Digital Occlusion in the Workflow of Implant Rehabilitations (original) (raw)
Related papers
International Journal of Implant Dentistry
Background: A dentition with adequate function and esthetics is essential for the well-being and quality of life. A full implant-retained fixed prosthetics is an ideal solution for fully edentulous arch, however requires complex planning, surgical, and prosthetic procedure. With the help of digital workflow, it becomes a predictable and fast solution for the dentists and the patients. This retrospective study analyzed the most advanced surgical approach in full-arch rehabilitation with dental implants and immediate loading using digital workflow. Methods: Patient records of fully edentulous jaws treated in four clinical centers in Warsaw, Poland, were evaluated. Computer-assisted planning and surgical template fabrication were done using the planning software coDiagnostiX™, based on a pre-op cone beam computed tomography (CBCT) and scanned data of a plaster model. A post-op CBCT was acquired after the placement of four to six implants by the guided system. The influence of different surgical variables on the discrepancy between planning and execution was analyzed, together with the biomechanical indices. Results: A total of nine patient records were selected of 12 edentulous jaws treated with 62 implants. The overall mean three-dimensional (3D) offset at the implant base was 1.60 mm, at the tip 1.86 mm. The mean angle of deviation was 4.89°, the mean implant stability quotient (ISQ) 70.42, and the insertion torque 35.58 Ncm. The 3D offsets were influenced by the gender of the patient, treated jaw, the diameter, and length of the implant. The angle of deviation was affected only by the treated jaw. Insertion torque was influenced by the treated jaw, the age of the patient, the length of the implant, tooth type, and the side of the jaw. Discussion: Bone quality of the patient and implant preparation procedure influenced the discrepancy between the planning and the execution of the digitally guided implant placement. Dense bone-mandible, posterior area, young age, and man-and multiple preparations of the implant bed-wider and longer implant-could be suggested as risk factors. Conclusion: Digital workflow successfully enabled the immediate full-arch rehabilitation with a predictable outcome by different surgeons in multiple centers.
A Digital Workflow for an Implant Retained over Denture: A New Approach
Biomedical Journal of Scientific & Technical Research
The development of digital technologies in dentistry has changed the therapeutic approach in edentulous patients both in the preliminary stages of clinical case studies and when supporting the actual fabrication phases. The goals of digital fabrication are to reduce the number of patient appointments and improve the predictability of treatment outcome. A thorough description of a complex clinical case analyzes how these new digital technologies are used in every step of the prosthetic therapy to perform the reconstruction of a bar retained overdenture.
Applied Sciences
The transfer of information such esthetics and occlusion from the preoperative to the postoperative digital impression could reduce the time needed to build an immediately loaded full-arch not-guided rehabilitation and improve the quality of the immediate interim restoration. Based on the digital technology advances of the last years, the purpose of the present clinical report is to describe a novel digital workflow based on computer-aided design and computer-aided manufacturing aimed at fabricating an interim fixed full-arch restoration. The protocol entails recording preoperative information such as esthetics, the occlusal plane and the intermaxillary relationship in implant-supported complete rehabilitations before the surgical insertion of the fixtures. Then, the information is transferred to the postoperative impression using a digital index in the lower jaw and the palatal rugae in the upper jaw. Within the inherent limitations of a case report, the workflow was accurate, pred...
Prosthesis
Fully digital workflow in implant dentistry is ever increasing. Treatment of partial edentulous cases is well-documented; nevertheless, complete edentulous cases are still a challenge. To present several innovations in the treatment of complete edentulous patients using digital solutions, both for implant placement and restoration delivery, was the objective of this study. It was designed as a retrospective case series study, aimed to tune further research with larger sample size, and a longer follow-up. Patients requiring complete, implant-supported restoration were asked to participate in this study. Enrolled patients were treated with four implants, immediate loading and a definitive complete arch restoration. Patients were treated using computer-assisted, template-based surgery. Multi-piece surgical templates were used to accurately place the implants, to manage the bone if needed and to make immediate loading procedure quicker and easier. After osseointegration period, definiti...
