Application of sticky bone combined with concentrated growth factor (CGF) for horizontal alveolar ridge augmentation of anterior teeth: a randomized controlled clinical study.

OBJECTIVE: This study was designed to estimate the effect of sticky bone combined with concentrated growth factor (CGF) on anterior alveolar horizontal augmentation during implantation. METHODS: Twenty-eight patients were randomly assigned to either the test group (Group 1, n = 14) or the control group (Group 2, n = 14). Patients in Group 1 and Group 2 underwent GBR using sticky bone combined with CGF and bone powders mixed with saline, respectively. On postoperative Day 7, the patients completed the visual analogue scale (VAS). Three-dimensional models of maxillary alveolar bone were reconstructed from CBCT data at different periods, and the bone volume conversion rate was calculated with the assistance of a measurement marker guide. Labial bone thickness before and after trauma closure and bone density at six months postoperatively were also measured. RESULTS: The mean bone volume conversion rate for Group 1 (72.09 ± 12.18%) was greater than that for Group 2 (57.47 ± 9.62%, P = 0.002). The VAS score was lower for Group 1 than for Group 2 (P = 0.032). At six months postoperatively, greater bone density was found in patients in Group 1 than in those in Group 2, although the difference was not statistically significant (P > 0.05). The change in the thickness of the labial bone graft material in Group 1 was smaller than that in Group 2 (P = 0.025). CONCLUSION: Sticky bone combined with CGF was able to achieve better bone augmentation than conventional GBR. With excellent mechanical properties and the capacity to release growth factors, sticky bone is an ideal material for bone grafting. TRIAL REGISTRATION: The study was registered at the Chinese Clinical Trial Registry on 10/04/2022 (Identification number: ChiCTR2200058500).

Time management in multistep periodontal and implant treatments: a practical guide.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

Peri-Implant Mucosal Fenestration and Histologic Observation of Bone Xenograft Material 7-Years After Implant Installation: A Case Report.

Bone augmentation is often required before the installation of dental implants. Here, we report a case for a patient who previously received bone augmentation at the upper right jaw using a xenogenic graft, followed by successful implant installation. Seven years later, the patient presented with mucosal fenestration with bone exposure at the area and gave a history of a recent diagnosis of cutaneous lichen planus. Several attempts were made to manage the situation, and finally, we resorted to connective tissue graft placement at the site. A piece of bone was sent for histologic evaluation, where the results indicated the presence of un-resorbed graft material surrounded by inflammatory cells, with no evidence of bone formation in the area. The case presents histologic evidence for the lack of new bone formation using xenograft over the evaluation period. The case also shows lichen planus, a possible cause for oral complication for patients undergoing augmentation and implant installation.

The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-Arch Implant Restoration.

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

Correlation Between Acquisition of Dental Implant Stability and Hounsfield Units at Dental Implant Placement.

Alveolar bone quality at the implantation site affects the initial stability of dental implant treatment. However, the relationship between bone quality and osseointegration has yet to be evaluated. Herein, we aimed to investigate the effect of bone quality on dental implant stability in osseointegration formation changes. Patients underwent computed tomography imaging before dental implantation at the posterior. Hounsfield units were measured at the platform, middle, and tip sites. Implant stability was measured using resonance frequency analysis immediately and at 3 months postoperatively, in which the difference in implant stability quotients (ISQ) was defined as the change between primary and secondary fixation. In multiple regression analysis, the dependent variable was the change between the immediate and secondary fixations. We included 81 implants that conformed to the criteria. Primary fixation yielded the following results: R2 = 0.117, F = 2.529, and P = .047. The difference between the maxilla and mandible of the implantation site (P = .02) and the platform-site Hounsfield units (P = .019) were identified as significant factors. The following results were obtained regarding the change between the immediate and secondary fixation: R2 = 0.714, F = 40.964, and P < .001. The difference between diameter (P = .008) and the immediate ISQ (P < .001) were identified as significant factors. Overall, the bone quality of the implantation site affected initial fixation; however, it had limited effect on secondary fixation. Our findings clarified the period where bone quality affects dental implant treatment and is expected to advance dental implant treatment.

Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial.

OBJECTIVES: A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment. MATERIAL AND METHODS: Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded. RESULTS: Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed. CONCLUSIONS: Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings. TRIAL REGISTRATION: The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171.

Do Implant Coatings Affect Healing of Placed Implants? An Umbrella Review.

