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This study aims to determine the success of implant-borne prostheses and the accuracy of implant placement that can be achieved using fully guided static Computer Assisted Implant Surgery (sCAIS). Additional aims included the evaluation of the stability and health of hard and soft tissues, respectively surrounding the dental implants.
Surgical planning A virtual planning software is used for surgical planning. Cone beam computed tomography (CBCT) reconstruction and intraoral scans are registered. Prosthetic plans are created in the software, or the radiological template was used as one. The angulation and position of the dental implants are determined by the prosthetic plan.
Surgical guides The surgical templates are manufactured by rapid prototyping (3D printing). To guide the drills for implant bed preparation sleeves are inserted in the surgical guides.
Surgical protocol Surgical interventions are performed by a single clinician experienced in dental implant placement and static navigation. Patients rinse with 0.2% chlorhexidine solution for 1 min before surgery. The fit of the surgical guide is checked under local anesthesia. Fully guided implant bed preparation is performed. Dental implants are placed non-submerged. Sutures are removed at 7 days postop. The prosthetic stages of treatment begin after a two-month healing period.
Prosthetic procedures Implant-borne overdentures are manufactured using a hybrid (analog-digital) workflow. An open tray impression is taken using a medium body silicone impression material to capture the position of the implant platforms. An overdenture and a bar mesostructure are manufactured by the dental laboratory with a precision attachment.
Fixed partial dentures (FPD) are manufactured using either a hybrid or a digital workflow. An open tray impression is taken using a medium body silicone impression material or postoperative intraoral scans are performed with scan bodies to capture the position of the implant platforms. Screw or cement-retained porcelain fused to metal FDPs are manufactured by the dental laboratory. Pre-contacts are finished using articulating papers until balanced occlusion in cases of overdentures or lateral guidance in cases of FPDs are obtained. Patients are recalled twice per year for controls and professional dental hygiene intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| static Computer Assisted Implant Placement | Patients who received implant-borne prostheses following fully guided sCAIS at the Department of Public Dental Health, Semmelweis University were included in this retrospective observational study. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| dental implant placement | Procedure | The fit of the surgical guide was checked and a flapless procedure was performed under local anesthesia. However, in cases where the width of keratinized mucosa was insufficient a limited full-thickness flap was elevated. The surgical template was fixed on the remaining dentition and mucosa using template fixation pins. Fully guided implant bed preparation was performed. Osteotomies were carried out with external cooling at a drill rotation speed of 800 rpm. Implant placement was performed using a manual torque wrench Dental implants were placed non-submerged. In cases of flap elevation, wound margins were stabilized with single interrupted sutures. Sutures were removed at 7 days postop. |
| Measure | Description | Time Frame |
|---|---|---|
| Implant survival | The implant is present at the surgical site without signs of failure, mobility, and pain at the time of the follow-up | 5 years |
| Implant success | According to The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Success (optimum health) No pain or tenderness upon function 0 mobility less than 2 mm radiographic bone loss from initial surgery No exudates in the patient's history II. Satisfactory survival No pain on function 0 mobility 2-4 mm radiographic bone loss No exudates in the patient's history III. Compromised survival May have sensitivity on function No mobility Radiographic bone loss of more than 4 mm (less than half of the length of the implant body) Probing depth of more than 7 mm May have exudates in the patient's history IV. Failure (clinical or absolute failure) Any of the following: Pain on function Mobility Radiographic bone loss of more than half length of the implant Uncontrolled exudate Implant no longer in mouth | 5 years |
| Success of the implant borne prostheses | Prostheses with four or fewer complications (screw loosening, decementation, chipping) that could be treated chairside. | 5 years |
| Measure | Description | Time Frame |
|---|---|---|
| Intra-operative complications |
| at the time of the surgery |
| Marginal Bone Loss (MBL) |
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Inclusion Criteria:
Exclusion Criteria:
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Patients of the Department of Public Dental Health, Semmelweis University are included in this study.
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| Name | Affiliation | Role |
|---|---|---|
| Márton Kivovics, DMD | Semmelweis University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Public Dental Health | Budapest | 1088 | Hungary |
Individual participant data that underlie the results published after de-identification.
Immediately after publication, no end date.
Anyone who wishes to access the data.
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MBL is measured on the control panoramic radiographs using ImageJ software (National Institutes of Health, Bethesda, MD, U.S.A.) by calibrating the measurement tool with the known length of the implant. Marginal bone loss was measured as the average value of the distance from the platform of the implant to the most coronal bone-to-implant contact on the mesial and distal aspects of each implant in mm. |
| 5 years |
| Biomechanical complications | The presence or absence of biomechanical complications of the implant-borne prostheses observed during follow-up.
| 5 years |
| Implant placement accuracy (Apical Global Deviation) | The 3D deviation between the planned and the placed implants at the center of the implant apex in mm. | 2 months |
| Implant placement accuracy (Coronal Global Deviation) | The 3D deviation between the planned and the placed implants at the center of the implant platform in mm. | 2 months |
| Implant placement accuracy (Angular deviation) | Angular deviation of the implant axis between planned and clinically achieved implant positions in degrees. | 2 months |
| Peri-implant mucositis | Presence of peri-implant signs of inflammation (redness, swelling, line or drop of bleeding within 30s following probing) combined with no additional bone loss following initial healing | 5 years |
| Peri-implantitis | Radiographically determined vertical bone loss ≥3 mm in combination with bleeding on probing (BOP) and probing depths (PD) ≥ 6 mm were deemed to indicate peri-implantitis. | 5 years |