Abstract
Statement of problem
In patients with a completely edentulous maxilla, the variability in resilience and
mucosal thickness and the lack of teeth and rigid supporting structures may lead to
poor adaptation of the surgical guide and significant variation in the definitive
implant position. Whether a modified double-scan technique with overlap of surfaces
will improve implant placement is unclear.
Purpose
The purpose of this prospective clinical study was to evaluate the 3-dimensional position
and the correlation of 6 dental implants in participants with a completely edentulous
maxilla using a mucosa-supported flapless surgical guide designed with 3 matched digital
surfaces obtained with a modified double-scan protocol.
Material and methods
Dental implants were installed with an all-on-6 protocol in the edentulous maxilla
of participants at the Santa Cruz Public Hospital, Chile. A stereolithographic mucosa-supported
template was fabricated from a cone beam computed tomography (CBCT) scan made with
a prosthesis with 8 radiopaque ceramic spheres inserted and by scanning the same prosthesis
with an intraoral scanner. The mucosa was obtained by digitally casting the relining
of the removable complete denture in the design software program. After 4 months,
a second CBCT scan was obtained to evaluate the position of the installed implants
measured at 3 locations: apical, coronal, platform depth, and angulation. Differences
in position between the 6 implants in the completely edentulous maxilla and their
linear correlation at the measured points were compared with the Kruskal-Wallis and
Spearman correlation tests (α=.05).
Results
Sixty implants were installed in 10 participants (age 54.3 ±8.2 years; 7 women). The
average deviation in the apical axis was 1.02 ±0.9 mm, coronal 0.76 ±0.74 mm, platform
depth 0.92 ±0.8 mm, and the major axis angulation of the 6 implants was 2.92 ±3.65
degrees. The implant in the maxillary left lateral incisor region had the most significant
deviation in apical and angular points (P<.05). A linear correlation between apical-to-coronal deviations and apical-to-angular
deviations was observed for all implants (P<.05).
Conclusions
A stereolithographic mucosa-supported guide designed with the overlap of 3 digital
surfaces had average dental implant position values similar to those reported by systematic
reviews and meta-analyses. In addition, implant position varied based on the location
of the implant installation in the edentulous maxilla.
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Article info
Publication history
Published online: May 13, 2023
Publication stage
In Press Corrected ProofIdentification
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© 2023 by the Editorial Council for The Journal of Prosthetic Dentistry.
