Abstract
Purpose To present a digital method that combines intraoral and face scanning for the computer-assisted design/computer-assisted manufacturing (CAD/CAM) fabrication of implant-supported bars for maxillary overdentures. Methods Over a 2-year period, all patients presenting to a private dental clinic with a removable complete denture in the maxilla, seeking rehabilitation with implants, were considered for inclusion in this study. Inclusion criteria were fully edentulous maxilla, functional problems with the preexisting denture, opposing dentition, and sufficient bone volume to insert four implants. Exclusion criteria were age < 55 years, need for bone augmentation, uncompensated diabetes mellitus, immunocompromised status, radio- and/or chemotherapy, and previous treatment with oral and/or intravenous aminobisphosphonates. All patients were rehabilitated with a maxillary overdenture supported by a CAD/CAM polyether-ether-ketone (PEEK) implant-supported bar. The outcomes of the study were the passive fit/adaptation of the bar, the 1-year implant survival, and the success rates of the implant-supported overdentures. Results 15 patients (6 males, 9 females; mean age 68.8 ± 4.7 years) received 60 implants and were rehabilitated with a maxillary overdenture supported by a PEEK bar, designed and milled from an intraoral digital impression. The intraoral scans were integrated with face scans, in order to design each bar with all available patient data (soft tissues, prosthesis, implants, and face) in the correct spatial position. When testing the 3D-printed resin bar, 12 bars out of 15 (80%) had a perfect passive adaptation and fit; in contrast, 3 out of 15 (20%) did not have a sufficient passive fit or adaptation. No implants were lost, for a 1-year survival of 100% (60/60 surviving implants). However, some complications (two fixtures with peri-implantitis in the same patient and two repaired overdentures in two different patients) occurred. This determined a 1-year success rate of 80% for the implant-supported overdenture. Conclusions In this study, the combination of intraoral and face scans allowed to successfully restore fully edentulous patients with maxillary overdentures supported by 4 implants and a CAD/CAM PEEK bar. Further studies are needed to confirm these outcomes.
Highlights
The digital revolution is changing the world of dentistry [1]
The digital revolution has a strong impact because the dentist can capture optical impressions with Intraoral scanners (IOSs) [2, 3, 11,12,13]; these impressions are used by the dental technician for the planning and the production of a whole series of fixed prosthetic restorations
The present clinical study was based on a sample of 15 patients (6 males, 9 females, mean age 68 8 ± 4 7 years, range 58–76, median 69, 95% confidence interval (95% CI): 66.5–71.1) rehabilitated with an implant-retained bar-supported maxillary overdenture
Summary
Intraoral scanners (IOSs) [2, 3], face scanners (FSs) [4, 5], and cone beam computed tomography (CBCT) [6] allow the dentist to capture three-dimensional (3D) information about the patient and, from such data acquisition, create virtual models of teeth, face, and bone bases These data are imported into specific computer-assisted design (CAD) software and superimposed upon each other in order to obtain. Within the CAD software, the dentist and dental technician plan the therapy and design a series of devices (surgical templates [9, 10], prostheses [11,12,13], and orthodontic devices [14]) to be used on patients These devices are processed by appropriate computer-assisted manufacturing (CAM) software, milled or 3D printed, and are available for clinical use [15]. The high quality of the 3D images derived from the optical impressions even makes the IOS useful as a marketing tool with patients
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