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The fourth edition of Implant Restorations: A Step-by-Step Guide provides a wealth of updated and expanded coverage on detailed procedures for restoring dental implants. Focusing on the most common treatment scenarios, it offers concise literature reviews for each chapter and easy-to-follow descriptions of the techniques, along with high-quality clinical photographs demonstrating each step. Comprehensive throughout, this practical guide begins with introductory information on incorporating implant restorative dentistry in clinical practice. It covers diagnosis and treatment planning and digital dentistry, and addresses advances in cone beam computerized tomography (CBCT), treatment planning software, computer generated surgical guides, rapid prototype printing and impression-less implant restorative treatments, intra-oral scanning, laser sintering, and printing/milling polymer materials. Record-keeping, patient compliance, hygiene regimes, and follow-up are also covered. * Provides an accessible step-by-step guide to commonly encountered treatment scenarios, describing procedures and techniques in an easy-to-follow, highly illustrated format * Offers new chapters on diagnosis and treatment planning and digital dentistry * Covers advances in cone beam computerized tomography (CBCT), computer generated surgical guides, intra-oral scanning, laser sintering, and more An excellent and accessible guide on a burgeoning subject in modern dental practice by one of its most experienced clinicians, Implant Restorations: A Step-by-Step Guide, Fourth Edition will appeal to prosthodontists, general dentists, implant surgeons, dental students, dental assistants, hygienists, and dental laboratory technicians.

This study aimed to describe a case of simultaneous guided bone regeneration (GBR) and implant placement in a patient with prior aesthetic implant failure, focusing on achieving optimal aesthetic and functional outcomes, and to perform a literature review of the current evidence. A 38-year-old male presented with an improperly positioned implant at the level of the right upper central (tooth 2.1), leading to aesthetic and functional issues. The initial assessment included a panoramic radiograph revealing marginal bone loss and an enlarged peri-implant space, necessitating implant removal. Following implant removal and provisional restoration, the patient was re-evaluated for subsequent therapeutic treatments. The patient underwent orthodontic treatment to improve mesio-distal spacing, followed by surgical intervention involving GBR and simultaneous implant placement. The GBR procedure utilised bone substitutes and resorbable membranes, with soft tissue augmentation conducted subsequently. The surgical intervention involved local anaesthesia, flap design, defect assessment, and palatally oriented implant placement. GBR was then performed. After six months, implant uncovering and soft tissue augmentation were conducted. The implant was loaded with a screwed restoration following complete hard and soft tissue healing. The patient was monitored every six months for two years, then annually. At the 10-year follow-up, no signs of bone resorption or soft tissue inflammation were observed. This case demonstrated that GBR and simultaneous implant placement, with the application of advanced biomaterials, effectively promoted osseointegration and maintained aesthetic and functional stability over a decade.

To compare conventional and osseodensification techniques assessing insertion/removal torque, stability (ISQ), maximum temperature, and bone structural alterations, as well as evaluating the performance of osseodensification with two bur systems: Densah®/Versah and Bone Reamer Drills®/WF. Sixteen bovine ribs were prepared into standardized samples. Each bone block received three osteotomies using different techniques following manufacturers' protocols: G1 - conventional burs; G2 - osseodensification with Densah®/Versah burs (VS); G3 - osseodensification with Bone Reamer Drills®/WF burs. Osteotomies were performed under irrigation with 0.9% saline at 4-6 °C. Heat generation was recorded with a thermocouple; torque was measured at implant insertion and removal; ISQ was obtained after implant insertion using Osstell ISQ positioned 2 mm from the SmartPeg at a 45º angle. The burs were weighed before and after perforations and analyzed by scanning electron microscopy (SEM). Bone samples also underwent SEM analysis after implant removal. The osseodensification groups exhibited increased insertion and removal torque values and bone compaction at the implant interface was observed. There was no significant increases in ISQ or maximum temperature compared to conventional drilling. No significant mass loss was observed in either systems. Bone instrumentation with both osseodensification kits improved primary implant stability, demonstrating higher insertion and removal torque values than conventional drilling in type IV bone. No significant ISQ and temperature differences were found. SEM revealed compacted bone at the implant interface in the osseodensification groups. No significant mass changes were observed. Results suggest that both techniques are safe and effective for clinical recommendation.

