Abstract
Background: This case series describes the surgical workflow during maxillary full-arch rehabilitations in two patients through the All-on-4 concept (standard and hybrid) assisted by DTX Studio Implant Software planning and X-Guide Navigation. Results: The X-Guide Navigation enabled the drills and implants to be positioned and oriented precisely, allowing the implants to be positioned favorably under the surgical and prosthetic points of view through the avoidance of damage to the maxillary sinus and nasal cavity. Dynamic navigation-assisted surgery provided advantages, including the possibility to modify the implants’ system, length, or location perioperatively. However, it must be underlined that to achieve proficiency with this technology it is necessary to consider a necessary learning curve. Conclusion: The insertion of dental implants assisted by dynamic navigation for maxillary full-arch rehabilitations was considered a safe and predictable procedure. Nevertheless, it can be improved (such as with a simpler fiducial markers protocol), aiming to simplify the procedure.
Highlights
The All-on-4 treatment concept consists of an immediate function rehabilitation protocol for full-arch rehabilitation of edentulous arches with insertion of four implants in the anterior region to support a fixed prosthesis [1,2]
This concept was further developed to include the use of zygomatic implants alone or in combination with standard implants in situations of extreme maxillary resorption (All-on-4 Extra-maxilla or All-on-4 Hybrid) [3,4]
The zygomatic implant emerged at the second premolar position at the crest level benefiting from the extra-maxillary surgical technique with zygomatic bone anchorage and only accommodated in the maxilla (Figure 29)
Summary
The All-on-4 treatment concept consists of an immediate function rehabilitation protocol for full-arch rehabilitation of edentulous arches with insertion of four implants in the anterior region (two axial implants inserted anteriorly and two distally tilted posterior implants) to support a fixed prosthesis [1,2] This concept was further developed to include the use of zygomatic implants alone or in combination with standard implants in situations of extreme maxillary resorption (All-on-4 Extra-maxilla or All-on-4 Hybrid) [3,4]. FigurFeig2u4r.e 2P4.ePreioripoeprearatitvivee phhoottooggrarapphhilluilslutrsatrinagtitnhge uthseeouf tshee o2.f9 tmhme 2tw.9ismt dmrilltfworisztygdormilla ifmorplzayngt oma implapFnirgetupprarerea2pt4iao.rnPa.etrioionp.erative photograph illustrating the use of the 2.9 mm twist drill for zygoma implant preparation. The zygomatic implant emerged at the second premolar position at the crest level benefiting from the extra-maxillary surgical technique with zygomatic bone anchorage and only accommodated in the maxilla (no maxillary anchorage) (Figure 29). Clin.hMigehd.-d20e2n0s,i9ty, 42a1crylic-resin (PalaXpress, Kulzer Hanau, Germany) with 12 teeth (Mondial and of 16 Premium teeth, Kulzer) (Figure 31) re-adapted to the position of the zygomatic implant.
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