Search Results (104)

Background/Objectives: Fully digital workflows used in implant dentistry have been evolving to improve rehabilitation times and patient satisfaction. More studies are necessary for full scientific validation. The aim of this study was to evaluate the 6-month outcome of implant-supported fixed prostheses for full edentulism rehabilitation using OnX Tough 2 resin (SprintRay) and the Pro 2 (SprintRay) 3D printer following the All-on-4 concept. Methods: This study included 16 patients (10 female, 6 male) with 20 implant-supported fixed full-arch prostheses following the All-on-4 concept (10 rehabilitations for each stackable guide and photogrammetry protocols). Primary The primary outcome measure was implant and prosthetic survival. The secondary outcome measures included manufacturing issues, prosthetic passive fit, marginal bone loss (MBL), mechanical and biological complications, modified plaque and bleeding indexes, pocket depths, patient subjective evaluation, and the Oral Health Impact Profile. Results: No patients were lost to follow-up. Two prostheses failed and 2 two implants were lost, resulting in a cumulative survival rate of 90% and 97.5% at 6 months for prostheses and implants, respectively. The mean MBL was 0.31 mm ± 0.52 mm at 4 months. The mechanical complications rate was 50% at patient level. One patient (6.3%) experienced one biological complication. The grades regarding “comfort of prostheses in the mouth” and “overall chewing feeling” were 9.35 ± 1.29 and 8.79 ± 1.67 out of 10, respectively. The mean total sum of the OHIP-14 was 1.61 out of 56. Conclusions: Implant-supported full-arch rehabilitations with fixed prostheses following the All-on-4 concept, through a fully digital workflow protocol, are a viable option in the short term. Full article

Background: Accurate digital transfer of implant positions is critical for the long-term success of full-arch prosthetic rehabilitation. Photogrammetry remains the benchmark for accuracy, but its high cost and complexity limit clinical adoption. Artificial intelligence (AI)-driven intraoral scanning protocols incorporating real-time library matching and irregular, individually coded scan bodies have been proposed as accessible alternatives to improve accuracy and reproducibility. Methods: This in vitro study evaluated the trueness and precision of a full-arch implant scanning workflow using an AI-assisted real-time library matching system in combination with irregular multi-geometry titanium scan bodies. A high-accuracy structured-light scanner served as the reference standard. Six implant positions (35, 33, 31, 41, 43, 45) were scanned across 20 datasets (n = 120). Mean surface deviations were calculated against the reference STL using CloudCompare v.2.14. and a two-way ANOVA (α = 0.05) in SPSS tested the effects of implant position and scan iteration. Results: The workflow achieved a mean deviation of 13.55 ± 9.70 μm (range 0.77–43.46 μm) across all positions. Anterior sites showed the lowest deviations (e.g., position 31: 3.95 μm; 45: 5.96 μm), while posterior sites exhibited higher deviations (e.g., position 43: 26.15 μm). No mean deviation exceeded 30 μm, and no individual measurement surpassed 45 μm. Implant position significantly affected accuracy (p < 0.001), whereas scan iteration did not (p > 0.05). Conclusions: Within the limitations of this in vitro model, an AI-assisted real-time library matching workflow used in conjunction with irregular multi-geometry scan bodies achieved accuracy levels well within clinically acceptable ranges for full-arch implant impressions. Although comparable to values reported for photogrammetry under laboratory conditions, clinical equivalence should not be assumed. Further in vivo validation is required to confirm performance under routine clinical conditions. Full article

