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Purpose: To assess and compare the accuracies of intraoral scanners (IOS) and stereophotogrammetry (SPG) devices for complete-arch digital implant impressions., Methods: A 4-analog model was digitized using a desk scanner to obtain a reference file. Thirty test scans were conducted using the investigated IOS device, while an additional 30 scans were performed using the SPG device. Using the best-fit algorithm, the resulting 60 test files were aligned with the reference file. Linear (ΔX, ΔY, and ΔZ-axis) and angular deviations (ΔANGLE) were evaluated. Three-dimensional (3D) deviation was calculated based on the Euclidean distance (ΔEUC). The analysis was stratified according to the scanning device and implant position. Fisher's F and t-tests were used to compare the variances and expected values of the two scanning systems., Results: IOS expressed a higher 3D (ΔEUC) mean deviation than SPG (52.8 µm vs. 33.4 µm, P < 0.0001), with extreme measurements up to 181.9 µm. A significantly higher standard deviation (SD) was associated with IOS (37.1 µm vs. 17.7 µm, P < 0.0001). Considering angular deviations, the IOS showed slightly higher angular mean deviations (ΔANGLE) than the SPG (0.28° vs. 0.24°, P = 0.0022), with extreme measurements of up to 0.73°. The SPG SD values were significantly lower than the IOS SD values (0.14° vs. 0.04°, P < 0.0001)., Conclusions: The SPG showed significantly higher 3D and angular accuracies for complete arch implant impressions, with consistent repeatability. IOS scanning revealed significantly higher extreme deviations exceeding the acceptable threshold value. Despite study limitations, SPG appears more feasible than IOS for complete-arch digital implant impressions.

Statement of Problem: Despite the broad clinical application of zirconia for fixed implant-supported prostheses, evidence of long-term performance is sparse., Purpose: The purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of zirconia-based partial and complete screw-retained implant-supported zirconia fixed dental prostheses (ISZFDPs)., Material and Methods: Records of patients treated with dental implants and ISZFDPs between December 2004 and June 2017 were screened. Eligible study participants, according to inclusion criteria, were contacted and invited to undergo clinical and radiographic examinations. Outcomes were evaluated as implant and prosthetic survival rates, prosthetic success rate, complications, marginal bone level (MBL) change, and soft tissue condition. Along with the effects of zirconia prosthesis type and level, the effects of implant type and connection, type of loading, and follow-up on MBL were tested with a generalized linear effects model (GLEM) (α=.05)., Results: A total of 118 patients were identified, of whom 20 (16.9%) were not available for clinical examination for various reasons. Ninety-eight participants (mean age 60.7 ±11.7 years) with 337 implants were included, of which 176 (52.2%) had been immediately loaded. A total of 111 ISZFDPs (96 zirconia connection and 15 titanium base) were investigated: 24 complete ISZFDPs with a zirconia connection (12.9 ±0.97 dental units, minimum 12, maximum 14), 72 partial with a zirconia connection (3.11 ±1.12, minimum 2, maximum 7), 15 partial with a titanium base (3.62 ±1.02, minimum 2, maximum 5). Forty ISZFDPs had been in function for ≥10 years (36%), 38 for 5 to 9 years (34.2%), and 33 for 2 to 4 years (22.8%). The mean follow-up time was 7.2 ±3.4 years. No zirconia fractures were identified. Two implants and 2 ISZFDPs failed, with chipping being the most common complication (13.5%). The implant survival rate was 99.4%, and the prosthetic survival rate was 98.2%. The cumulative prosthetic success rate was 91.9%. MBL change was -0.18 ±0.59 mm. Thirteen implants were treated for peri-implantitis (3.8%), and 9 for mucositis (2.7%), but presented healthy peri-implant soft tissues at the follow-up examination. A significant difference was found between the implant-level and abutment-level prostheses (P=.013), with less marginal bone loss observed in ISZFDPs delivered at the implant level., Conclusions: Zirconia-based screw-retained implant-supported prosthesis can be considered a reliable long-term treatment option for partial and complete edentulism. No zirconia fractures were experienced. Stable bone levels and low peri-implantitis rates were reported regardless of the ISZFDP type and level, implant type and connection, and type of loading., (Copyright © 2021 Editorial Council of the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess accuracy of implant complete-arch digital impression with intraoral scanner (IOS) and implant scanbody splinting (ISS)., Methods: An edentulous mandibular model with 4 analogues was fabricated. Four polyetheretherketone (PEEK) implant scanbodies (ISBs) were scanned, according to a randomized sequence, by investigated IOS with (ISS+) and without implant scanbody splinting (ISS-), resulting in 30 test and 30 control files. The model was digitized by industrial optical scanner and the related file superimposed to the test and control files by a best fit algorithm. Linear (ΔX, ΔY and ΔZ-axis) and angular deviations (ΔANGLE) were evaluated for each analogue. A global measure of linear absolute error (ΔASS) was calculated considering the sum of absolute linear discrepancies. Influence of ISS and implant position on IOS accuracy was assessed using General Linear Model and possible interaction between ISS and implant position evaluated., Results: Implant position showed a significant main effect (p<0.0001) and interaction with ISS (p=0.0454) when ΔASS was considered as response variable. Posterior implants resulted as less accurate. ISS was able to reduce ΔASS for both distal analogues (4.7, p=0.0188). When ΔANGLE was considered as a response variable, implant position and ISS showed significant main and interactive effects (p=0.0039, p<0.0001, p<0.0001). Analogue 3.6 was associated with highest angular discrepancy. This error was significantly reduced by ISS (p<0.0001)., Conclusions: Complete-arch implant digital impression with scanbody splinting showed a significant improvement of the overall accuracy, particularly reducing linear and angular deviations at the most critical posterior implant positions., Clinical Significance: Intraoral scanner accuracy for implant complete-arch digital impression could be improved by a low cost, easy to assemble and use implant scanbodies splinting 3D printed modular chain., (Copyright © 2022. Published by Elsevier Ltd.)

