Maxillary Defects Research Articles

Novel Membrane for the Treatment of Multiple Gingival Recession Defects-RCT

Objective Evaluation and comparison of Collagen Matrix Ossixreg Volumax and Subepithelial connective tissue graft SCTG in combination with modified coronally advanced flap MCAF in the treatment of Miller Class I and II multiple gingival recession defects MARDs.Methods Twelve patients presenting adjacent Miller Class I and II maxillary and mandibular gingival recession defects participated in this randomized controlled study. A total of sixty defects were received n 30 either Ossix Volumax collagen matrix VCMX and MCAF test group or MCAF and Subepithelial connective tissue graft control group n 30. Parameters like gingival recession depth gingival recession width probing depth clinical attachment level and keratinized tissue width were checked at baseline 6 weeks 3 months and at 6 months after treatment. P value lt0.05 was considered statistically significant.Results The percentage of complete root coverage was 80 for the test group and 60 for the control group. The percentage of mean recession coverage for the test group was 60 and the control group was 85. Adjacent gingival recession was successfully treated with MCAF and Ossixreg Volumax or with MCAF and SCTG. The use Ossixreg Volumax was more comfortable during the postoperative period.Conclusion We suggest the use of Ossixreg Volumax as a promising collage matrix for the treatment of MARDs.

Preparation and properties of a 3D printed nHA/PLA bone tissue engineering scaffold loaded with a β-CD-CHX combined dECM hydrogel.

Jaw defects, which can result from a multitude of causes, significantly affect the physical well-being and psychological health of patients. The repair of these infected defects presents a formidable challenge in the clinical and research fields, owing to their intricate and diverse nature. This study aims to develop a personalized bone tissue engineering scaffold that synergistically offers antibacterial and osteogenic properties for treating infected maxillary defects. This study engineered a novel temperature-sensitive, sustained-release hydrogel by amalgamating β-cyclodextrin (β-CD) with chlorhexidine (CHX) and a decellularized extracellular matrix (dECM). This hydrogel was further integrated with a polylactic acid (PLA)-nano hydroxyapatite (nHA) scaffold, fabricated through 3D printing, to form a multifaceted composite scaffold (nHA/PLA/dECM/β-CD-CHX). Drug release assays revealed that this composite scaffold ensures prolonged and sustained release. Bacteriological studies confirmed that the β-CD-CHX loaded scaffold exhibits persistent antibacterial efficacy, thus effectively inhibiting bacterial growth. Moreover, the scaffold demonstrated robust mechanical strength. Cellular assays validated its superior biocompatibility, attributed to dECM and nHA components, significantly enhancing the proliferation, adhesion, and osteogenic differentiation of osteogenic precursor cells (MC3T3-E1). Consequently, the nHA/PLA/dECM/β-CD-CHX composite scaffold, synthesized via 3D printing technology, shows promise in inducing bone regeneration, preventing infection, and facilitating the repair of jaw defects, positioning itself as a potential breakthrough in bone tissue engineering.

Extensive Partial Obturador Oropharyngeal in Class IV Aramany after Oral Adenocarcinoma

When a patient is interrupted by velopharyngeal closure or defects in the hard palate, air escapes inappropriately through the nose in nasal speech sounds. The obturator prosthesis with extension to the oropharynx is currently the best indication for maxillary defects, but it also represents a challenge for manufacturing and oral adaptation. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 65-year-old woman who presented with a defect in the maxilla, soft palate, tonsil, and oropharynx after treatment for polymorphous low-grade adenocarcinoma. With her considerable loss of structure and tissue, she reported difficulties with impaired functions such as chewing, swallowing, and speaking and difficulty interacting with people. The oral rehabilitation was performed with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture. This case demonstrates that the rehabilitation with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture provides speech, chewing, and phonetics, directly interfering with her social life in the mutilated patient.