Key Points Explores the effect of various dental implant surfaces on osseointegration. Explains different materials, designs and surface characteristics that are available for dental implants. Discusses the techniques that are used to modify dental implant surfaces to provide more predictable outcomes. Aim The aim of this literature review is to find current knowledge of dental implants focusing on materials, designs and surface modifications and to understand which implant surfaces have more predictable clinical outcomes. Research material and methods An electronic search using PubMed/Medline, Scopus and The Cochrane Library databases from 1950 onwards was conducted using keywords and terms. Published papers were then obtained online or from specialist libraries. References from individual published papers were also searched for relevant publications. Results Different designs, materials and methods to modify surfaces of implants have been discussed in this paper. Many laboratory studies using animal models reported improved biological outcomes with surface modification of implants at the microscopic level. Despite pure titanium being commercially the prime material of choice, ceramics have the potential to become the next generation of dental implants. Presently there is not sufficient scientific evidence for routine use of ceramic implants. Conclusions Pure titanium is the ideal material for implants. Rough implant surfaces are believed to deliver better osseointegration compared with smooth surfaces however, results from different studies vary. It is not clear which combination of different surface modifications provide a more predictable outcome. More standardised high quality prospective studies are required to prove which implant surfaces have the optimum properties for replacing missing teeth.

Non-invasive objective implant stability measurements are needed to determine the appropriate timing of prosthetic fitting after implant placement. We compared the early implant stability results obtained using resonance frequency analysis (RFA) and damping capacity analysis (DCA) depending on the implant length and bone density. Total 60, 4.0 mm diameter implants of various lengths (7.3 mm, 10 mm, and 13 mm) were used. In Group I, low-density bone was described using 15 PCF (0.24 g/cm3) polyurethane bone blocks, and in Group II, 30 PCF (0.48 g/cm3) polyurethane bone blocks were used to describe medium density bone. RFA was performed using an Osstell ® Beacon+; DCA was performed using Anycheck ® . Measurements were repeated five times for each implant. Statistical significance was set at P <0.05. In Group I, bone density and primary implant stability were positively correlated, while implant length and primary implant stability were positively correlated. In Group II, the implant stability quotient (ISQ) and implant stability test (IST) values in did not change significantly above a certain length. Primary implant stability was positively correlated with bone density and improved with increasing implant length at low bone densities. Compared with the Osstell ® Beacon+, the simplicity of Anycheck ® was easy to use and accessible.

This study assessed the accuracy of robotic computer-aided implant surgery (rCAIS) in partially edentulous patients using a standard operation procedure. Patients who underwent implant placement surgeries using the robotic system under a standard operation procedure were recruited. Deviations of dental implants were calculated after superimposition of the preoperative and postoperative cone-beam computed tomography (CBCT) images. The possible effects of the implant regions on these deviations were investigated. A total of 30 participants were enrolled in the study and 44 implants were inserted. The median (25th-75th percentile) global coronal deviation, global apical deviation, and angular deviation were 0.62 mm (0.46–1.00), 0.62 mm (0.49–1.01) and 1.16 (0.69–1.69) °, respectively. The jaw was a factor in the lateral coronal, vertical coronal, and vertical apical deviations (P < 0.05). Both the lateral coronal and apical deviations were greater for immediate implant placements than for delayed implant placements (P < 0.05). The implant dimensions significantly affected the apical deviation (P < 0.05). These results indicate that rCAIS based on a standard operation procedure is safe and accurate in partially edentulous patients. However, there remains a need to optimize robotic systems to simplify the workflow and improve their ability to recognize and respond to complex bone structures. Further clinical studies should also focus on comparing the long-term implant success rate and related complications of rCAIS with traditional approaches.

To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms “surgery”, “computer-assisted”, “dynamic computer-assisted”, “robotic surgical procedures”, and “dental implants”. The outcome variables were discrepancies including the implant’s 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02–1.19), and 1.40 mm (95% CI: 1.31–1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27–3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

The aims of the present study are to measure and compare dental implant deviations with fully guided and pilot-drill-guided protocols using dynamic navigation systems in polyurethane models. The pilot-drill-guided group was determined to be the study group and included 12 implant applications. In this group, the pilot hole was drilled with navigation guidance, and the procedure was completed freehandedly. In the control group, all the drilling and implant placement steps were performed using the navigation system, and a total of 12 implants were placed. The pre- and postoperative images were compared to calculate the magnitude of implant deviation. The quantitative data of the two groups were compared using the independent-samples t-test and Mann-Whitney U-test. The analyses revealed that the length of the procedure significantly differed between the two groups (p < 0.001). The procedure duration was significantly shorter in the study group. The entry deviation values of the two groups were not significantly different (p = 0.079). The analysis revealed the apex deviation to be higher in the study group than in the control group (p = 0.003). However, the two-dimensional vertical apex deviation values of the implants were not significantly different between groups (p = 0.068). Angular deviation was determined to be significantly higher in the study group (p < 0.001). In the present study, all implants were successfully placed in the models using a dynamic navigation system. The results of this study may be useful for future clinical studies.