Computer-guided flapless placement of immediately loaded dental implants in the edentulous maxilla: a pilot prospective case series

Aims: The aim of this case series was to evaluate the Procera Software v1.6 and the surgical templates for flapless implant placement and immediate loading in atrophic fully edentulous maxillae. Materials and methods: The Procera Software was used to plan the exact position of the implants, and surgical templates were made to guide flapless implant placement. To allow for immediate loading, implants had to be placed with an insertion torque > 30 Ncm. Provisional cross-arch prostheses, produced before surgery using the software planning, were delivered immediately after implant placement, and replaced by final restorations after 6 months. Outcome measures were: prosthetic and implant failures, complications, post-operative pain and swelling, consumption of analgesics, and patient satisfaction. The followup stopped at 8 months post-loading. Results: Thirteen consecutive patients with atrophic maxillae were treated with 89 implants (6 to 8 implants per patient). Two flaps had to be elevated in two patients. One template fractured during surgery. Three implants in two patients were not loaded immediately. In four patients, impressions had to be taken to fit the provisional prostheses onto the implants. Five implants failed in four patients. One patient dropped out, due to financial reasons, with the provisional prosthesis still in function. Eight months after loading, all prostheses were successful and 11 out of 12 patients reported their quality of life and lifestyle had improved. Conclusions: This software-based treatment planning may be useful in planning and treating challenging cases such as flapless implant placement and immediate loading of maxillary cross-arch bridges, but a learning curve is necessary. Keywords: case series, computer-guided surgery, edentulous maxilla, flapless procedure, immediate loading