Clinical retrospective study on effectiveness, duration of surgery and postoperative pain after placing single implants with and without Chair Side CAD CAM fabricated surgical guide

Abstract

Background Successful dental implant rehabilitation requires precise treatment planning of surgical procedure and implant placement based on final prosthodontic planning. Lately the widespread use of cone beam computed tomography (CBCT) in dental industry has enabled the surgeons to evaluate and diagnose the jaws in three dimensions and thus help to virtually plan prosthesis and related implant positions before the surgery. Proper, prosthetically driven implant positioning is fundamental in order to ac Aim/Hypothesis It is assumed that computer-aided technologies open the opportunity to streamline workflows in implant rehabilitation concepts. Developments of CBCT and software planning include the reduction of the number of steps needed from the preoperative examination of the patient to the actual execution of Material and Methods A total of 41 patients requiring single tooth replacement were included in the assessment. 21 patients were selected for the use of the whole digital Cerec Guide workflow including Diagnostic phase with CBCT, intraoral scan and planning of the crown, planning of the implant position and fabrication of the guide, guided surgery and cerec Tbase scan and fabrication of Emax crown. Surgery was performed flapless or with minimum crestal incision flap and in 5 patient directly in extraction socket. A total of 20 patients were treated conventionally without guide, with the same planning, with either minimal invasive surgical technique or in 5 patients with immediate implant placement in extraction socket. Minimal invasive surgical technique means flapless technique or with crestal incision within the tooth gap only, excluding sulcus of neighbouring teeth and no hard or soft tissue graft used. For both groups, the workflow feasibility was assessed and effectiveness, planning time, time Results The use of CEREC guide 2 had an effectiveness of 90.5% (19 of 21 patients). In one case the Cerec Guide was ineffective due to incorrect case indication and in one case due to inappropriate fit of surgical sleeve into the Cerec guide 2. Postoperative pain within the first 3 days after surgery was slightly higher in patients with the guide, but this was mainly due to occurrence of aphtous stomatitis on the day 2 in two patients. When comparing durations of surgery, the surgery was faster with guides, but this was compensated with longer planning phase in the guided group. The overall CEREC guide 2 workflow times was markedly reduced as the familiarity and use of the software increased. Conclusions and Clinical Implications Within the limitations of the present study, we found no obvious differences between guided and conventional implant treatments regarding duration of surgical intervention and postoperative pain. It is clear that chairside approach has an immediate effect on surgical procedure as well as on prosthetic rehabilitation. Comprehensive learning curve in computer- guided implantology is necessary to obtain predictable results.