Impact of nylon versus heat cure acrylic resin on microbial adhesion of closed hollowed obturators

Purpose This study aimed to evaluate the effect of nylon versus heat-cure acrylic resin on microbial adhesion of a closed hollowed obturator. Patients and methods Twelve male patients with a unilaterally acquired maxillary defect (Aramany Class IV) were chosen from the outpatient clinic of the Prosthodontics Department at the Faculty of Dentistry, Sinai University (Kantara branch). These patients were divided into two equal groups: group I was provided with an obturator made of heat-cured acrylic resin (P.M.M.A.-Vertex), while group II received an obturator made of thermopress resin (nylon breflex, 2nd edition). Each group underwent microbial evaluation through follow-up recall visits at 2 and 4 weeks. The results were recorded, tabulated, and subjected to statistical analysis. Results There is a significant difference between group I and group II. The conventional acrylic resin group showed higher bacterial adhesion than the nylon. Conclusion Within the limitations of the study, a closed hollow bulb constructed with thermopress resin exhibits reduced bacterial colonization when compared to heat-cured acrylic resin.

The detection of Gper1 as an important gene promoting jawbone regeneration in the context of estrogen deficiency

Numerous studies have demonstrated that estrogen deficiency inhibit the proliferation and differentiation of pre-osteoblasts in skeleton by affecting osteogenic signaling, lead to decreased bone mass and impaired regeneration. To explore the mechanisms maintaining bone regeneration under estrogen deficiency, we randomly selected 1102 clinical cases, in which female patients aged between 18 and 75 have underwent tooth extraction in Stomatological Hospital of Tongji University, there is little difference in the healing effect of extraction defects, suggesting that to some extent, the regeneration of jawbone is insensitive to the decreased estrogen level. To illuminate the mechanisms promoting jawbone regeneration under estrogen deficiency, a tooth extraction defect model was established in the maxilla of female rats who underwent ovariectomy (OVX) or sham surgery, and jawbone marrow stromal cells (BMSCs) were isolated for single-cell sequencing. Further quantitative PCR, RNA interference, alizarin red staining, immunohistochemistry and western blotting experiments demonstrated that in the context of ovariectomy, maxillary defects promoted G protein-coupled estrogen receptor 1 (Gper1) expression, stimulate downstream cAMP/PKA/pCREB signaling, and facilitate cell proliferation, and thus provided sufficient progenitors for osteogenesis and enhanced the regeneration capacity of the jawbone. Correspondingly, the heterozygous deletion of the Gper1 gene attenuated the phosphorylation of CREB, led to decreased cell proliferation, and impaired the restoration of maxillary defects. This study demonstrates the importance of Gper1 in maintaining jawbone regeneration, especially in the context of estrogen deficiency.

Obturator hygiene among patients with maxillary defects at two teaching hospitals in Ghana

Background: An obturator may be defined as the component of a prosthesis that fits into and closes a defect within the oral cavity or other body defects. Cleaning one’s obturator is essential to prevent offensive odour, poor aesthetics, the accumulation of plaques, and damage to both natural and prosthetic teeth due to bacteria contamination in the oral cavity.Aim: The study aimed to determine how palatal obturator wearers practice good obturator cleaning habits.Method: A cross-sectional study design was used for this study. A sample size of 40 palatal obturator wearers was used. Data was collected using a well-structured questionnaire. The questionnaire included demographic data (age, sex, educational level, occupation and years of wearing a prosthesis, obturator cleaning habits, obturator cleaning methods, and obturator wearing habits. The data were summarized using Descriptive statistics with tables and charts and analyzed using a chi-square test from Statistical Package for Social Sciences (SPSS version 22.0) and Microsoft Office Excel 2016 at p-value< 0.05.Results: Sixteen (40%) of the total number were males, and 24(60%) were females giving a male-to-female ratio of 2:3. Twelve (30%) of the participants fell between the ages 31-40 years. Participants with tertiary education have better cleaning habits and knowledge of cleaning agents used. Fifteen (37.5%) participants who had worn a palatal obturator between 1-2 years frequently visited the dental clinic for a check-up; however, this number gradually decreased.Conclusion: The majority of the patients evaluated had good clean habits with their prostheses and the cleaning agents used. However, participants with tertiary education had better prosthesis hygiene and maintenance methods.

