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Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topog...
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Context 1
... an additional manual search from the references through reading of selected articles was performed by the authors and completed the list. A total of 42 articles were reviewed (see Figure 1 for graphical flow-chart). ...
Context 2
... an additional manual search from the references through reading of selected articles was performed by the authors and completed the list. A total of 42 articles were reviewed (see Figure 1 for graphical flow-chart). ...
Citations
... For senior people, getting used to replacement dentures can be a constant challenge, especially when significant adjustments are needed to the fitting as well as occlusal denture surfaces (1,3) . The most challenging patients are those who have systemic diseases like Parkinson's, dementia, and physical frailty. ...
... While several case reports and case series have been published on the use of stackable surgical guides, most of these studies involved open-flap surgery and the use of a bone reduction guide to establish a suitable ridge for implant placement and to accommodate a bone-supported drill guide [8,[35][36][37]. ...
Background: In recent years, advancements in digital dentistry have provided new opportunities for more predictable and efficient treatment options, particularly in patients with failing dentition. This study aimed to evaluate the effectiveness and accuracy of a fully digital workflow using stackable surgical templates for complete dental arch rehabilitation with implant-supported fixed restorations. Methods: Four patients, comprising two males and two females with a mean age of 66 years, were included in this case series. Each patient underwent meticulous digital planning, including CBCT and intraoral scanning, to create a virtual patient for preoperative assessment and virtual treatment planning. The assessment of the trueness of implant positioning was conducted in Geomagic Control X software (version 2017.0.3) by referencing anatomical landmarks from both the preoperative and one-year postoperative CBCT scans. Results: A total of 25 dental implants were placed in the maxilla, followed by the installation of long-term provisional restorations. The results showed minimal deviation between the planned and actual implant positions, with mean 3D coronal, apical, and angular discrepancies of 0.87 mm, 2.04 mm, and 2.67°, respectively. All implants achieved successful osseointegration, and no failures were recorded, resulting in a 100% survival rate at the one-year follow-up. Patients reported high satisfaction with both the esthetic and functional outcomes based on their subjective feedback. Conclusions: The findings suggest that the use of a fully digital workflow with stackable surgical templates is a reliable and effective approach for immediate implant placement and prosthetic rehabilitation, enhancing treatment precision and patient comfort.
... The whole mini-implant length had to be drilled in the bone instead of the recommended two-thirds, but with a narrower drill to achieve sufficient primary stability [13,[39][40][41]. The MDIs ended in a very dense bone and could fracture under too high insertion torque; therefore, the drilling encompassed the whole implant's length [13,14]. ...
This clinical report describes how a decubital ulcer arose from the direct contact of the vestibular movable mucous membrane against mini-implant balled-type heads after the mini-implant insertion in the edentulous atrophic mandible of a 78-year-old patient who was not wearing a conventional mandibular complete denture for more than 10 years. Due to severe alveolar ridge atrophy, mini-implant insertion (2.0 mm wide) was an option without extensive surgical procedures. The patient signed the informed consent. A few days after the implant insertion, injury, inflammation, and induration of the vestibular movable mucous membrane were observed on the movable vestibular mucosa on the right side, opposing the mini-implants. The cause of inflammation was attributed to increased perioral muscle tonus which pushed the movable mucosa onto the mini-implant heads and caused mechanical trauma. During the period of edentulism, the perioral muscle tonus increased, directing the mucous membrane of the lips and cheeks against residual ridge to enable food comminution. To treat the persistent decubitus, a bulk of dental composite resin was placed around mini-implant heads and light-cured to protect the mucosa from further mechanical trauma, as the patient did not possess an old mandibular denture to cover the mini-implant heads. Vestibuloplastic surgery (disinsertion of movable attachments and deepening of the vestibulum) was also done. After the surgery, a silicone splint, resembling an occlusal rim, was made to protect the mucous membrane, keep medicaments for faster epitalization in place, to decrease perioral muscle tonus before the new dentures’ delivery, and to prevent movable tissue relapse. The custom impression, jaw relationship determination, and try-in of the artificial teeth setup were made with sutures still in place. After the denture delivery and implant loading, the patient was instructed to sleep with the dentures to protect the movable mucous membrane. One year later, almost no peri-implant marginal bone loss was observed, attached and peri-implant mucosa were healthy, and the patient was delighted.
