Position of digitally guided implants in completely edentulous maxillae by using a modified double-scan and overlap of three digital surface protocol

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.