition group. Masticatory ability, measured by patient reported outcomes, was not different between the graftless sinus floor augmentation group and implant-retained overdentures group without augmentation, but the natural dentition group showed better results. Thereby, the better the masticatory performance in patients with a graftless sinus membrane elevation the better the patient satisfaction for 'prosthesis', 'appearance of prostheses', 'speech' and 'mastication and eating'. CONCLUSIONS: Patients with implant-supported overdentures show inferior masticatory function compared to those with natural dentition. There were no significant differences in masticatory performance between patients with implant-retained overdentures, with or without graftless augmentation. The decision on the preferred procedure should consider additional factors such as anatomical, surgical-technical aspects and patient's preferences.

Accuracy of edentulous full-arch implant impression: An in vitro comparison between conventional impression, intraoral scan with and without splinting, and photogrammetry.

OBJECTIVES: The purpose of this in vitro study was to compare the trueness and precision of complete arch implant impressions using conventional impression, intraoral scanning with and without splinting, and stereophotogrammetry. MATERIALS AND METHODS: An edentulous model with six implants was used in this study. Four implant impression techniques were compared: the conventional impression (CI), intraoral scanning (IOS) without splinting, intraoral scanning with splinting (MIOS), and stereophotogrammetry (SPG). An industrial blue light scanner was used to generate the baseline scan from the model. The CI was captured with a laboratory scanner. The reference best-fit method was then applied in the computer-aided design (CAD) software to compute the three-dimensional, angular, and linear discrepancies among the four impression techniques. The root mean square (RMS) 3D discrepancies in trueness and precision between the four impression groups were analyzed with a Kruskal-Wallis test. Trueness and precision between single analogs were assessed using generalized estimating equations. RESULTS: Significant differences in the overall trueness (p = .017) and precision (p < .001) were observed across four impression groups. The SPG group exhibited significantly smaller RMS 3D deviations than the CI, IOS, and MIOS groups (p < .05), with no significant difference detected among the latter three groups (p > .05). CONCLUSIONS: Stereophotogrammetry showed superior trueness and precision, meeting misfit thresholds for implant-supported complete arch prostheses. Intraoral scanning, while accurate like conventional impressions, exhibited cross-arch angular and linear deviations. Adding a splint to the scan body did not improve intraoral scanning accuracy.

In situ shell technique for edentulous ridge augmentation.

BACKGROUND: The novel two-stage technique presented in this study is based on guided bone regeneration for three-dimensional bone augmentation. METHODS AND RESULTS: The proposed technique was performed to augment an atrophic alveolar ridge in the maxilla and mandible. This method is based on using an autogenous bone plate, a mixture of allogeneic bone graft and injectable -platelet-rich fibrin, and a bioresorbable barrier membrane. Based on the cases presented in this study, sufficient osseous regeneration was achieved to place dental implants in an ideal position. CONCLUSION: Within the limitations of the present study, it seems that in situ shell technique could be a beneficial method to augment the extremely atrophied ridges with less morbidity and shorter operative time. KEY POINTS: Why is this case new information? The cases presented a new technique using in situ autogenous plates for ridge augmentation. What are the keys to the successful management of this case? The keys to the successful management of these cases are proper flap management and less traumatic bony plate preparation. What are the primary limitations to success in this case? The primary limitation to success in this technique would be a need for high surgical skills to conduct the procedure accurately.

Clinical accuracy of partially guided implant placement in edentulous patients: A computed tomography-based retrospective study.