PURPOSE: To analyze the available evidence and assess the effect of different implant coatings on healing outcomes. MATERIALS AND METHODS: Using the PICOS strategy, a structured question was formed. A protocol was agreed upon and registered with PROSPERO (no. CRD42022321926). The MEDLINE, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Pubmed, and ScienceDirect databases were searched using a structured strategy. Study selection was independently carried out in duplicate, first by title and abstract, then by full-text assessment. Quality and risk of bias were independently assessed in duplicate using AMSTAR 2 and ROBIS. Data extraction was independently undertaken in duplicate using a predefined extraction form. RESULTS: The search yielded 11 systematic reviews for inclusion. The most commonly assessed coatings were based on calcium phosphate-including hydroxyapatite (HA), brushite, and bioabsorbable nano-HA-followed by bisphosphonate, then bioactive glass coatings. Included reviews most frequently assessed marginal bone loss (MBL), bone-to-implant contact (BIC), and survival/success rates. There was considerable heterogeneity and small sample sizes. The quality assessment suggested low confidence in the reviews and high risk of bias. CONCLUSIONS: The included reviews provide weak evidence that implant coatings improve osseointegration and reduce MBL following implant placement. There was weak evidence for progressive complications for calcium phosphate coatings. Further research and long-term multicenter controlled clinical trials with improved standardization and control of bias are required to better understand the effects of coating implants.

Volumetric Analysis of Peri-implant Tissue Change Over Time: Validating an Innovative 3D Method.

PURPOSE: To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method-in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects-to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. MATERIALS AND METHODS: Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). RESULTS: The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. CONCLUSIONS: The new volumetric method was validated and can be considered a trustworthy tool.

Guided and Prosthetically Driven Bone Augmentation Using the Shell Technique and Allogeneic Cortical Plate: A Prospective Case Series.

PURPOSE: To describe the use of digital technology to surgically guide the shell technique using allogenic cortical plates for a fully guided bone augmentation procedure. MATERIALS AND METHODS: A total of 10 patients who required bone augmentation for implant placement were included in this study. Allogenic cortical plates were planned using CAD/CAM to have identical thickness to the original cortical plates, then were digitally positioned and shaped to outline the bone defect according to the existing anatomical details. A cutting pattern and a surgical template were manufactured according to the digitally preplanned bone graft and the intraoral setting. RESULTS: A total of 12 horizontal bone grafting procedures were performed using the shell technique with allogenic cortical plates. All grafting procedures were deemed successful and allowed for ideal 3D implant positioning. Of the 12 bone grafting procedures, which used a surgical template to position the cortical plate, 3 required an adjustment to reposition the plate to a more ideal position. CONCLUSIONS: Digital technology was used to create a surgical template to guide the shell bone grafting technique with allogenic cortical plates. All surgical templates offered a fixed support to hold the cortical allogenic plate in the preplanned position, offering a predictable, simplified, and accurate guided bone grafting procedure. Further studies on a larger population of patients are necessary to assess those results and to verify the treatment approach described in this study.

Evaluation of the Correlation Between the Structural Parameters of Trabecular Bone in CBCT and the Primary Stability of Dental Implants.

PURPOSE: To investigate the relationship between the structural parameters of trabecular bone obtained from CBCT imaging and the primary stability of dental implants. MATERIALS AND METHODS: Sixty patients underwent implant placement followed by primary stability evaluation via measurement of the insertion torque (IT) and the implant stability quotient (ISQ). Gray values (GV) and the fractal dimension (FD) were also measured using pretreatment CBCT images. RESULTS: FD values showed a positive and significant relationship with ISQ and IT values (P = .017 and P = .004, respectively). Additionally, there was a positive and significant correlation between GV and IT (P = .004) as well as between GV and ISQ (P = .010). FD and GV showed a considerable difference between the maxillary and mandibular jaws and were higher in the mandible. Only FD was significantly different between men and women and was higher in men. In the two age groups (older and younger than 45 years), only GV was considerably higher in people older than 45 (P < .05). CONCLUSIONS: Both fractal dimension and gray values obtained from CBCT are efficient methods for predicting the primary stability of the implant due to their relationship with ISQ and IT values.

[Review of clinical effects of disk-up sinus reamer(DSR)-based internal sinus floor elevation with implantation in 10 years].