Background: Stackable metallic or magnetic multi-template systems translate a prosthetically (facially) driven plan into each surgical phase of full-arch rehabilitation. Our objective was to map and critically describe the clinical applications, accuracy, and short-term outcomes of stackable/sequential guides and to illustrate the operational steps with a standardized magnet-retained case. Methods: Following a prospectively registered protocol (OSF, June 2025), we performed a scoping review in accordance with and PRISMA guidance. PubMed, Scopus and Embase were searched to 26 June 2025 for primary human studies using stackable or sequential static guides to place ≥4 implants per arch with immediate (≤72 h) loading. Duplicate-independent screening and data-charting captured guide design, planning platform, surgical accuracy, implant survival, prosthetic outcomes and patient-reported measures. A single non-analytic clinical vignette was included solely to illustrate the facially driven stackable workflow. Results: Eight studies (five countries, 2021–2025) encompassing 351 implants and one additional clinical case met the inclusion criteria. Mechanical indexing predominated (7/9 protocols); only two papers, including our case, used magnetic retention. Mean coronal and angular deviations, reported in two cohorts, were 0.95 mm/2.8° and 0.87 mm/2.67°, respectively—well within accepted thresholds for full-arch guided surgery. Immediate loading was achieved in 100% of arches; cumulative implant survival was 97.1% after 3–12 months. Patient-reported satisfaction exceeded 90 mm on VAS scales when measured. Our case demonstrated 0.90 mm/2.95° accuracy, 100% implant stability ≥ 35 N cm and uneventful provisionalisation at 12 weeks. Conclusions: Early clinical reports show clinically acceptable accuracy and high short-term survival with streamlined workflow. However, evidence remains heterogeneous and short-term; prospective multi-centre studies with standardized accuracy metrics, ≥3-year follow-up, validated PROMs, and cost-effectiveness analyses are still needed. Full article

Background: This retrospective comparative clinical study aimed to evaluate the performance of digital versus conventional impression techniques in the fabrication of implant-supported prosthetic restorations. Materials and Methods: A total of 40 cases were included: 20 impressions obtained with conventional elastomeric materials (polyvinyl siloxane and polyether), and 20 impressions acquired digitally using two intraoral scanners (TRIOS 3 and Medit i700). All patients received partial fixed implant restorations and were documented across all stages of prosthetic treatment. Accuracy and passive fit were assessed using radiographic measurements and the Sheffield test. Linear distances (mm) at the implant–abutment interface, chairside time (min), and VAS scores (1–10) were analyzed. Clinical efficiency was evaluated based on procedural steps, chairside time, and adjustment frequency. Patient satisfaction was assessed through a structured 10-item Visual Analog Scale (VAS) questionnaire. Results: Results showed a lower misfit rate in the digital group (15%) compared to the conventional group (25%), with no final-stage misfits in digital cases. Digital workflows demonstrated shorter impression times, fewer procedural steps, and reduced the need for prosthetic adjustments. Patient satisfaction scores were significantly higher in the digital group across all VAS parameters (p < 0.001), particularly in comfort and esthetic satisfaction. Conclusions: These findings support the use of digital impressions as a clinically efficient and patient-preferred alternative to conventional methods for partial implant restorations. However, conventional impressions remain a viable option in settings where digital technology is not available. Further studies with larger sample sizes and long-term follow-up are recommended to assess outcomes in full-arch rehabilitation. Full article

Finite element analysis is commonly used to evaluate implant biomechanics, yet limited data exist on arch form and trabecular-surfaced implants. This study aimed to investigate the biomechanical impact of a designed trabecular surface compared with a standard implant surface in full-arch, four-implant-supported restorations, using two mandibular arch forms and four placement configurations. Finite element analyses were conducted under a 250-N oblique load applied at 30° to the posterior segment. The prosthesis was modeled as a titanium–acrylic hybrid structure. Stress distribution was evaluated in cortical and cancellous bones, implants, and prosthetic frameworks. Implants with a trabecular surface demonstrated lower stress concentrations in both bone and implant structures. The von Mises stress at the neck of the posterior implant decreased from 383.3 MPa (standard implant, hyperbolic arch, configuration 1) to 194.9 MPa (trabecular-surfaced implant, U-shaped arch, configuration 4). Similarly, the average maximum principal tensile stress in cortical bone reduced from 44.32 to 40.99 MPa with the trabecular design. Among placement strategies, Configuration 3 (all implants tilted distally) yielded the highest bone stress, whereas Configurations 2 and 4 provided more favorable load distribution. Stress concentrations were also higher in hyperbolic arches, whereas U-shaped arches exhibited a more uniform distribution. These findings emphasized the biomechanical advantage of the designed trabecular surface in reducing stress across bone and implant components, indicating that trabecular titanium may represent a more reliable and cost-effective alternative for clinical applications, potentially enhancing long-term stability. Independently, the arch form and placement strategy also significantly influenced load distribution. Despite assumptions such as isotropic, homogeneous, and linearly elastic material properties, and the use of a single oblique loading condition, this study offers valuable biomechanical insights such as the stress-reducing effect of the trabecular surface, the influence of three-dimensional arch anatomy on stress concentration sites, and the necessity of selecting implant configurations according to arch forms, which may inform future full-arch implant rehabilitations. Full article