The direct digital workflow in fixed implant prosthodontics: a narrative review.
Background: The purpose of this narrative review was to examine the applicability of IOS procedures regarding single and multiple fixed implant restorations. Clinical outcomes for monolithic zirconia and lithium disilicate restorations produced through a direct digital workflow were reported. Methods: A MEDLINE (Pubmed) search of the relevant English-language literature spanning from January 1st 2015 until March 31st 2020 was conducted. In vitro studies comparing digital implant impression accuracy by different IOS devices or in vitro studies examining differences in accuracy between digital and conventional impression procedures were included. Also, RCTs, clinical trials and case series on the success and/or survival of monolithic zirconia and lithium disilicate restorations on implants, manufactured completely digitally were included. In vitro and in vivo studies reporting on restorations produced through an indirect digital workflow, case reports and non-English language articles were excluded. The aim was to investigate the accuracy of IOS for single and multiple fixed implant restorations compared to the conventional impression methods and report on the variables that influence it. Finally, this study aimed to report on the survival and success of fixed implant-retained restorations fabricated using the direct digital workflow. Results: For the single and short-span implant sites, IOS accuracy was high and the deviations in the position of the virtual implant fell within the acceptable clinical limits. In the complete edentulous arch with multiple implants, no consensus regarding the superiority of the conventional, splinted, custom tray impression procedure compared to the IOS impression was identified. Moreover, complete-arch IOS impressions were more accurate than conventional, non-splinted, open or close tray impressions. Factors related to scanbody design as well as scanner generation, scanning range and interimplant distance were found to influence complete-arch scanning accuracy. Single implant-retained monolithic restorations exhibited high success and survival rates and minor complications for short to medium follow-up periods. Conclusions: The vast majority of identified studies were in vitro and this limited their clinical significance. Nevertheless , intraoral scanning exhibited high accuracy both for single and multiple implant restorations. Available literature on single-implant monolithic restorations manufactured through a complete digital workflow shows promising results for a follow-up of 3-5 years.
2018
The development of digital technologies in dentistry has changed the therapeutic approach in edentulous patients both in the preliminary stages of clinical case studies and when supporting the actual surgical and manufacture phases. The goals of the digital workflow are to reduce the number of patient appointments and to improve the predictability of treatment outcome. A thorough description of a complex clinical case analyzes how these new digital technologies are used in every step of the surgical and prosthetic therapy to perform the reconstruction of a bar retained overdenture.
Journal of Esthetic and Restorative Dentistry, 2017
Objective: To present a rationale to reduce treatment complexity, number of surgeries, and overall treatmenttime for patients with extreme mandibular ridge def|ciency. Clinical Considerations: A 67-year-old fully edentulous male presented with a chief complaint of poor retention and stability of the mandibular complete denture with consequent discomfort and inability to chew. A novel 3appointment protocol from guided implant placementto def|nitive prosthesis delivery was implemented. Atthe f|rst appointment, a guided surgery protocol with the All-on-4 concept was used in the mandible.Implant placement was followed by immediate loading with a f|xed provisional prosthesis providing the patient with immediate function.Final impression, cast verif|cation and articulation, determination of VDO, and interocclusal records were obtained in the same appointment.In the second appointment, the framework try-in was performed and a pickup impression was taken after a new CR record.The third appointment included the delivery of the f|nal screw-retained, one-piece, full-arch prosthesis opposed by a maxillary complete denture. Conclusion: This expedited protocol allows for implant placement with a surgical template generated from preoperative virtual planning of the implants and the CAD/CAM prosthodontic rehabilitation using a digital workflow.The patient was satisf|ed with the esthetic and functional outcome and was enrolled into a 6-month recall program. CLINICAL SIGNIFICANCE This article describes an expedited protocol illustrating a digital workflow for full arch implant rehabilitation of the extremely atrophic mandible.Flapless implant placement with a surgical template generated from virtual planning was followed by immediate loading with a f|xed prosthesis.Digitalimpression/digitization of the working cast and CAD/ CAM technology were used to mill the def|nitive prosthesis.From guided surgery to the def|nitive rehabilitation only three appointments were necessary.This digital workflow can enhance patient acceptance and comfort and serve as an alternative treatment in the indicated clinical scenario.