Marine Collagen Matrix Carrier with Injectable Platelet-Rich Fibrin in Management of Gingival Recession Defects

Background. The gold standard in the management of gingival recession (GR) defects has been connective tissue graft (CTG) with coronally advanced flap (CAF). But patient morbidity associated with graft harvesting is a major drawback and has led to the development of various substitute biomaterials which have been tried and tested. Aim. Our study is aimed at checking the efficacy of marine collagen matrix (MCM) impregnated with injectable platelet-rich fibrin (I-PRF) with modified CAF in the treatment of Miller’s class I and II recession defects. Case Description. Six patients with ten GR defects in maxilla were treated with CAF + MCM + I-PRF. Clinical parameters like recession height (RH), recession width (RW), root coverage (RC%), width of attached gingiva (WAG), keratinized tissue height (KTH), probing pocket depth (PPD), clinical attachment level (CAL), gingival biotype (GB), plaque index (PI), and visual analogue score (VAS-E) esthetic scores were evaluated up to six months. There was significant root coverage observed at three- and six-month follow-ups. Conclusion. The proposed treatment was effective in the management of GR defects and improvement in soft tissue biotype without the morbidity associated with soft tissue harvest.

Reconstruction of the anterior maxillary defect using a vascularized bone flap with residual teeth in the posterior maxilla.

Microsurgical bone reconstruction is challenging in cases of anterior maxillary defects because of the presence of residual teeth. The study analyzed the method and feasibility of using vascularized bone flaps to reconstruct anterior maxillary defects. We retrospectively analyzed 15 patients treated at the Department of Oral and Maxillofacial Surgery, Peking University School, and Hospital of Stomatology between November 2017 and January 2023. A total of 14 patients were successfully reconstructed using the digital technique: 6 deep circumflex iliac artery (DCIA) flaps and 8 fibular free flaps. Palatal and buccal pedicle paths were used in 4 and 10 cases, respectively, for vascular anastomosis. The implant coverage rates of the DCIA and fibular free flaps were 87.2% and 92.6%, respectively (p > 0.05). Anterior maxillary defects reconstructed with the DCIA and fibular free flaps are reliable methods. Furthermore, the palatal and buccal paths are recommended for vascular anastomosis.

A successfully rehabilitated post-mucormycosis maxillary defect with guided quad-zygomatic implants: A case report

Introduction: Mucormycosis infection has received occasional attention because of the low number of cases in comparison with other frequent infections. With the emergence of the SARS-CoV-2 disease, the incidence of fungal infections like mucormycosis has increased. In mucormycosis, after surgical debridement, the defects that result are different from other maxillary defects. In terms of functional and aesthetic rehabilitation there are several treatment options for patients with maxillectomy defects. Amidst all, zygomatic implants are more favorable and viable solution for the above-mentioned defects. Since there is a scarcity in literature on the use of zygomatic implants in such cases, we presented a case report using the utmost advantage of these implants in rehabilitation of maxillary defects. Case Report: In the present case report, a 38-year-old male patient presented with an absence of the maxillary alveolar bone and anterior nasal spine and minimal presence of hard palate. Such type of maxillary defect following mucormycosis was managed with quad zygomatic implants with computer-guided approach. Conclusion: Thus, the author concluded through this case report that a severe maxillectomy defects can be managed well with the zygomatic implants. In the present article, the author preferred to perform under guide in order to avoid errors while placement of implants. Hence, proper diagnosis with definitive surgical approach can help in achieving precise treatment outcome and establishing patient’s self-esteem.

Evaluation of orthodontists' experience with the surgery first protocol in orthodontic-surgical management

The aim of this study was to analyze the popularity of surgery first among orthodontists as well as the protocols used for its implementation and to collect the opinions (favorable or unfavorable) of practitioners and patients regarding it. A questionnaire was sent to a population of dental surgeons qualified in Dentofacial Orthopedics or in the process of specialization (residents) practicing in France. The questionnaire consisted of a total of 27 questions. There were 10 open-ended questions and 17 closed-ended questions (8 binary and 9 multiple choices). The conditional pathway allows the respondent's path through the form to be modified based on their answers. This survey was conducted using Google Forms online survey software. On average, the responding practitioners had 15.9 years of experience, and most of them (78.2%) work in private practice. Most treated between 200 and 400 cases per year, of which 7% were surgical cases. Orthodontists who are familiar with and practice the surgery first protocol use it on average for 7 cases per year. The most frequent indication for the surgery first protocol was: transverse maxillary defects. Surgery first protocol is a preferred option in cases of high severity since it prevents respiratory worsening during the pre-surgical orthodontic phase. The lack of a standardized protocol for this approach, at the pre-surgical and post-surgical levels, requires an increase in the number of high-level evidence publications to clarify the methods of application of this protocol.