Objective: To assess clinical, radiological performance of novel navigation guided socket-shield technique (NSS) with immediate implant placement and loading., Materials and Methods: Eighteen patients (12 females; age 52.54 ± 4.92; 33-72) treated between January 2018 and June 2019, were investigated, and followed for at least 1 year after definitive prosthesis placement (mean 20.1 months, 18-23). Primary outcomes: implant and prosthetic success rates, surgical, biologic, prosthetic complications., Secondary Outcomes: marginal bone loss (MBL), implant stability quotient (ISQ), pink esthetic score (PES), plaque and bleeding indexes., Results: Sixty-nine navigation guided socket-shield procedures were performed (27 implant-sites and 42 pontic-sites) and 27 implants (NobelParallel, NobelBiocare AG) positioned and immediately loaded. Mean insertion torque and ISQ at implant positioning were 49 ± 5.34 Ncm (36-74), 73 ± 5.72 (68-81). No implant failure was experienced. Two root-shield exposures with mucositis, ulceration and bleeding were reported at two pontic-sites (2.9%) and successfully treated. No complications were experienced at implant-site leading to an overall NSS success-rate of 100%. No prosthetic complications occurred. Mean MBL was -0.72 ± 0.26 mm (-0.42 to -1.06 mm). PES final at the last follow-up 12.84 ± 0.92. The plaque and bleeding scores were 18.5 ± 6.12 and 3.15 ± 2.21., Conclusions: Within study limitations, dynamic navigation was effective to streamline execution of socket-shield technique at implant and pontic sites, shortening treatment time and reducing complications. Navigation guided socket-shield technique was reliable to achieve digitally planned shield-to-implant distance, facilitate immediate implant placement and loading and establish the mucosal dimension needed for underlying bone-to-implant protection and esthetic integration., Clinical Significance: The investigated NSS technique overcomes the difficulties related to root preparation at implant and pontic-sites, facilitating immediate implant placement and loading. Dynamic guided surgery contributed to make socket-shield technique less technical-sensitive, shortening time for execution, reducing complication rate., (© 2022 Wiley Periodicals LLC.)

