Edentulous jaws restoration with guided surgery and immediate loading . Retrospective analysis of 23 consecutively treated cases
Materials and methods : The clinical and radiological outcome of 23 full edentulous ridges (15 maxilla 8 mandible) restored with fix implant supported prosthesis was evaluated. All patients were treated with computer assisted implant surgery protocol (Nobel Guide, Nobel Biocare) in all cases screw-retained provisional metal-acrylic prostheseis prepared in advance was delivered immediately. The guided surgical procedure was performed under local anesthesia. 120 implants (Nobel Replace tapered groovy) were placed. The implant length ranged between 10 and 13 mm and the implant diameter was either 4.3 or 5 mm. 117 implants were immediately loaded 12 of them were inserted in fresh extraction sockets. A flapless approach was used in 14 maxillary arches and in only one mandibular case. Definitive prosthesis was delivered after 6-12 months with screw retained zirconia ceramic implant bridges or composite resin titanium implant bridges.
Methods of data analysis : Outcome measures were radiographic marginal bone-level changes, survival of implants, soft tissue aspects (probing depth, and BOP index) and patient satisfaction. Marginal bone loss was measured with periapical radiographs taken upon implant insertion , 12 and 24 months after loading Implants were considered successful after 12 months if no pain or mobility was caused under unscrewing torque of 20 N.cm. Soft tissue aspect data were collected at 6,12,24 months after prosthetic loading. Analytic statistical analysis was carried out on the resulting data.
Results : All the cases have at least 24 months follow-up with a cumulative survival rate of 97,4%. Every patient received a correct prosthetic rehabilitation with high degree of satisfaction when it comes to masticatory function, social functioning and overall quality of life. Radiological examination, showed a mean marginal bone loss of 1.5mm+/-0.3mm after 24 months. All of the patients present healthy soft tissues with stable probing depth and good BOP values after one year. Some minor prosthetic complications were recorded: fracture of a provisional prosthesis (4 cases), ceramic chipping (1 case).
Conclusions: Although limited by the number of patients, it can be concluded that computer guided surgery and immediate loading, for completely edentulous jaws, provided a reliable results with a high implant survival rate , good perimplant marginal bone loss values, high degree of patient satisfaction after 24months of follow-up.
References
1) Meloni S.M., De Riu G., Pisano M., Cattina G., Tullio A. Implant treatment software planning and guided flapless surgery with immediate provisional prosthesis delivery of the fully edentulous maxilla. A retrospective analysis of 15 consecutively treated patients. European Journal of Oral Implantology. 2010 Autumm; 3(3) 245-51.
2)Malo P, de Araujo Nobre M, Lopes A.The use of computerguided flapless implant surgery and four implants placed in immediate function to support a fixed denture: preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent 2007;97:S26-S34