Case Report: A Method of Impression-Making for Massive Maxillectomy Defects

Maxillary defects occur for various reasons, such as congenital malformations, cancer, pathological changes, radiation burns or surgical interventions. Patients with large defects, progressive disease and those undergoing post-operative chemotherapy or radiotherapy must be rehabilitated by obturator prostheses. Making a well-extended impression for obturator prostheses may be difficult in the case of massive defects. This article presents a method for making impressions of massive maxillary defects using a special tray with a wide opening in the palatal region.

From bench to bedside - current clinical and translational challenges in fibula free flap reconstruction.

Fibula free flaps (FFF) represent a working horse for different reconstructive scenarios in facial surgery. While FFF were initially established for mandible reconstruction, advancements in planning for microsurgical techniques have paved the way toward a broader spectrum of indications, including maxillary defects. Essential factors to improve patient outcomes following FFF include minimal donor site morbidity, adequate bone length, and dual blood supply. Yet, persisting clinical and translational challenges hamper the effectiveness of FFF. In the preoperative phase, virtual surgical planning and artificial intelligence tools carry untapped potential, while the intraoperative role of individualized surgical templates and bioprinted prostheses remains to be summarized. Further, the integration of novel flap monitoring technologies into postoperative patient management has been subject to translational and clinical research efforts. Overall, there is a paucity of studies condensing the body of knowledge on emerging technologies and techniques in FFF surgery. Herein, we aim to review current challenges and solution possibilities in FFF. This line of research may serve as a pocket guide on cutting-edge developments and facilitate future targeted research in FFF.

Accuracy of intraoral scanning versus conventional impressions for partial edentulous patients with maxillary defects

This study aimed to evaluate the accuracy of digital dental impressions obtained by intraoral scanning (IOS) for partial edentulous patients with maxillary defects by comparing them with conventional impression techniques. Ten subjects underwent an experimental procedure where three ceramic blocks were affixed to the healthy palate mucosa. Digital dental impressions were captured using IOS and subsequently imported into software. Conventional impressions obtained by silicone rubber were also taken and scanned. Linear distance and best-fit algorithm measurements were performed using conventional impression techniques as the reference. Twenty impressions were analyzed, which included 30 pairs of linear distances and 10 best-fit algorithm measurements. Regarding linear distance, paired two-sample t-test demonstrated no significant differences between IOS and model scanning in groups A and C, whereas significant differences were found in group B (P < 0.05). Additionally, ANOVA revealed significant differences among the groups (P < 0.05). No significant differences were found for the best-fit algorithm measurement of the dentition. IOS can provide accurate impressions for partial edentulous patients with maxillary defects and its accuracy was found to be comparable with conventional impression techniques. A functional impression may be needed to ensure accurate reproduction of soft and hard tissues in defect or flap areas.

Evaluation and comparison of retention and patient satisfaction with milled polyetheretherketone versus metal maxillary obturators

Statement of problemMetal and polyetheretherketone (PEEK) have been used to rehabilitate maxillary defects with obturators, each having advantages and disadvantages. However, patient satisfaction with the obturator retention of each material is unclear. PurposeThe purpose of this crossover clinical study was to compare retention and patient satisfaction between a milled cobalt chromium and a milled PEEK framework, each with a hollow bulb extension in polymethyl methacrylate (PMMA). Material and methodsTwenty patients who had received unilateral total maxillectomy and were treated in the prosthodontic department's maxillofacial clinic were enrolled in this crossover study. Each participant wore 2 different types of obturators for 6 months after insertion. Type CoCr received a milled cobalt chromium framework with a hollow bulb extension in PMMA first, and type Pk received a milled modified PEEK (BioHPP) framework with a hollow bulb extension in PMMA first. Patient satisfaction and retention force were measured immediately, at 3 months, and at 6 months after obturator insertions. The Fischer exact, chi-squared, and Monte Carlo tests were used to compare qualitative data. One-way ANOVA with the post hoc Tukey test was used for pair-wise comparison, and repeated measures ANOVA was used to compare before and after treatment at 3 and 6 months. ResultsNo significant difference was found between types in obturator insertion (P>.999), appearance of the upper lip (P>.999), mouth feeling (P=.301), pronunciation of words (P=.217), and talking in public (P=.589). A significant difference between types was found in speech after 6 months of obturator insertion (P=.016), swallowing liquids and food (P=.04), masticating foods (P=.007), appearance of clasps on anterior teeth (P=.002), satisfaction with appearance (P=.005), or avoidance of family events (P=.014) after 6 months of insertion. Types of obturators showed a statistically significant decrease in retention force with time (P<.001). ConclusionsAlthough the retention force was less with PEEK than with Co-Cr clasps engaging the same undercuts, this retention force was adequate for retaining removable partial dentures. Co-Cr clasps can be considered better than PEEK clasps because they engage the same undercuts regarding loss of retention with time. Quality of life in patients after maxillary resection could be improved by using maxillary obturators. Type Pk was better than type CoCr in terms of esthetics, but the retention of the PEEK obturator after 6 months decreased because of wear, leading to difficulty swallowing food or liquids, mastication, and speech.