Objectives: To evaluate clinical, radiological performance of novel digital workflow integrating dynamic navigation to streamline in one-visit single-implant immediate loading in aesthetic zone., Material and Methods: Consecutive patients requiring one single-implant in aesthetic zone of both jaws were treated between May and September 2017. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications, marginal bone loss (MBL), final pink aesthetic score (PES-f), and implant stability quotient (ISQ-f). Secondary outcomes were ISQ-0 and PES-0 at implant positioning and PES-p at definitive prosthesis placement. Potential effect of jaw (maxilla vs mandible), biotype (thin vs thick), type of incision (flap vs flapless), and implant site (healed vs. post-extractive) on the primary outcomes (MBL, PES-f, and ISQ-f) was evaluated through a multivariable analysis., Results: Fifty-two implants were placed (follow-up 18.6, 15-20 months). One post-extractive implant failed. No other surgical, biological complications occurred, accounting for 98.10% cumulative success rate (CSR). No definitive prostheses failed. Mean MBL was -0.63 ± 0.25 mm (-1.69 to -0.06). PES-f was 12.34 ± 1.41 (9-14). ISQ-f was 78.1 ± 3.2 (70-84). Age had significantly negative effect on MBL and PES-f (p = .0058 and p = .0052). No other variables significantly affected primary outcomes., Conclusions: Within study limitations, investigated digital workflow integrating dynamic navigation was reliable for single-implant immediate loading in aesthetic zone in one visit. No statistically significant difference was found for MBL, PES-f, and ISQ-f, considering type of incision (flap vs. flapless), implant site (healed vs post-extractive), jaw (maxilla vs. mandible), and biotype (thick vs. thin). Live-tracked dynamic navigation may have contributed to improve operator clinical performance regardless of implant site characteristics. Further investigations are needed to confirm positive outcomes., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Purpose: To introduce a digitally assisted technique to achieve the ideal soft and bone tissue interface for anatomic-driven pink free implant supported fixed prosthesis, and prefabricate an interim prosthesis to be used the day of the surgery as a prosthetic scaffold to condition the healing., Methods: The digital assisted soft tissue sculpturing (DASS) technique allows the previsualization of the ideal soft and bone tissue interface and fabricate a computer aided design computer aided manufacturing (CAD-CAM) anatomic-driven pink free complete arch interim prosthesis for the immediate loading. Bone and soft tissue interface as well as the interim prosthesis design are performed in a segmented multiple standard tessellation language (STL) file embedding the bone anatomy, the intraoral surface anatomy (dental and soft tissue), the digital wax-up and the implant positioning. The interim prosthesis is used as a prosthetic scaffold to guide the soft and bone tissue surgical sculpturing and regeneration., Conclusions: The DASS technique is a predictable integrated digital workflow that simplifies the achievement of a scalloped tissue interface for pink free fixed implant prosthesis, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health. The surgical sculpturing and maturation of the soft and bone tissue is driven and enhanced by the xenogeneic collagen matrix grafting and prosthetic scaffold effect of the digitally prefabricated interim prosthesis delivered the day of the surgery.

Objective: To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete-arch prosthesis., Materials and Methods: This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48-75) requiring at least one complete-arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes)., Results: Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete-arch FDPs immediately loaded (mean follow-up 16.2 ± 1.7 months, 14-18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65-78). The mean MBL was -0.53 ± 0.28 mm (-0.22 to -1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively., Conclusion: Within the limitations of this proof-of-concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete-arch FDP was facilitated, resulting in high implant and prosthetic success rates., Clinical Significance: The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete-arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health., (© 2021 Wiley Periodicals LLC.)

Purpose: To evaluate the influence of implant scanbody (ISB) material, position and operator on the accuracy of a confocal microscopy intraoral scanning (IOS) for complete-arch implant impression., Methods: An edentulous maxillary model with 6 internal hexagonal connection analogues was scanned with an extraoral optical scanner to achieve a reference file. Three ISBs made of different materials (polyetheretherketone (Pk), titanium (T) and Pk with a titanium base (Pkt)) were scanned with IOS by 3 operators. The resulting 45 test files were aligned to the reference file with a best fit algorithm. Linear (ΔX, ΔY and ΔZ-axis) and angular deviations (ΔANGLE) were assessed. Absolute values of the linear discrepancies were summed up to obtain a global measure of linear absolute error (ΔASS). Influence of ISB material, position and operator was statistically assessed using the mixed general linear model., Results: At multivariate analysis, whenΔASS was considered as response variable, it was identified a significant influence of material (p<0.0001) and position (p=0.0009) while no significant operator effect was detected. When ΔANGLE was considered as response variable, material and position significantly influenced the expected ΔANGLE (p=0.0232 and p<0.0001) and no operator effect was identified., Conclusions: The investigated IOS for complete-arch digital impression was influenced by the ISB material with peek reporting the best results on both linear and angular measurements followed by titanium, peek-titanium resulting as the less accurate. Implant angulation affected significantly the linear deviations while implant position the angular deviations. Operator did not show any significant effect on the IOS accuracy., (Copyright © 2019 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