Digital implant planning and guided implant surgery – workflow and reliability
British Dental Journal, 2019
To create individual and aesthetically pleasing restorations with a favourable long-term functional prognosis is the main objective of modern restorative dentistry. Patient expectations of oral implantology are high, as these procedures are typically associated with substantial cost and because any surgical intervention places great strain on the patient. Digital implant-prosthetic planning provides a variety of interesting perspectives in terms of diagnostics, individual treatment planning and exact surgical and prosthetic implementation, if the right preconditions exist. 7,8 The present paper intends to provide a comprehensive overview of the workflow and to discuss and critically assess the factors determining the reliability of three-dimensional implant planning and static guided implant placement using surgical templates. Some of the advantages of digital implant planning and guided surgery are self-evident. Three-dimensional visualisation of anatomical structures and improved assessment of the available bone volume and quality facilitate a more precise diagnosis and allow potential problems to be identified early, enabling high levels of predictability in surgical planning. The courses of nerves, the delimitations of the
APPLICATION Zusammenfassung Ziel: Dieser Fallbericht beschreibt einen digitalen Workflow für die prothetisch orientierte Behandlungsplanung, Implantatinsertion und Herstellung zweier verschraubter, implantatgetragener Full-arch-Brücken bei einem zahnlosen Patienten. Ziel der Kasuistik ist es, die digitalen Arbeitsschritte des Workflows, insbesondere die Scantechnik für die Erfassung der zentrischen Kondylenposition, anhand eines klinischen Falls zu zeigen und zu erläutern. Außerdem werden die Grenzen des Workflows diskutiert. Material und Methoden: Die statische computergestützte Implantation (static Computer-aided Implant Surgery, y y s-CAIS) wurde auf Basis einer digitalen Volumentomografie, eines Intraoralscans und eines digitalen Bissregistrats dreidimensional geplant. Mittels s-CAIS wurden vier Implantate im Unter-und sechs Implantate im Oberkiefer des unbezahnten Patienten platziert. Die definitiven Full-arch-Restaurationen aus monolithischem Zirkonoxid wurden in einem digitalen Workflow hergestellt, der die zuvor benutzte Röntgenschablone in modifizierter Form für die digitale Kieferrelationsbestimmung nutzte. Schlussfolgerungen: Die Entwicklung digitaler Methoden ermöglicht die Konstruktion, Verarbeitung und Herstellung implantatgetragener Full-arch-Versorgungen in einem chirurgischen, prothetischen und zahntechnischen Workflow auf Grundlage eines dreidimensionalen Backward-Planning. Anhand der digitalen prothetischen Auf-f f stellung lassen sich mittels CAD/CAM-Technik intraorale Prototypen herstellen, die als Vorlage für die definitive monolithische Zirkonoxid-Suprastruktur dienen.
A Digital Approach to Immediate-Load, Full-Arch Implant Dentistry: A Case Report
The International Journal of Periodontics & Restorative Dentistry
Conventional approaches to full-arch implant dentistry require a verified master model created by luting together impression jigs. This process involves numerous steps and is sometimes prone to errors that require subsequent correction. A novel approach involving an extraoral scanning technique using an Imetric 4D Imaging system demonstrates an alternative for same-day delivery of printed full-arch prosthetics. Advantages include the ability to offer a sameday provisional restoration without needing to verify an analog master cast. Int