Single-stage computer-assisted approach for tumour resection and functional restoration of Brown class III maxillary defects—titanium mesh and zygomatic implants combined with vascularized anterolateral thigh flap

The functional restoration of Brown class III maxillary defects is a challenging endeavour in oral and maxillofacial surgery. Conventional reconstruction techniques with osseous free flaps have certain limitations, such as the need for multiple operations and greater patient morbidity. This study introduces a single-stage computer-assisted approach for tumour resection and functional restoration of these defects using titanium mesh, zygomatic implants, and a vascularized anterolateral thigh flap (ALTF). Virtual surgical planning was used to simulate tumour resection, titanium mesh placement, and zygomatic implant insertion. Surgery was performed under the guidance of mixed reality and surgical navigation. The tumour was resected by total hemimaxillectomy, and the reconstruction was performed using a pre-bent patient-specific titanium mesh for the orbital floor and two zygomatic implants placed and exposed through tunnels in an ALTF. The ALTF survived without any perioperative complications. A fixed prosthesis with built-in titanium frame was delivered 4 months postoperatively. At the 1-year follow-up, there was no tumour recurrence, the implants were osseointegrated, and aesthetics and masticatory function were satisfactory. An occlusal force of 155 N was attained on the reconstructed side, compared to 127 N on the non-surgical side.

Preliminary impression for maxillary defect: A two-step technique.

Preliminary impressions must record the periphery and height of maxillary defects to allow for an eventual extension of the master impression tray. These impressions are usually made with irreversible hydrocolloid. Carrying the impression material into the defect can be complex, especially in the case of a limited oral opening. Moreover, the patient can be harmed during the removal procedure, and material may be stuck in anatomical structures. The technique presented in this article avoids these issues in any maxillary defect with a two-step preliminary impression. An elastomeric material ball is first placed in the defect until full setting. Then, this "obturator bulb" is removed and eventually relined until it is retentive. Retentions are designed on the oral side of the bulb and the bulb is placed back into the defect. Finally, an alginate over-impression of the maxillary is made. The alginate is removed after full setting, and the obturator can be reassembled on the maxillary impression to provide a full recording of the maxillary. This protocol can safely be used for defects of any size, despite eventual limitations in oral opening.

Histological examination of tooth-derived biomaterials obtained from different devices

ABSTRACT Aim The aim of the present study was to investigate the histological differences between samples processed by different devices and to confirm safe clinical application of different dentin matrix obtained from three devices: BonMaker, Tooth Transformer, and Smart Dentin Grinder in regeneration of maxillary defects. Research design The study involved 39 patients with two-wall or three-wall defects who underwent bone augmentation procedures in the maxilla using dentin matrix grafts from the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices. Histological examination was conducted on samples obtained from patients who received each device. In this article, histological samples have been selected and are presented. Results In all patients, bone defects were successfully augmented with ground dentin matrix. The histological examination revealed no inflammation and a good connection between the bone and dentin matrix and clinically all patients were qualified for implant placement. Conclusions After comparing the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices in our practice, we concluded that all these systems have the potential for obtaining regenerative material from the patient’s teeth.

