Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series

Abstract

The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.

Accuracy assessment of dynamic computer–aided implant placement: a systematic review and meta-analysis

“…Figure 2 shows the complete flowchart of the study selection process. Of the 24 articles, 10 reported on clinical studies involving humans [43][44][45][46][47][48][49][50][51][52] and 14 reported on preclinical "in vitro" studies [53][54][55][56][57][58][59][60][61][62][63][64][65][66]. The types of studies included for each system can be observed in Table 2.…”

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

“…Pterygoid implants in a full-arch rehabilitation obtain an optimal distribution of functional loads thanks to a wider implant-prosthetic polygon. Apart from a case report without immediate loading [ 31 ], the use of bilateral pterygoid implants associated with two to four standard fixtures in the anterior zone, with a flapless approach, has been reported by Stefanelli et al [ 26 ] for the immediate loading full-arch rehabilitation of the upper jaw. These authors adopted the dynamic navigation implantology after a digital accurate planning to reduce the risk of anatomical injuries and to facilitate prosthetic management.…”

“…Indeed, this report’s clinicians, really expert, could not have otherwise reached all their goals, a fast and harmless flapless surgical procedure with an immediate aesthetic and functional prosthetic finalization, at least with such accuracy. The ND system adopted to treat the herein reported case presents the advantage of accomplishing the registration process by tracing the existing teeth, used as fiducial markers [ 26 ]: the presence of stable residual teeth, to be removed because useless for the prosthetic rehabilitation, allows the software to overlap the planning information on the preliminary taken by the patient CBCT, avoiding the need of a new one, that generally must be performed after the insertion of the fiducial markers. This property could not have been exploited in this case report, for the stability reduction of the residual teeth.…”

“…The full-arch rehabilitation of edentulous upper jaws can be performed with the use of two posterior tilted and two frontal implants [ 23 ]. These graft-less procedures, faster and less prone to complications, can be applied even in systemic health critical patients [ 24 , 25 ] The use of bilateral pterygoid implant in a full-arch rehabilitation associated with two-four anterior ones has been adopted with good results, and Stefanelli et al succeeded in obtaining the full-arch maxillary restorations of thirteen patients with immediate loading and flapless surgery [ 26 ]. The use of zygoma implants can be indicated in case of extreme alveolar bone loss, since the difficulties in their placement and loading [ 19 ].…”

Validation of an Intra-Oral Scan Method Versus Cone Beam Computed Tomography Superimposition to Assess the Accuracy between Planned and Achieved Dental Implants: A Randomized In Vitro Study

“…The existing discrepancies between a planned implant and an inserted implant are one of the most relevant challenges for the operators to understand if the method used for that surgery is accurate enough to guarantee the requested results [ 14 , 15 , 16 ].…”