... These implants are designed to replicate the natural movement and function of the knee joint, thereby restoring mobility and reducing pain. The procedure typically includes steps such as preoperative planning using imaging, bone resection, implant fitting, and postoperative rehabilitation (8). Recent advancements have focused on developing patientspecific instrumentation (PSI) and computer-assisted surgery (CAS), which enhance the precision of implant placement and alignment (9). ...
Background
Accurate delineation of knee bone boundaries is crucial for computer-aided diagnosis (CAD) and effective treatment planning in knee diseases. Current methods often struggle with precise segmentation due to the knee joint’s complexity, which includes intricate bone structures and overlapping soft tissues. These challenges are further complicated by variations in patient anatomy and image quality, highlighting the need for improved techniques. This paper presents a novel semi-automatic segmentation method for extracting knee bones from sequential computed tomography (CT) images.
Methods
Our approach integrates the fuzzy C-means (FCM) algorithm with an adaptive region-based active contour model (ACM). Initially, the FCM algorithm assigns membership degrees to each voxel, distinguishing bone regions from surrounding soft tissues based on their likelihood of belonging to specific bone regions. Subsequently, the adaptive region-based ACM utilizes these membership degrees to guide the contour evolution and refine segmentation boundaries. To ensure clinical applicability, we further enhance our method using the marching cubes algorithm to reconstruct a three-dimensional (3D) model. We evaluated the method on six randomly selected knee joints.
Results
We evaluated the method using quantitative metrics such as the Dice coefficient, sensitivity, specificity, and geometrical assessment. Our method achieved high Dice scores for the femur (98.95%), tibia (98.10%), and patella (97.14%), demonstrating superior accuracy. Remarkably low root mean square distance (RSD) values were obtained for the tibia and femur (0.5±0.14 mm) and patella (0.6±0.13 mm), indicating precise segmentation.
Conclusions
The proposed method offers significant advancements in CAD systems for knee pathologies. Our approach demonstrates superior performance in achieving precise and accurate segmentation of knee bones, providing valuable insights for anatomical analysis, surgical planning, and patient-specific prostheses.
... 14 Besides preventing insufficient and irregular reduction of the alveolar ridge, they also protect adjacent vital structures. 15,16 In addition, stackable systems enable multiple procedures, including bone reduction, implant placement, and immediate provisionalization. This strategy reduces treatment time and costs, minimizes postsurgical complications, and increases patient comfort. ...
... The stackable system provides consistent registered positions for the base guide and each subsequent guide. Therefore, it minimizes surgical and prosthetic deviations, decreases surgical time, and enhances precision for immediate loading procedures.16 In addition, magnetic attachments in surgical guides facilitate positioning T A B L E 1 Discrepancies between planned and postsurgical implant positions. ...
Objective
The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D‐printed stackable guides.
Clinical Considerations
A 3D‐printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66‐year‐old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implant positions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2–7.3) and mean 3D discrepancies were of 0.90 mm (0.46–1.12) at the entry point and 1.68 mm (1.00–2.20) at implant apex. Case follow‐up revealed stability, patient's comfort, and no intercurrences.
Conclusion
Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision‐making and communication between the multidisciplinary team and the patient, while decreases time and costs.
Clinical Significance
Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care.
... Most of the time, in completely edentulous patients, due to an irregular post-extraction bone anatomy, guided bone reduction may be essential to establish a suitable ridge for implant placement and to fit a bone-supported drill guide [8][9][10][11]. In these specific clinical cases, conventional stereolithographic surgical guides, which are printed solely to guide drilling, cannot be manufactured to anticipate the new anatomical situation. (Fig. 1) Stackable guides are a recent evolution of stereolithographic guides whose main objectives are to achieve both bone reduction, if necessary, and placement of implants planned. ...
Purpose
The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of the temporary prosthesis at the time of implant placement. This scoping review aimed to assess the current knowledge available on stackable guides.
Methods
The review focused on fully edentulous or requiring total edentulism patients. The procedure studied was the use of stackable guides for edentulous patients in order to place immediate temporary prostheses. The clinical endpoint was immediate placement of the provisional prosthesis after surgery combined with a prior bone reduction using a stackable guide.