Reconstruction of Maxillary Defects Using Virtual Surgical Planning and Additive Manufacturing Technology: A Tertiary Care Centre Experience

IntroductionMaxillary reconstruction is often a challenging task for the surgeons because of the complex anatomy. However, with the advances in virtual surgical planning (VSP) and 3D printing technology there is a new avenue for the surgeons which offers a suitable alternative to conventional flap-based reconstructions.Patients and MethodsIn this article, we have described 4 case scenarios which were managed with the help of VSP and additive manufacturing technology for complex maxillary reconstruction procedures. Use of the technologies aided the clinician in achieving optimal outcomes with regards to form, function and esthetics.DiscussionVirtual surgical planning (VSP) has gained a lot of impetus in past 1 decade. These aides the surgeon in determining the extent of disease and also carry out the treatment planning. In addition to VSP, the concept of additive manufacturing provides a viable alternative to the conventional reconstruction modalities for maxillary defect rehabilitation. Increased accuracy, rehabilitation of normal anatomical configuration, appropriate dental rehabilitation, decreased intra-operative time and post-operative complications are some of the advantages. In addition, patient-specific implants eliminate the need for a separate donor site. Apart from the treatment of pathologies, they also can be used for reconstruction of post-traumatic defect, where endosteal implant placement is not possible.ConclusionThese modalities show promising results for reconstruction of complex maxillary defects.

Long-term quality of life in patients with BrownⅡ maxillary defect repaired by different methods

Objective: To analyze the long-term quality of life of patients with Brown Ⅱ maxillary defect repaired by tissue flap or prosthesis. Methods: Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term (>5 years) quality of life using the fourth edition of the University of Washington quality of life questionnaire (UW-QOL). Mann Whitney U test was used to examine the differences between two groups. Results: In this study, 4 cases were lost to follow-up, 9 died, and a total of 46 valid questionnaires were collected, including 24 males and 22 females, aged 19-86 years. There were 26 cases of class Ⅱb/c and 20 cases of class Ⅱd. Tissue flap reconstruction was performed in 29 cases (tissue flap group) and prosthesis restoration in 17 cases (prosthesis group). The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group (Z=-2.787, P=0.005), but the scores of entertainment, swallowing, speech and emotion QOL in the former group were respectively lower than those in the latter group (Z=-3.185, -2.091, -2.556 and -1.996, respectively, all P values<0.05). In patients with Brown Ⅱb/c defect, the prosthesis repair could improve the chewing QOL score (Z=-2.830, P=0.005), but no statistically significant differences in other QOL scores between two groups. In patients with Brown Ⅱd defect, the tissue flap reconstruction could improve the scores of pain, entertainment, swallowing and speech QOL (Z=-2.741, -2.517, -2.320 and -2.843, respectively, all P values<0.05), and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group (Z=-2.276, P=0.023). Conclusion: For postoperative long-term quality of life, both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with Brown Ⅱb/c defect, and patients with Brown Ⅱd defect repaired by tissue flap reconstruction have better speech and swallowing functions. Tissue flap reconstruction may bring more entertainment and emotional benefits.

Influence of Kennedy class and number of implants on the accuracy of dynamic implant navigation: An in vitro study using an X-ray free evaluation methodology

ObjectivesThe aim of this in vitro study was to evaluate the accuracy of fully guided dynamic implant navigation surgery in Kennedy I, II, and III class dental arch defects with two different implant designs, using an X-ray free evaluation method. MethodsPolyurethane resin maxillary models simulated posterior edentulous defects. Four cone beam computed tomography (CBCT) scans and four intraoral (IOS) scans were obtained for each model and a digital wax-up with the correct implant positions was made. The accuracy of implant positions was evaluated using an IOS-based X-ray-free method (3Shape). Four deviation characteristics were evaluated: insertion point, depth deviation, horizontal and angle deviation. ResultsThe insertion point deviation measures ranged from 0.19 mm to 1.71 mm. Depth (s) and (u) deviations ranged from -1.47 mm to 0.74 mm and from 0.02 mm to 1.47 mm, respectively. Horizontal deviation ranged from 0.09 mm to 1.37 mm. ConclusionsThere is a tendency of a decreasing insertion point deviation for an increasing number and distribution area of the teeth (increasing Kennedy class number). Kennedy class II and distal implant position had the most influence for the higher deviations. Clinical significanceDynamic implant guidance provides accurate spacing, angulation, depth and position of the implants. It is important to understand how the number of missing teeth and implant design could influence the accuracy of dynamic implant navigation. Thus, it is important to evaluate factors influencing the accuracy of dynamic systems by using a X-ray-free post-operative method and to overcome the limitations of providing multiple CBCT scans.