Planning Implant Placement on 3D Stereolithographic Models Applied with Immediate Loading of Implant-Supported Hybrid Prostheses After Multiple Extractions: A Case Series

Purpose: The aim of this noninterventional, retrospective case series was to evaluate the outcome of immediately loaded implants in patients with failing dentitions that require bone tabling using a bone reduction guide and a surgical guide manufactured directly on three-dimensional (3D) stereolithographic models. Materials and Methods: Consecutive patients with failing dentition and at least two remaining teeth who were treated in a single center between December 14, 2009 and September 23, 2013 were eligible. All patients receiving implants loaded with a hybrid prosthesis on the same day as extraction with their surgery planned on 3D models and performed using a surgical guide manufactured in a laboratory on the planning model were included. Patients who had undergone bone grafting procedures were excluded. Descriptive statistical analyses of available data were performed, including life-table calculations to derive a cumulative survival rate (CSR). Results: Two hundred twenty-eight patients (105 females and 123 males) received 1,657 implants (NobelActive) in 321 arches, in most cases 5 implants (range, 5 to 7) per arch. Ten preexisting implants were used. The mean insertion torque was 60.02 ± 13.1 Ncm (range, 15 to 75 Ncm). The definitive abutment was placed on the same day as surgery in all cases, and the definitive prosthesis (n = 304) was delivered after a mean of 7.9 ± 2.6 months. All implants were followed for 20.01 ± 11.3 months (range, 0 to 52 months) from implant insertion. Four implants (3 patients) had delayed loading, and one implant was left as a sleeping implant. Eight implants among six patients failed, two of the implants after prosthesis delivery. The CSR of the placed implants was 99.4% at implant level and 96.2% at patient level. Conclusion: Planning on 3D models to remove bone and place implants using custom-made bone reduction and surgical guides with immediate loading on the same day as extraction of remaining teeth was safe and effective for implant survival and rehabilitation of patients with periodontitis and failing dentition. Keywords: bone reduction guide, dental implant, extraction sockets, immediate loading, surgical guide