PURPOSE: To analyze the bone remodeling around the implant 10 years after disk-up sinus reamer(DSR)-based internal sinus floor elevation with implantation and to investigate the influence of different factors on implant retention. METHODS: The clinical and imaging data of patients undergoing DSR-based sinus floor elevation with simultaneous implantation were collected from the Department of Dental Implantology, Affiliated Hospital of Qingdao University from January 2008 to December 2011. Panoramic film and CBCT were used to measure the changes of bone mass around implant in different periods. Kaplan-Meier and Log-rank tests were used to analyze the effects of different factors on implant retention with SPSS 26.0 software package. RESULTS: The study included 98 patients with a total of 128 implants. During the follow-up of 0-168 months, 7 implants failed, and the remaining formed good osseointegration and functioned, with a 10-year cumulative retention rate of 94.53%. The height of bone formation was (0.29±0.15) mm at the top and (2.74±0.66) mm in the sinus of 75 implant sites with complete imaging data obtained ten years after surgery. Kaplan-Meier and Log-rank tests showed that 8 factors including initial bone height, elevated bone height, mucosal perforation, implant length, implant torsion, diabetes, smoking and periodontitis had significant effects on implant retention. CONCLUSIONS: The DSR-based internal sinus floor elevation with implantation is a reliable and stable bone augmentation operation for vertical bone defect in maxillary posterior region, with a 10-year cumulative retention rate of no less than 94%. Initial bone height, elevated bone height, mucosal perforation, implant length, implant torsion, diabetes, smoking and periodontitis are the important factors affecting the long-term retention rate of implants.

Magnetic resonance imaging in dental implant surgery: a systematic review.

PURPOSE: To comprehensively assess the existing literature regarding the rapidly evolving in vivo application of magnetic resonance imaging (MRI) for potential applications, benefits, and challenges in dental implant surgery. METHODS: Electronic and manual searches were conducted in PubMed MEDLINE, EMBASE, Biosis, and Cochrane databases by two reviewers following the PICOS search strategy. This involved using medical subject headings (MeSH) terms, keywords, and their combinations. RESULTS: Sixteen studies were included in this systematic review. Of the 16, nine studies focused on preoperative planning and follow-up phases, four evaluated image-guided implant surgery, while three examined artifact reduction techniques. The current literature highlights several MRI protocols that have recently investigated and evaluated the in vivo feasibility and accuracy, focusing on its potential to provide surgically relevant quantitative and qualitative parameters in the assessment of osseointegration, peri-implant soft tissues, surrounding anatomical structures, reduction of artifacts caused by dental implants, and geometric accuracy relevant to implant placement. Black Bone and MSVAT-SPACE MRI, acquired within a short time, demonstrate improved hard and soft tissue resolution and offer high sensitivity in detecting pathological changes, making them a valuable alternative in targeted cases where CBCT is insufficient. Given the data heterogeneity, a meta-analysis was not possible. CONCLUSIONS: The results of this systematic review highlight the potential of dental MRI, within its indications and limitations, to provide perioperative surgically relevant parameters for accurate placement of dental implants.

Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials.

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

Effect of different thread configurations on hydrophilic implant stability. A split-mouth RCT.

This split-mouth randomized controlled trial aimed to evaluate the primary and secondary stability of hybrid implants with different thread configurations and hydrophilic surfaces. Twenty patients with a partially edentulous maxilla were selected. These patients received two types of implants with the same hydrophilic surface: CTP group: Cylindrical-Tapered implant with perforating threads; CTH: Cylindrical-Tapered implant with hybrid threads configuration (perforating and condensing threads). The primary and secondary stability parameters were measured by insertion torque and resonance frequency analysis at the time of implant placement and 7, 28, 56, and 90 days after the surgical procedure. The paired t-test was used to compare the data on the implant's stability between the groups. The statistical analysis was performed with a confidence level set at 95%. It was found that the implants in the CTH group presented higher primary stability values ​​at the time of implant placement, due to the higher ISQ (63.61 ± 9.44 vs. 40.59 ±7.46) and insertion torque (36.92 ± 16.50 Ncm vs. 28.00 ± 14.40 Ncm), than the implants in the CTP group. The CTH group presented higher ISQ values ​​in all follow-up periods: 7 days (68.67 ± 7.60 vs. 41.55 ± 9.07), 28 days (68.61 ± 5.98 vs. 47.90 ±13.10), 56 days (74.09 ± 3.96 vs. 55.85 ± 13.18), and 90 days (75.45 ± 4.02 vs. 63.47 ± 6.92) after implant placement. Hybrid implants with perforating and condensing threads demonstrated greater stability than hybrid implants with only perforating threads.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study.

BACKGROUND: The placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth. PURPOSE: This study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study. MATERIALS AND METHODS: CBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed. RESULTS: Safe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0). CONCLUSION: The possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

Semi-customized three-dimensional ultra-fine titanium meshes in guided bone regeneration for implant therapy in severe alveolar bone defect: a case report.