Results
12 case reports or case series articles met inclusion criteria, which did not allow an analysis by a systematic review. The included studies were case reports or case series. Most of the articles showed a base stabilized by 3 or 4 bone-pins, anchored in buccal or lingual part. Regarding the accuracy of bone reduction (ranged from 0.0248 mm to 1.98 mm) and implant placement when compared to planned, only 4 articles reported quantitative data. 11 articles showed an immediate loading with the transitional prosthesis after implant placement.
Conclusions
There are as yet no prospective or comparative studies on the efficiency of this technique. In a reliable way, stackable guides seem to be able to guide the practitioner from the flap elevation to the placement of the temporary screw-retained implant supported prosthesis. Given the lack of studies in this specific field of guided surgery, further studies are needed to confirm the clinical relevance of this technique.
Graphical Abstract
... The stackable guide protocol usually includes a bone foundation guide (first guide for bone reduction), drill guide (for implant osteotomies) and carrier guides (that have posts for anchoring transitional prostheses over multi-unit abutments). 22,23 After deciding on the type of surgical guide, the clinician can employ one of three ways to fabricate a stent. The clinician can send their case to a dental laboratory that deals with digital workflow; or to a dental laboratory owned by or attached to a software company; or with use of in-office subtractive (computer aided design/computer aided manufacturing) or additive manufacturing (three-dimensional printing) techniques. ...
For dentists who were trained without computers and planning software, the introduction of any sort of digital technology can be met with reservation. Clinicians had to weigh the benefits of a new technique versus the cost and time involved in making it an effective investment. In low- and middle-income countries, the introduction of guided implant surgery is still in a nascent state. The procedures that fall into this category merge patients' data, both clinical and radiographic, to better visualize and guide access to the target site. Guided implant surgery is a minimally invasive, reproducible technique that substantially reduces the risk of injuring critical anatomical structures. Previously published data on guided implant surgery are limited and contain outdated methodology. In this review, the authors introduce the benefits, general principles and updated clinical workflow for guided dental implant surgery.
CPD/Clinical Relevance: Guided implant surgery is a reproducible technique that results in predictable implant placement.
... 2 The most recent trend in addressing this treatment is immediate implant placement and loading with a provisional implant-supported fixed prosthesis, which brings improved esthetics and function and less discomfort compared with the conventional approach. 2, 3 Bidra and Agar 4 classified patients requiring implant-supported fixed prosthesis into 4 types. Class IV patients of this classification refer to the patients with excessive gingival display (gummy smile), which might happen due to various etiologies. ...
... 1,9 Recent advances in digital technology and their uses in prosthodontics and implant dentistry have brought promising solutions for a broad range of clinical cases from simple to complex. 3,10 One of the most important aspects of virtual documentation of patients is the ability to simulate various possible treatment approaches, evaluate, and decide to perform the ideal scenario, 3,10 thus bringing the opportunity of an interactive treatment planning using cone-beam computerized tomography (CBCT), intraoral scans (IOS), and computer-aided design and computer-aided manufacturing (CAD/CAM) altogether. 3,10,11 In the abovementioned cases, the amount of bone reduction should be determined carefully based on the functional, occlusal, and esthetic parameters. ...
... 1,9 Recent advances in digital technology and their uses in prosthodontics and implant dentistry have brought promising solutions for a broad range of clinical cases from simple to complex. 3,10 One of the most important aspects of virtual documentation of patients is the ability to simulate various possible treatment approaches, evaluate, and decide to perform the ideal scenario, 3,10 thus bringing the opportunity of an interactive treatment planning using cone-beam computerized tomography (CBCT), intraoral scans (IOS), and computer-aided design and computer-aided manufacturing (CAD/CAM) altogether. 3,10,11 In the abovementioned cases, the amount of bone reduction should be determined carefully based on the functional, occlusal, and esthetic parameters. ...
Aim
The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3D printed guide according to the future gingival margin of the planned dentition.
Materials and Methods
A 61-year-old female with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of re-contouring of the alveolar ridge and gingiva and placement of six implants and a FP-1 prosthesis after extraction of all remaining maxillary teeth.
