Digital protocol for reference-based guided surgery and immediate loading: a prospective clinical study

To evaluate the performance of a computer-aided three-dimensional planning protocol in combination with previously inserted reference mini-implants and CAD/CAM technology to restore completely edentulous patients. The study evaluated implant and superstructure survival in a prospective clinical trial.The plan protocol called for treatment of 35 patients who were edentulous in either arch. Mini implants were used to establish a platform for computed tomography and fixation of the surgical template. The planning software based on three-dimensional simulation was used to plan ideal implant placement, digitally integrating the future prosthetic and anatomical situations to design the definitive superstructure.A total of 35 patients, 20 with edentulous maxillae, 10 with edentulous mandibles, and 5 patients with edentulism in both arches were treated. All patients received definitive prostheses on the day of surgery. The majority of patients treated in maxilla underwent a sinus graft procedure to achieve sufficient bone to place implants. A total of 40 superstructures were inserted and immediately loaded. Of the 240 inserted implants, 229 (95.4%) survived, with 146 (93.6%) and 83 (98.8%) implants in the maxillary and mandibular arches, respectively. Of the 10 implants that failed in the maxilla, 9 occurred in patients with an augmented sinus. All definitive restorations demonstrated clinically acceptable fit.When evaluating implant and superstructure survival, reference-based guided surgery seems to be a reliable treatment option for edentulous patients. The CAD/CAM superstructure, inserted and loaded immediately after guided implant insertion, demonstrated acceptable fit to the underlying implants.