OBJECTIVES: This retrospective study was intended to evaluate the clinical accuracy of partially guided template in guiding implant placement in edentulous patients. METHODS: A total of 120 implants were placed in 24 patients with at least one completely edentulous arch with a partially guided system. Based on CBCT data, a repeatable method was used to measure linear and angular deviations of implants at 3D level in Mimics medical software. The influence of supporting tissue and implant region on the accuracy was assessed, followed by the evaluation of direction of linear deviations in biologically vital areas. RESULTS: Linear deviations of all implants were 1.91 ± 0.68 mm, 1.47 ± 0.68 mm, and 1.02 ± 0.69 mm at apical, apical lateral, and apical vertical levels. When at the cervical, cervical lateral, and cervical vertical levels, the linear deviations were 1.53 ± 0.65 mm, 0.98 ± 0.53 mm, and 1.01 ± 0.69 mm, respectively. Angular deviation of all implants was 7.14 ± 3.41°. Implants guided by mucosa + tooth-supported templates showed higher linear deviations at apical vertical level (1.21 ± 0.72 mm vs. 0.86 ± 0.63 mm, p < .05) and cervical vertical level (1.18 ± 0.72 mm vs. 0.87 ± 0.63 mm, p < .05) than mucosa-supported templates, and implants in maxilla were found higher angular deviation than mandible (7.89 ± 3.61° vs. 6.29 ± 2.97°, p < .05). CONCLUSIONS: The partially guided template served as clinically viable surgical assistance in implant placement in edentulous patients. When using mucosa + tooth-supported template or placing implants in maxilla, more caution was required, especially in biologically vital areas.

Accuracy of the Yakebot dental implant robotic system versus fully guided static computer-assisted implant surgery template in edentulous jaw implantation: A preliminary clinical study.

AIMS: To compare the accuracy of the Yakebot dental implant robotic system with that of fully guided static computer-assisted implant surgery (CAIS) template in edentulous implantation. MATERIALS AND METHODS: Thirteen patients with edentulous were recruited and divided into two groups: the Yake robotic system group (experimental) (n = 5) and the CAIS group (control) (n = 8). Postoperative cone-beam computed tomography (CBCT) was performed immediately, and the 3-dimensional positions of implants were obtained and compared with that in the preoperative design. The comparison showed platform, apical, depth, and angular deviations. A value of p < 0.05 was considered statistically significant. RESULTS: A total of 84 implants (36 in the robotic group and 48 in the CAIS group) were placed. The mean deviation at the implant platform, apex, depth, and angle in the CAIS group was 1.37 ± 0.72 mm, 1.28 ± 0.68 mm, 0.88 ± 0.47 mm, and 3.47 ± 2.02°, respectively. However, the mean deviation at the implant platform, apex, depth, and angle in the robotic group was 0.65 ± 0.25 mm, 0.65 ± 0.22 mm, 0.49 ± 0.24 mm, and 1.43 ± 1.18°, respectively. Significant differences in the four types of deviation (p < 0.05) between the two groups were observed. CONCLUSION: The accuracy of robotic system in edentulous implant placement was superior to that of the CAIS template, suggesting that robotic system is more accurate, safe, and flexible, can be considered a promising treatment in clinical practice.

A randomized, multicenter, double-blinded parallel study to evaluate the safety and performance of zoledronate-coated versus uncoated dental implants in partially edentulous patients.

OBJECTIVE: To evaluate patient safety, implants survival and implant stability of the bisphosphonate (zoledronate) as a coating on dental implants in patients requiring oral rehabilitation in the posterior maxilla. MATERIALS AND METHODS: In this multicenter, double-blind, randomized controlled study, 62 patients were randomized to receive either zoledronate-coated or uncoated control implants in the premolar or molar area of the maxilla, using a one stage-protocol. Due to dropouts and exclusion 49 patients completed the study. The implants were examined by resonance frequency analysis (RFA) using an implant stability quotient (ISQ) scale at the time of insertion, and at 8 weeks, and after 12 weeks prior to prosthetic restoration. Radiographs were taken prior to surgery, directly after insertion, and during the follow-up at 12 weeks, 6 months, and 1 year to analyze changes in marginal bone levels (MBL). Finally, all complications and adverse effects (AE) were observed and recorded. RESULTS: Out of 62 included patients, 49 patients completed the study. No AE were reported by patients receiving zoledronate-coated implants. There was no statistically significant difference between the zoledronate-coated or uncoated implant groups when comparing ISQ levels at insertion and after 12 weeks of healing, the mean of the ISQ values demonstrated a change of 4.64 (95% confidence interval: 15.46; 5.79, p = 0.43) between the two groups. At 8- and 12-weeks, ISQ values remained stable (range 62-70). Radiographic analysis showed no statistically significant difference in MBL between the two implant groups after 1 year of loading neither at the mesial side (p = 0.99) or the distal side (p = 0.97). MBL for coated implants were 0.57 mm at the mesial side and 0.46 mm at the distal side. For the uncoated implants, MBL was 0.48 mm at the mesial side and 0.47 mm at the distal side. CONCLUSION: The zoledronate-coated dental implants are safe to use in a one-stage surgery protocol in patients requiring oral rehabilitation in the posterior maxilla, after 1 year of loading. There were no statically significant changes in implant stability and marginal bone levels measured by intraoral radiographs in comparison to uncoated control implants.