Digital technologies have significantly advanced implant dentistry, refining diagnosis, treatment planning, surgical precision, and prosthetic rehabilitation. This review explores recent developments, emphasizing accuracy, efficiency, and clinical impact. A literature analysis identifies key innovations, such as digital planning, guided surgery, dynamic navigation, digital impressions and CAD/CAM prosthetics. Digital workflows enhance implant placement by improving precision and reducing deviations compared to freehand techniques. Dynamic navigation provides real-time guidance, offering accuracy comparable to static guides and proving benefits in complex cases. Digital impressions demonstrate high precision, which can match or, in some scenarios, surpass conventional methods, though conventional impressions remain the gold standard for full-arch cases. CAD/CAM technology optimizes prosthetic fit, aesthetics, and material selection. Artificial intelligence and machine learning contribute to treatment planning and predictive analytics, yet challenges persist, including high costs, the need for specialized training, and long-term clinical validation. This review underscores the advantages of digital approaches—improved accuracy, better communication, and minimally invasive procedures—while addressing existing limitations. Emerging technologies, such as AI, augmented reality, and 3D printing, are expected to further transform implantology. Continued research is crucial to fully integrate digital advancements and enhance patient outcomes. Full article

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article

The integration of artificial intelligence (AI) and advanced digital workflows is revolutionising full-arch implant dentistry, particularly for geriatric patients with edentulous and atrophic arches, for whom achieving both prosthetic passivity and optimal aesthetic outcomes is critical. This narrative review evaluates current challenges in intraoral scanning accuracy—such as scan distortion, angular deviation, and cross-arch misalignment—and presents how innovations like the Medit SmartX AI-guided workflow and the Scan Ladder system can significantly enhance precision in implant position registration. These technologies mitigate stitching errors by using real-time scan body recognition and auxiliary geometric references, yielding mean RMS trueness values as low as 11–13 µm, comparable to dedicated photogrammetry systems. AI-driven prosthetic design further aligns implant-supported restorations with facial symmetry and smile aesthetics, prioritising predictable midline and occlusal plane control. Early clinical data indicate that such tools can reduce prosthetic misfits to under 20 µm and lower complication rates related to passive fit, while shortening scan times by up to 30% compared to conventional workflows. This is especially valuable for elderly individuals who may not tolerate multiple lengthy adjustments. Additionally, emerging AI applications in design automation, scan validation, and patient-specific workflow adaptation continue to evolve, supporting more efficient and personalised digital prosthodontics. In summary, AI-enhanced scanning and prosthetic workflows do not merely meet functional demands but also elevate aesthetic standards in complex full-arch rehabilitations. The synergy of AI and digital dentistry presents a transformative opportunity to consistently deliver superior precision, passivity, and facial harmony for edentulous implant patients. Full article

