Digital Smile Designed Computer-Aided Surgery versus Traditional Workflow in "All on Four" Rehabilitations: A Randomized Clinical Trial with 4-Years Follow-Up.

Francesca Cattoni,Alberto Merlone,Michele Manacorda,Enrico Felice Gherlone,Luca Chirico,Raffaele Vinci

doi:10.3390/ijerph18073449

Abstract

The aim of the present study was to evaluate and compare the traditional “All on Four” technique with digital smile designed computer-aided “All on Four” rehabilitation; with a 4-years follow-up. The protocol was applied to a total of 50 patients randomly recruited and divided in two groups. Digital protocol allows for a completely virtual planning of the exact position of the fixtures, which allows one to perform a flapless surgery procedure with great accuracy (mini-invasive surgery) and also it is possible to use virtually planned prostheses realized with Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) (methods for an immediate loading of the implants. After 4 years from the treatments 98% of success were obtained for the group of patients treated with the traditional protocol and 100% for the digital protocol. At each time interval a significant difference in peri-implant crestal bone loss between the two groups was detected; with an average Marginal Bone Loss (MBL) at 4 years of 1.12 ± 0.26 mm in the traditional group and 0.83 ± 0.11 mm in the digital group. Patients belonging to the digital group have judged the immediate loading (92%), digital smile preview (93%), the mock-up test (98%) and guided surgery (94%) as very effective. All patients treated with a digital method reported lower values of during-surgery and post-surgery pain compared to patients rehabilitated using traditional treatment. In conclusion, the totally digital protocol described in the present study represents a valid therapeutic alternative to the traditional “All on Four” protocol for implant-supported rehabilitations of edentulous dental arches.

Highlights

The therapeutic efficacy of rehabilitations based on the use of a reduced number of implants, with a high aesthetic and functional yield is universally recognized [1,2,3,4].Among the most adopted implantology protocols for the treatment of dental arches with moderate/severe bone atrophy, the “All on Four” technique continues to achieve great success among the scientific community [5,6,7,8]
Of them 100 were used in 25 cases of full-arch rehabilitations performed with the traditional All on Four method
The aim of this study was to evaluate the survival rate of implant-prosthetic rehabilitations in patients with an edentulous arch, rehabilitated according to an entirely digital protocol, in order to understand the value of this approach in the prosthetic and surgical phases of treatment, comparing with the traditional “All on Four” method, already validated by numerous studies in the literature [5,6,7,8]

Summary

Introduction

The therapeutic efficacy of rehabilitations based on the use of a reduced number of implants, with a high aesthetic and functional yield is universally recognized [1,2,3,4].Among the most adopted implantology protocols for the treatment of dental arches with moderate/severe bone atrophy, the “All on Four” technique continues to achieve great success among the scientific community [5,6,7,8]. 30–35◦ with respect to the occlusal plane in the lateral alveolar areas This inclination allows it to distalize the implant emergency and to provide support to a prosthetic arch up to the first molar, and to avoid any damage the noble structures such as the maxillary sinus (upper arch) and the inferior alveolar vascular-nerve bundle (lower arch). This prevents the bone regeneration procedure in the presence of severe atrophies [5]. Digital technologies have significantly changed the clinical dental practice with regards to diagnosis, prosthetic planning, guided surgery and implant-supported

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