Use of the universal scan template to achieve a predictable optical impression: Preliminary data of a case series study in complete edentulous patients.

BACKGROUND: Full-arch IOS scan of edentulous areas rehabilitated with dental implants is nowadays still described as an unpredictable procedure. To improve the accuracy, a universal scan template (UST®) is proposed in this article. The clinician can easily assemble the template with a mechanical coupling, by matching the scan bodies with objects of known dimension characterized by specific markers. The UST® facilitates the scanning of an entire arch on scan bodies, reducing the learning curve, simplifying acquisition movements, shortening the scanning time, and drastically reducing the risk of distortions and aberrations of the scans. MATERIALS AND METHODS: In a case series study on 12 patients, the improvement in the accuracy of the scans with UST® was validated by comparing the STL files derived from scans with and without the guide in place. A titanium bar was produced from each optical impression. RESULTS: The bars obtained from the optical impressions taken without UST® were found to be nonpassive in the mouth in the majority of the cases. On the contrary with the use of UST® we obtained 12 passive prosthetic rehabilitations. CONCLUSIONS: The proposed solution may represent a valid method to improve the predictability of full arch optical impressions on implants.

Full-arch restoration with the NEXUS IOS® system: A retrospective clinical evaluation of 37 restorations after a one year of follow-up.

OBJECTIVES: Report the results with a novel workflow of digital restoration for completely edentulous patients with implant supported full arch fixed dental prostheses (ISFDP). METHODS: This multicenter retrospective clinical study was based on the evaluation from a cohort of 29 patients restored with 37 ISFDP designed and manufactured from the data captured by a direct intraoral scan, using a novel full digital system (NEXUS IOS®, Osteon Medical, a Keystone Dental Group company, Melbourne, Australia). Data was collected over a 3-year period, in six different dental centers. This study reported on the clinical parameters including: precision of marginal fit, functional and aesthetic integration of Nexus ISFDP. All patients were followed for a period of one year post delivery. Implant survival, biologic and prosthetic complications were assessed, at one year. A statistical analysis was conducted. RESULTS: All 37 ISFDP were deemed clinically acceptable on insertion. Implant survival at one year was 100 %. The biologic and prosthetic complications were minimal during the follow-up period. CONCLUSIONS: ISFDP, designed and manufactured using the NEXUS IOS® system, are clinically acceptable, with a low incidence of complications at one year. Long-term clinical studies are needed. STATEMENT OF CLINICAL RELEVANCE: Within the limitations of this study (retrospective design, small patient sample, limited follow-up) the NEXUS IOS® system seems to represent a viable solution for the restoration of completely edentulous patients with ISFDP, in a full digital workflow.

Accuracy of autonomous robotic surgery for dental implant placement in fully edentulous patients: A retrospective case series study.

OBJECTIVES: This study evaluated the accuracy of dental implant placement using the robotic computer-assisted implant surgery (r-CAIS) technology in fully edentulous patients. MATERIALS AND METHODS: Fully edentulous and terminal dentition patients were enrolled for r-CAIS technology. Based on the cone-beam computed tomography (CBCT) examination, a customized positioning marker and a preoperative surgical plan were created before surgery. During the implant surgery, the implant osteotomy and placement were automatically performed using an autonomous robotic surgery system under the surgeon's supervision. A postoperative CBCT scan was used to determine the discrepancies between the planned and placed implants. RESULTS: Ten patients with 59 implants underwent autonomous robotic surgery. No adverse surgical events occurred. The deviations of global coronal, global apical, and angular were 0.67 ± 0.37 mm (95% CI: 0.58-0.77 mm), 0.69 ± 0.37 mm (95% CI: 0.59-0.78 mm), and 1.27° ± 0.59° (95% CI: 1.42°-1.11°), respectively. CONCLUSIONS: The autonomous r-CAIS technology proved an accurate surgical approach for implant placement in fully edentulous patients due to the control of the angular deviation. Autonomous robotic surgery seems promising as an accurate technology for treating fully edentulous patients. However, further trials are required to provide more hard clinical evidence.

