Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols.

Alessio Franchina,Gerardo Pellegrino,Simone Fedi,Luigi Vito Stefanelli,Giuseppe Lizio,Simone Gorini

doi:10.3390/mps3040084

Alessio Franchina, Gerardo Pellegrino + Show 4 more

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https://doi.org/10.3390/mps3040084

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Abstract

A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.

Highlights

The digitalization in implant-supported prosthetic rehabilitation is becoming more and more diffuse for the planning but even for the operative phase, for transferring the project into the clinical reality [1,2,3,4]
The dynamic computer-aided implantology, on the other hand, works like a Global Positioning System (GPS), in which one or two cameras detect in real-time the spatial relations of reference tools placed on the patient and the surgical handpiece, while software matches this information with CT images and with the superimposed project
The pterygoid implant, 13 to 20 mm long, works as the distal support for a prosthetic structure in the rehabilitation of posterior maxilla, avoiding any kind of distal cantilever; it by-passes the maxillary sinus and finds the primary stability involving the cortex of the pterygoid process of the sphenoid, the pyramidal process of the palatine bone after passing through the tuber maxillae

Summary

Introduction

The digitalization in implant-supported prosthetic rehabilitation is becoming more and more diffuse for the planning but even for the operative phase, for transferring the project into the clinical reality [1,2,3,4]. The dynamic computer-aided implantology, on the other hand, works like a Global Positioning System (GPS), in which one or two cameras detect in real-time the spatial relations of reference tools placed on the patient and the surgical handpiece, while software matches this information with CT images and with the superimposed project. This way the clinician can track the drill’s position on 3D radiological anatomy showed on the computer screen while working on the patient [8,9,15,16,17,18]. Both systems enable a mini-invasive and shorter surgery, with flap-less approaches and immediate prosthetic loading

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