This case report provides a detailed description of a simple and fast bone regeneration procedure using a semi-customized three-dimensional ultra-fine titanium mesh. A 50-year-old male with a severe vertical and horizontal bone defect in the anterior mandible underwent implant treatment in a staged approach. The autologous bone was combined with a xenograft, and the mixture was grafted to augment the bone defect and covered with semi-customized ultra-fine titanium meshes, which were selected among its various types according to size and configuration of the bone defect, directly connected and immobilized on the tenting screws with minimal shaping. In a postoperative 6 months re-entry surgery, the performed titanium meshes were removed, implants were placed, and a bone core biopsy was obtained that demonstrated satisfactory new bone formation. Finally, two months later, the definitive prosthesis was installed. This semi-customized ultra-fine titanium mesh could help an implant clinician obtain more predictable results in the guided bone regeneration (GBR).

Evaluating risk factors and complications in mandibular ramus block grafting: a retrospective cohort study.

OBJECTIVES: This retrospective cohort study aimed to identify the complications and risk factors associated with alveolar grafting using autologous mandibular ramus grafts, guided by the research question: What are the complications encountered in patients undergoing alveolar bone grafting using autologous mandibular ramus block and what are the risk factors associated with the development of these complications? MATERIALS AND METHODS: The study included 70 patients who underwent alveolar crest augmentation with autologous mandibular ramus block grafting. Intraoperative, early postoperative, and late postoperative complications were analyzed, as were various risk factors. RESULTS: The results showed that the majority of patients had successful outcomes with minimal complications. Sex was found to significantly influence the visibility of the inferior alveolar nerve (IAN). Early postoperative complications were associated with IAN visibility and the use of a single screw for graft fixation. Late postoperative complications were significantly associated with the presence of infection. CONCLUSION: The findings emphasize the importance of careful surgical techniques, infection prevention, and patient selection in minimizing complications. CLINICAL RELEVANCE: This article may contribute to clinicians' and so patients' understanding of potential risk factors associated with over all ramus block grafting procedure. Based on this information, clinicians can also improve their ability to manage risk factors and associated complications and compare ramus block grafting with other alternatives to determine the best treatment approach for that particular patient.

[Risk factors and prevention for implant treatment in patients with periodontitis].

In patients with periodontitis, due to problems of periodontal tissue infection as well as soft and hard tissues defects, it may lead to implant infection, gingival papilla loss, soft tissue recession and poor coordination with adjacent teeth. For such patients, periodontal infection should be actively controlled before dental implant therapy. In consideration of insufficient soft and hard tissues, alveolar ridge preservation and soft tissue augmentation procedure can be used to preserve or increase soft and hard tissues as much as possible. Multi-disciplinary treatment is often needed for occlusion problems and coordination with adjacent tooth. Periodontal maintenance treatment of implants and natural teeth is also necessary after implant therapy. This paper discussed these risk factors and strategies for prevention and control, in order to provide some clinical guidances for the implant treatment of periodontitis patients.

Effect of guided implant placement learning experiences on freehand skills: A pilot study.

OBJECTIVES: Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators. MATERIAL AND METHODS: Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05). RESULTS: Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts. CONCLUSIONS: Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario.

Evaluation and assessment of the survival of tooth implant supported prosthesis in tooth and implant supported rehabilitation cases with metal frameworks.

INTRODUCTION: Over the years, implant therapy has been a commonly used treatment option for individuals who are partially or totally edentulous, with a long-term success rate of over 90%. With significant advancements in biomaterials and technology, implant dentistry can now conduct prosthetic rehabilitations in the majority of patients catering to all types of needs. However, in order to meet the demands of a patient base that is always growing, new trends in implantology are emerging in recent years that are focused on minimally invasive surgery and financial sustainability. In certain clinical scenarios, connecting teeth and implants to support fixed partial prosthesis (FPPs) may be a predictable and workable course of treatment. MATERIALS AND METHODS: 22 patients were selected for this study who had tooth and implant supported prosthesis placed as a final restoration. Out of these 22 patients; 12 were male and 10 were female patients. Implants were placed following proper protocol and if grafting procedures were required they were carried out. A second stage surgical procedure was carried out and delayed loading protocols were followed. The statistical analysis was done using the IBM SPSS 24.0, Chicago, USA. The survival of the implants and teeth were measured by the Kaplan Meier survival scale. Bone loss was assessed at baseline(upon loading), 12 months and 24 months. RESULTS: The implant survival rate was measured at 6 months, 12 months, 18 months and 24 months. At 24 months, one implant showed failure, so the survival rate of the implants were 95.4%. Bone loss of 1 mm was seen around one implant at 12 months. Bone loss of 1 and 2 mm was present around two implants and one implant respectively at 24 months. CONCLUSION: From the results of this study, we can conclude that tooth implant supported prosthesis show very good survival when used in rehabilitation cases.