Group 4 ITI Consensus Report: Patient benefits following implant treatment in partially and fully edentulous patients.

OBJECTIVES: The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient-reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant-retained/supported dental prostheses were addressed. MATERIALS AND METHODS: Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal. RESULTS: Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant-supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness. CONCLUSIONS: Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

Oral function in completely edentulous patients rehabilitated with implant-supported dental prostheses: A systematic review and meta-analysis.

OBJECTIVES: This review evaluated the effects of rehabilitation with implant-supported prostheses on the oral function of completely edentulous adults. MATERIALS AND METHODS: Systematic literature searches were performed to identify records reporting on oral function in completely edentulous adults rehabilitated with implant-supported prostheses. Meta-analyses were performed on various outcomes including bite force, masticatory performance, muscle activity, mandibular movement/chewing pattern, and salivary flow. RESULTS: 5507 records were identified. Thirty studies qualified for data extraction and analysis. The kappa (𝛋) for the search and identification strategy ranged between 0.50 and 1.00. Meta-analysis was performed grouping the studies by outcomes and split by time points of 6-12 months, 12-36 months, and >36 months after implant therapy. The meta-analyses revealed a significant improvement in oral function of completely edentulous adults after rehabilitation with implant-supported prostheses at 6-12 months (Z = -4.895, p < .001; 95% CI: -0.703, -0.301; τ2 = .609; Q = 114.953, df = 17, p < .001; I2 = 85.2%), at 12-36 months (Z = -4.886, p < .001; 95% CI: -0.580, -0.248; τ2 = .908; Q = 280.611, df = 35, p < .001; I2 = 87.5%) and at more than 36 months (Z = -9.108, p < .001; 95% CI: -1.472, -0.951; τ2 = .019; Q = 7.918, df = 7, p = .340; I2 = 11.6%). The included studies demonstrated a low to moderate risk of bias. CONCLUSIONS: This systematic review concluded that the oral function of completely edentate adults significantly improved with implant-supported/retained prostheses, even when only one jaw received implant therapy. Therefore, implant therapy should be promoted for edentulous adults to alleviate the shortcomings of conventional complete removable dental prostheses.

Treatment effect of implant-supported fixed complete dentures and implant overdentures on patient-reported outcomes: A systematic review and meta-analysis.

OBJECTIVES: To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on dental patient-reported outcomes (dPROs). MATERIALS AND METHODS: In January 2022, Medline, Embase, CINAHL, Cochrane Library, PubMed Central, Web of Science, and ClinicalTrials.gov were screened for prospective clinical studies on completely edentulous patients treated with IFCDs and/or IODs, reporting pre-treatment and follow-up dPROs. Hedges' g effect sizes (ES) with corresponding 95% confidence intervals (CI) were calculated. Afterward, meta-analyses were conducted using random effect models. RESULTS: A total number of 1608 records was initially identified. Of those, 28 studies reporting dPROs from 1457 patients were finally included. The applied dental patient-reported outcome measures (dPROMs) included several versions of the Oral Health Impact Profile (OHIP) or specific items assessing satisfaction with Visual Analogue Scales (VAS). The overall ES was large for rehabilitation with IFCDs (1.68 [CI: 1.15, 2.20]) and IODs (1.26 [CI: 0.99, 1.52]) with no significant difference (p = .165) between the two. Denture stability was the only factor rated significantly higher for IFCDs (ES difference: 2.37 [CI: 0.21, 4.54]; p = .032). Subgroup analyses revealed moderately higher ES for IODs on two implants relative to one implant (ES difference: 0.73 [CI: 0.34, 1.12]; p < .001). CONCLUSIONS: There is a strong positive effect of implant treatment in edentulous patients, independent of the type of prosthetic rehabilitation. In patients seeking high stability, IFCDs may be preferable. In mandibular IODs on a single implant, there was a significantly positive effect of an additional implant on dPROs.