Results
Digital smile design was completed, and a fully-digitally-guided surgery was planned. This consisted of utilizing three surgical guides. Starting with the fixation pin guide and continuing with the scalloped hard and soft tissue reduction guide and finally, the implant placement template. Following the surgery, the patient received a temporary restoration and on the 4-month follow-up, a new poly-methyl meta-acrylate temporary prosthesis was delivered. The patient’s 7-month follow-up is presented in the paper.
Conclusions
The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.
... Replacement dentures are generally similar to the patient's existing ones [2]. For senior people, adapting to replacement dentures can be a constant challenge, especially when significant adjustments are needed to the CD's occlusal and fitting surfaces [1,3]. Patients who have systemic diseases like Parkinson's, dementia, and physical frailty are considered the most at-risk patients. ...
Background: Digital technology has been introduced in prosthodontics, and it has been widely used in denture duplication instead of a conventional denture duplication technique. However, research comparing different denture duplication techniques and how they affect the fitting accuracy of the denture base is scarce. Objectives: The aim was to assess the impact of duplication techniques on the accuracy of the fitting surface of computer-aided design and manufacturing (CAD-CAM) milled, 3D-printed, and injection-molded complete denture bases (CDBs). Methodology: This study involved fabricating a mandibular complete denture base with three marked dimples as reference marks (A, B, and C at the incisive papilla, right molar, and left molar areas) using a conventional compression molded technique. This denture was then scanned to generate a standard tessellation language (STL) file; after that, it was duplicated using three different techniques (milling, 3D printing, and injection molding) and five denture base resin materials—two milled CAD-CAM materials (AvaDent and IvoBase), two 3D-printed materials (NextDent and HARZ Labs), and one injection-molded material (iFlextm). Based on the denture base type, the study divided them into five groups (each with n = 10). An evaluation of duplication accuracy was conducted on the fitting surface of each complete denture base (CDB) using two assessment methods. The first method was a two-dimensional evaluation, which entailed linear measurements of the distances (A–B, A–C, and B–C) between reference points on both the scanned reference mandibular denture and the duplicated dentures. Additionally, a three-dimensional superimposition technique was employed, involving the overlay of the STL files of the dentures onto the reference denture’s STL file. The collected data underwent statistical analysis using a one-way analysis of variance and Tukey’s pairwise post hoc tests. Results: Both evaluation techniques showed significant differences in fitting surface accuracy between the tested CDBs (p ˂ 0.001), as indicated by one-way ANOVA. In addition, the milled CDBs (AvaDent and IvoBase) had significantly higher fitting surface accuracy than the other groups (p ˂ 0.001) and were followed by 3D-printed CDBs (NextDent and HARZ Labs), while the injection-molded (iFlextm) CDBs had the lowest accuracy (p ˂ 0.001). Conclusions: The duplication technique of complete dentures using a CAD-CAM milling system produced superior fitting surface accuracy compared to the 3D-printing and injection-molded techniques.
... 2 The most recent trend in addressing this treatment is immediate implant placement and loading with a provisional implant-supported fixed prosthesis, which brings improved esthetics and function and less discomfort compared with the conventional approach. 2, 3 Bidra and Agar 4 classified patients requiring implant-supported fixed prosthesis into 4 types. Class IV patients of this classification refer to the patients with excessive gingival display (gummy smile), which might happen due to various etiologies. ...
... 1,9 Recent advances in digital technology and their uses in prosthodontics and implant dentistry have brought promising solutions for a broad range of clinical cases from simple to complex. 3,10 One of the most important aspects of virtual documentation of patients is the ability to simulate various possible treatment approaches, evaluate, and decide to perform the ideal scenario, 3,10 thus bringing the opportunity of an interactive treatment planning using cone-beam computerized tomography (CBCT), intraoral scans (IOS), and computer-aided design and computer-aided manufacturing (CAD/CAM) altogether. 3,10,11 1 In the abovementioned cases, the amount of bone reduction should be determined carefully based on the functional, occlusal, and esthetic parameters. ...
... Digitally designed surgical guides have been shown that provide immense benefits in this regard. 3,11,12 Conventionally, a flat surgical guide is used to determine the level at which the residual ridge is planned to be reduced. 3,9 Nevertheless, the flat orientation of these guides usually fails to dictate the functional nature of the forthcoming implant-supported implants as it fails to fulfill functional and esthetic requirements in certain cases. ...
The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)–printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient’s 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.