This in vitro study aims to compare the trueness of digital impressions obtained using two intraoral scanners (IOS) and one photogrammetry device for full-arch implant-supported rehabilitations. According to the Caramês Classification I, three models were produced with Straumann implants arranged in different spatial distributions: Option A with six implants and Options B and C with four implants each. The three models were scanned using a 12-megapixel scanner to create digital master casts. For each reference model, 30 digital impressions were acquired: 10 with the 3Shape Trios 3 intraoral scanner, 10 with the Medit i500 intraoral scanner, and 10 with the PIC Dental photogrammetry device. Trueness was assessed through best-fit superimpositions between the digital master casts and the corresponding virtual models. The Shapiro–Wilk test was applied to assess the normality of the data distribution, and Levene’s test was used to evaluate the homogeneity of variances. The non-parametric Kruskal–Wallis test was employed to compare group differences, with post hoc adjustments made using the Bonferroni correction. A significance threshold of p = 0.05 was adopted for all statistical tests. Statistically significant differences were observed in the root mean square values among the three devices. The Medit i500 demonstrated the highest trueness, with a median (interquartile range) deviation of 24.45 (18.18) µm, whereas the PIC Dental exhibited the lowest trueness, with a median deviation of 49.45 (9.17) µm. Among the implant distribution, the Option C showed the best trueness, with a median deviation of 19.00 (27.83). Considering the results of this in vitro study, intraoral scanners demonstrated comparable trueness, whereas the photogrammetry-based system exhibited lower trueness values. Additionally, a smaller number of implants and reduced inter-implant distances were associated with improved trueness in digital impressions for full-arch implant rehabilitation. Full article

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. Data were collected on demographics, medical status, type and location of prostheses, implant type, abutments, method of fixation, and complications. Statistical analysis included Fisher’s exact test, the Mann–Whitney U test, and chi-squared tests, with a significance level set at p < 0.05. Results: Mechanical complications occurred in 41.4% of patients (29 out of 70), with framework fractures reported in eight cases (27.6%), ceramic chipping in six cases (20.7%), and resin discoloration in four cases (13.8%). The prostheses were fabricated using monolithic zirconia, metal–ceramic crowns, zirconia on titanium bars, and hybrid resin/PMMA on cobalt–chromium frameworks. Gingival inflammation was also noted in 41.4% of cases (n = 29), predominantly in posterior implant regions. Younger patients and those without systemic diseases showed a significantly higher incidence of mechanical complications. Conclusions: Two years post-treatment, mechanical and biological complications appear to be independent phenomena, not significantly associated with most prosthetic variables. Patient-specific factors, particularly age and general health status, may have greater predictive value than prosthetic design. Limitations of the study include its retrospective design and the lack of radiographic data to assess peri-implant bone changes. Full article

Background. Digital dentistry continues to evolve, offering improved accuracy, efficiency, and patient experience across various prosthodontic procedures. Many previous reviews have focused on digital applications in prosthodontics. But the use of a fully digital workflow for full-arch implant-supported prostheses in edentulous patients remains an emerging and underexplored area in the literature. Objective. This article presents a comprehensive methodological review of the digital workflow in full-arch implant-supported rehabilitation. It follows a structured literature exploration and synthesizes relevant technological processes from patient assessment to prosthetic delivery. Methods. The relevant literature was retrieved from the PubMed database on 20 June 2024, to identify the most recent and relevant studies. A total of 22 articles met the eligibility criteria and were included in the review. The majority included case and technical reports. Results. The review illustrates the integration and application of digital tools in implant dentistry, including cone-beam computed tomography (CBCT) exposure, intraoral scanning, digital smile design, virtual patients, guided surgery, and digital scanning. The key findings demonstrate multiple advantages of a fully digital workflow, such as reduced treatment time and cost, increased patient satisfaction, and improved interdisciplinary communication. Conclusions. Despite these benefits, limitations persist due to the low level of evidence, technological challenges, and the lack of standardized protocols. Further randomized controlled trials and long-term clinical evaluations are essential to validate the effectiveness and feasibility of a fully digital workflow for full-arch implant-supported rehabilitation. Full article