Three-Dimensional Evaluation of the Accuracy of Zygomatic Implant Placement Through an In-House Fully Guided Approach.

Purpose: To validate guided surgery for zygomatic implants (ZIs) by analyzing the final position of the implants relative to the preoperatively planned position. Material and Methods: Five patients with fully edentulous atrophic maxillae treated with four ZIs through a fully guided implant surgical approach were evaluated. The preoperative phase included digital planning, through which the surgical guide was designed and created. Analysis of the guided surgery accuracy was carried out by superimposing the digital planning over the final position of the implants using preoperative and postoperative CBCT. The radiologic evaluation included implant angular deviation, entrance deviation, exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. Results: All five patients (two men and three women; mean age: 61.8 ± 3 years) were each treated with four ZIs using a fully guided approach with an extrasinusal path, obtaining ideal emergence of the implants. Superimposition comparison found a mean axial angular implant deviation of 0.79 ± 0.41 degrees and a mean implant entrance deviation of 0.95 ± 0.26 degrees. The platform deviation was 0.62 ± 0.19 mm buccopalatally and 0.76 ± 0.14 mm mesiodistally, while the apical deviation was 0.42 ± 0.13 mm buccopalatally and 1.06 ± 0.37 mm mesiodistally. Conclusions: Guided surgery in zygomatic implants appears to be sufficiently accurate to make it a safe and predictable technique.

Preplanned Computer-Assisted Advanced Implant Placement for Orthodontic Patients: Presentation of a Novel Multidisciplinary Treatment Approach and a Case Report.

This case report describes a novel approach combining orthodontic and implant digital treatment planning workflows to enable prosthetically driven implant placement before orthodontic treatment is performed or completed. The computer-assisted implant placement is performed using a static surgical guide based on the future positions of the teeth after completion of orthodontic treatment. This innovative approach allows for select partially edentulous patients to undergo fixed prosthetic rehabilitation before orthodontic treatment is completed.

Digital design and manufacture of a stackable implant surgical guide for immediate loading in completely edentulous full-arch cases: a dental technique.

The design and manufacture of a stackable surgical guide for implant placement with immediate prosthetic loading of completely edentulous cases is described in this dental technique. To achieve this, the stackable attachment is designed using free-form designing software, which is later joined to the implant placement guide and the dental prosthesis. This technique should provide the patient with a same-day implant and an esthetic restoration accurately placed in the predesigned position of the centric occluding relationship. It also reduces the number of visits and prosthetic complications related to the improper implant position.

The accuracy of dynamic computer assisted implant surgery in fully edentulous jaws: A retrospective case series.

OBJECTIVES: To evaluate the accuracy of implant placement using a dynamic navigation system in fully edentulous jaws and to analyze the influence of implant distribution on implant position accuracy. MATERIALS AND METHODS: Edentulous patients who received implant placement using a dynamic navigation system were included. Four to six mini screws were placed in the edentulous jaw under local anesthesia as fiducial markers. Then patients received CBCT scans. Virtual implant positions were designed in the planning software based on CBCT data. Under local anesthesia, implants were inserted under the guidance of the dynamic navigation system. CBCTs were taken following implant placement. The deviation between the actual and planned implant positions was measured by comparing the pre- and postsurgery CBCT. RESULTS: A total of 13 edentulous patients with 13 edentulous maxillae and 7 edentulous mandibles were included, and 108 implants were placed. The average linear deviations at the implant entry point and apex were 1.08 ± 0.52 mm and 1.15 ± 0.60 mm, respectively. The average angular deviation was 2.85 ± 1.20°. No significant difference was detected in linear and angular deviations between the maxillary and mandibular implants, neither between the anterior and posterior implants. CONCLUSIONS: The dynamic navigation system provides high accuracy for implant placement in fully edentulous jaws, while the distribution of the implants showed little impact on implant position accuracy.