The aim of this review was to collect available evidence and evaluate accuracy outcomes of dental implant impression techniques, and to compare the accuracy of conventional implant impression versus digital implant impression. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; studies no older than five years; analyzing the accuracy of digital vs conventional technique impression on implants. The exclusion criteria were: publications that reported the same data as later publications by the same authors and systematic reviews; commentaries and letters to the editor; case report and case series. The search resulted in 106 titles. Following the first stage of screening, after the records identification through database manual searching, 112 potentially relevant studies were identified. After the second stage screening, 33 full text publications were obtained and analyzed and 17 were excluded. Afterwards, 18 articles resulted eligible after full text reading and a cross search of the articles' references was accomplished; 3 articles were consequently added. At the end only 7 articles were included in the quantitative analysis. Within the limitations of this systematic review, digital impression on dental implants offers a comparable accuracy compared with conventional impressions technique. More clinical trials are recommended to investigate the accuracy of these scanners and their validity in clinical use., (Copyright 2020 Biolife Sas. www.biolifesas.org.)

The purpose of this study is to evaluate the influence of implant scanbody (ISB) material and operator on scanning fluency and polygonal mesh numbers of a confocal microscopy intraoral scanning (IOS). An edentulous maxillary master model with 6 implant analogues was assembled. Thereafter 3 ISBs featured with same geometry but different materials (polyetheretherketone (PK), titanium (T) and PK with a titanium base (PKT)) were produce and scanned according to a randomized sequence by three different operators. The confocal microscopy IOS resulted in 45 STL test files that were processed to a dedicate software to obtain the request data. The overall analysis of fluency (imm/sec) showed the following results: mean 11.997 imm/sec, SD 2.355. The multivariate analysis showed statistical significance of material (p<.0001) and operator (p<.0001) influence. The univariate analysis referred to polygonal mesh numbers expressed the following results: mean 30327.8, SD 2432.5. The multivariate analysis stressed how there is a related effect to materials (p<.0001) and operator (p=0.0205). PKT represented the material with the best results for both. Analyzing the overall distribution histogram for scanning fluency, the IOS device seems to work with higher frequency at level of 13 imm/sec. The distribution of the measurements in the reference histograms showed an effect related to both variables referring to scanning fluency as well as to polygonal mesh numbers. Operator can be considered as a random effect; regarding the materials, the difference between PKT and PK can be related to the different base material. The dissimilar optical properties of T justify the different behavior., (Copyright 2020 Biolife Sas. www.biolifesas.org.)

Purpose: To introduce a proof of concept technique and new integrated workflow to optimize the functional and esthetic outcome of the implant-supported restorations by means of a 3-dimensional (3D) facially-driven, digital assisted treatment plan., Methods: The Smiling Scan technique permits the creation of a virtual dental patient (VDP) showing a broad smile under static conditions. The patient is exposed to a cone beam computed tomography scan (CBCT), displaying a broad smile for the duration of the examination. Intraoral optical surface scanning (IOS) of the dental and soft tissue anatomy or extraoral optical surface scanning (EOS) of the study casts are achieved. The superimposition of the digital imaging and communications in medicine (DICOM) files with standard tessellation language (STL) files is performed using the virtual planning software program permitting the creation of a VDP., Conclusions: The smiling scan is an effective, easy to use, and low-cost technique to develop a more comprehensive and simplified facially driven computer-assisted treatment plan, allowing a prosthetically driven implant placement and the delivery of an immediate computer aided design (CAD) computer aided manufacturing (CAM) temporary fixed dental prostheses (CAD/CAM technology)., (Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