Background: The increasing adoption of digital workflows in implant dentistry necessitates rigorous assessment of intraoral scanning, particularly for complex full-arch rehabilitations like All-on-Four prostheses, where posterior implant angulation may impact the accuracy of optical data acquisition. Objectives: This in vitro study aimed to assess the accuracy of digital intraoral scanners in scanning All-on-Four implant models with different posterior implant angulations. Methods: Two epoxy resin All-on-Four implant models were fabricated with two posterior implant angulations (30-degree and 45-degree). Both models were digitized to obtain control datasets using a Smart Optics reference scanner (REF). Four intraoral scanners were comparatively assessed: Cerec Omnicam AC (OMN), Trios 4 (TRI), Cerec Primescan AC (PRI), and Medit i700 (MED), with nine scans per each scanner (n = 9). All STL files were exported and analyzed using Geomagic Control X with root mean square (RMS) values computed for trueness and precision assessments. Results: The comparison between IOS types in terms of trueness revealed that with 30° angulation, the MED group showed the statistically significant least deviation (p = 402). With 45° angulation, both PRI and OMN scanners showed the statistically significant highest deviation values (p = 0.047 and 0.007, respectively). MED again showed the statistically significant least deviation (p = 402). For precision evaluation in 30° angulation models, PRI and OMN scanners showed the statistically significant least deviation values (p = 402 and <0.001, respectively). While, in 45° angulation models, no statistically significant inter-scanner differences were observed. Conclusions: While MED, PRI, and OMN scanners demonstrated clinical validity for 30° angled posterior implants, only the MED system achieved sufficient accuracy for 45° tilt. These findings emphasize the critical relationship between scanner selection and extreme implant angulations in full-arch digital workflows. Full article

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection. Full article

Background: Topical application within peri-implant pockets ensures high drug concentrations at the infection site while minimizing systemic exposure. However, the comparative effectiveness of non-surgical causal therapy alone versus its combination with doxycycline remains unclear. This retrospective observational clinical study aimed to evaluate the impact of adjunctive doxycycline on peri-implant parameters, considering smoking, systemic conditions, and implant–prosthetic rehabilitation (single implant, implant-supported bridge, or full-arch). Methods: Patients were retrospectively assigned to a control group (CG), receiving non-surgical causal therapy alone, or a test group (TG), which is also treated with topical doxycycline. Peri-implant parameters, including Peri-implant Probing Depht (PPD), Bleeding on Probing (BoP), Plaque Index (PI), and suppuration, were assessed at baseline (T0) and follow-up (T1). Multivariate logistic regression and stratified subgroup analyses were conducted to adjust for confounders such as smoking, systemic conditions, and implant–prosthetic rehabilitation types. Results: Two hundred nine patients were included in the study, of whom 97 were in the CG and 112 were in the TG. At T1, the TG exhibited a statistically significant reduction in PPD, BoP, PI, and suppuration compared to the CG (p < 0.05). Conclusions: The adjunctive use of topical doxycycline significantly enhances clinical outcomes in non-surgical peri-implantitis treatment. Further longitudinal studies are needed to confirm these findings and assess long-term stability. Full article

Background/Objectives: Subperiosteal implants (SPIs) were first used in the 1940s, but due to their complications and the rise of dental implants, they were discontinued. Thanks to new technologies and new materials, nowadays they are being used again and studied as a treatment for severe bone defects. This review analyzes the clinical results—survival rates and complications—of SPIs used to support full arch rehabilitations of severely resorbed maxillae and mandibles, comparing the outcomes resulting from implant placement conducted in one or two surgical interventions. Methods: An automated search was conducted in four databases (Medline/Pubmed, Scopus, Web of Science, and Cochrane Library), as well as a manual search for relevant clinical articles published before 28 February 2025. The review included human studies with at least four patients, in which SPIs were placed to restore full-arch edentulous maxillae and mandibles. Quality of evidence was evaluated using the Newcastle–Ottawa Quality Assessment Scale and the Joanna Briggs Institute Critical Appraisal tool. Results: A total of 14 studies met the inclusion criteria and were included for analysis, including 958 patients and 973 SPIs. The survival rate was 100% when one surgical intervention was performed and 85% when two interventions were performed after 4–38 months and 3–22 years follow-up, respectively. Conclusions: SPIs would appear to offer a good alternative for patients with severe bone atrophies, especially SPIs fabricated using digital techniques in a single step, presenting promising survival rates and a low complication rate, although more randomized clinical trials with long-term follow-up are needed. Full article