Accuracy and patient-centered results of static and dynamic computer-assisted implant surgery in edentulous jaws: a retrospective cohort study.

OBJECTIVES: This study aimed to compare implant positioning accuracy and patient-centered results between static and dynamic computer-assisted implant surgery (s-CAIS and d-CAIS) in edentulous jaws. MATERIAL AND METHODS: The current study retrospectively evaluated a total of 110 implants placed in 22 fully edentulous patients via s-CAIS or d-CAIS (n = 11). The accuracy of implant positioning was assessed by measuring the implant's angular deviation and deviation at the platform and apex from the preoperative design postoperatively. Patient-centered results, including preoperative and intraoperative patient-reported experiences and postoperative patient-reported outcomes, were extracted from the medical records. The nested t test and chi-square test were used to compare accuracy and patient-centered results between s-CAIS and d-CAIS postoperatively. RESULTS: The implants in the s-CAIS group showed significantly smaller angular deviation (2.32 ± 1.23°) than those in the d-CAIS group (3.87 ± 2.75°). In contrast, the platform and apical deviation were significantly larger in s-CAIS (1.56 ± 1.19 mm and 1.70 ± 1.09 mm, respectively) than d-CAIS (1.02 ± 0.45 mm and 1.00 ± 0.51 mm, respectively). Furthermore, the implants in the s-CAIS group deviated significantly (p < 0.001) more toward the coronal direction than those in the d-CAIS group. Notably, all patients in the s-CAIS group reported an obvious foreign body sensation during surgery, representing a significant difference from the d-CAIS group. CONCLUSIONS: Compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation and less foreign body sensation. TRIAL REGISTRATION: The retrospective study was registered on the Chinese Clinical Trial Registry on August 8th, 2022, with registration number No. ChiCTR2200062484. CLINICAL RELEVANCE: Despite the increasing use of computer- assisted implant surgery in fully edentulous patients, clinical evidence comparing implant positioning accuracy and patient-centered results between static and dynamic CAIS systems is scarce. Our study demonstrated that compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation.

Treatment alternatives for the rehabilitation of the posterior edentulous maxilla.

Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.

The Reverse Scan Body Protocol: Completing the Digital Workflow.

Recently developed extraoral techniques have allowed for an alternative approach for the digital acquisition of implant positions in fully edentulous patients. The "reverse scan body protocol" digitally simulates the traditional back-pouring technique long utilized in analog workflows. This article presents two cases in which an extraoral scanning technique was used to capture implant positions, design a prototype, and fabricate the definitive monolithic zirconia full-arch prosthesis.

5- to 15-Year Survival of Immediately Loaded Implants in Fully Edentulous Maxillae: A Multilevel Analysis in a Retrospective Cohort Study.

PURPOSE: Although immediate-loading implant (ILI) treatment is a general treatment strategy for fully edentulous maxillae, long-term evidence is required. The purpose of this study was to evaluate the long-term clinical results of, and risk factors for, ILI treatment in fully edentulous maxillae. MATERIALS AND METHODS: ILI treatments of maxillae using 526 implants in 117 patients were reviewed retrospectively. The longest and mean observation periods were 15 years and 9.2 years, respectively. Kaplan-Meier survival curve analysis, log-rank tests, and multilevel mixed-effects parametric survival analysis were used for statistical analyses. RESULTS: Overall, 38 of 526 implants failed in 23 patients, and the estimated 15-year cumulative implant-level and patient-level survival rates were 90.7% and 73.7%, respectively. The cumulative implant survival rate was significantly higher in female patients than in male patients. Sex, implant length, and implant diameter were significantly associated with implant survival. CONCLUSION: ILI treatment of completely edentulous maxillae demonstrated viable long-term clinical outcomes. Male sex, shorter implant length, and narrow implant diameter negatively affected implant survival. Int J Oral Maxillofac Implants 2023;38:516-522. doi: 10.11607/jomi.10310.