The growing interest in minimally invasive implant placement and delivery of a prefabricated provisional prosthesis immediately, thus minimizing "time to teeth," has led to the development of numerous 3-dimensional (3D) planning software programs. Given the enhancements associated with fully digital workflows, such as better 3D soft-tissue visualization and virtual tooth rendering, computer-guided implant surgery and immediate function has become an effective and reliable procedure. This article describes how modern implant planning software programs provide a comprehensive digital platform that enables efficient interplay between the surgical and restorative aspects of implant treatment. These new technologies that streamline the overall digital workflow allow transformation of the digital wax-up into a personalized, CAD/CAM-milled provisional restoration. Thus, collaborative digital workflows provide a novel approach for time-efficient delivery of a customized, screw-retained provisional restoration on the day of implant surgery, resulting in improved predictability for immediate function in the partially edentate patient.

Nowadays computer-guided "flap-less" surgery for implant placement using stereolithographic tem-plates is gaining popularity among clinicians and patients. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, less post-surgical discomfort and reduced time required for definitive rehabilitation. Aim of this work is to describe a new protocol (Smart Fusion by Nobel Biocare), thanks to which is now possible to do a mini-invasive static guided implant surgery, in partially edentulous patients with at least 6 remaining teeth, without the use of a radiographic guide. This is possible thanks to a procedure named surface mapping based on the matching between numerous points on the surface of patient's dental casts and the corresponding anatomical surface points in the CBCT data. The full protocol is examined focusing the attention on the clinical and laboratory procedures. Conclusions. Also with some critical points and needing an adequate learning curve, this protocol allows to select the ideal implant position in depth, inclination and mesio-distal distance between natural teeth and or other implants enabling a very safe and predictable rehabilitation compared with conventional surgery. It represents a good tool for the best compromise between anatomy, function and aesthetic, able to guarantee better results in all clinical situations. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to describe a proof of concept digital workflow for the implant-prosthetic treatment in partially edentate patients and evaluate its clinical performance. Methods. A 55-year-old woman with a Kennedy class III bilateral edentulism in the mandible has been selected for a computer guided implantology according with the Smart Fusion® protocol (NobelBiocare, Kloten, Switzerland). After the template-guided implant placement, an immediate loading of the implants has been performed. QuickTemp conical temporary abutments were selected to deliver immediately prefabricated cement-retained provisionals. Two months after an impression was taken with an intraoral digital scanner (3Shape Trios3, Copenhagen, Denmark). The provisional restoration optical scanning was used to transfer the functionalized prosthetic contour to be duplicated into the definitive porcelain fused to zirconia restoration cemented on customized titanium abutments. Results. A satisfying esthetic and functional result has been achieved. No biological and mechanical complications were recorded. Conclusions. The investigated fully digital implant-prosthetic protocol provided a smooth, complication free and time effective treatment alternative to the conventional workflow. Besides the fully digital workflow allowed the surgical and prosthetic decision making and the communication within the dental team and with the patient. Further improvements heading to a direct match between the intraoral scan and the CBCT are strongly advised in order to create the so-called virtual patient. [ABSTRACT FROM AUTHOR]

Alveolar ridge, after tooth extraction, could reduce its volume up to 50% in buccal-lingual width in the first twelve months and residual dimensions could interfere with correct three dimensional placement of implants and influence negatively treatment outcomes with regard to function and aesthetic aspects. Over the last decades, several approaches have been proposed and tested in order to prevent ridge volumetric contraction and provide maximum bone availability for implant procedure. This article presents a case study with a single anterior tooth replacement, illustrating socket seal technique followed by a type 3 timing implant placement. Immediately after tooth extraction, residual socket was grafted using Deproteinized Bovine Bone Mineral and a free gingival punch harvested from palate. After 3 months, a root-form titanium implant was inserted without additional regenerative procedures. Follow-up examination revealed favourable preservation of soft tissue width and height in the aesthetic area. Socket seal approach maximizes soft tissue healing, preserving ridge envelope and the subsequent implant placement, furthermore, results simplified, as any augmentation techniques are required. Clinical advantages of this method include predictable preservation of the soft tissues, favourable healing features, easy handling of graft materials and a positive benefit-cost ratio. [ABSTRACT FROM AUTHOR]