Clinical and Radiographic Outcome of Implants Placed Using Stereolithographic Guided Surgery: A Prospective Monocenter Study

Purpose: The number of clinical reports giving detailed information on clinical outcomes with guided surgery is rather scarce despite its large-scale introduction over the last decade. The aim of this report was to determine implant survival and success in terms of peri-implant bone loss and evaluate whether smoking affects the outcome. Materials and Methods: A total of 26 cases with a partially or totally edentulous maxilla were selected for implant treatment using the Facilitate software system (Astra Tech). In totally edentulous cases, six fluoride-modified OsseoSpeed implants (Astra Tech) were inserted. Immediately after implantation, abutments were screwed onto the implants. Within 8 hours, a provisional screw-retained fiber-reinforced acrylic fixed dental prosthesis was screwed on the abutments. For the partial cases, the surgical guide rested on the remaining teeth and implants were not immediately loaded. Results: In total 13 out of 114 implants were lost within 12 months after surgery, resulting in 88.6% survival at 1 year. Twelve of those failures occurred in smokers, leading to 69.2% implant survival compared to 98.7% in nonsmokers. Implants were lost in 7 out of 26 (26.9%) patients; only 1 out of 17 nonsmokers (5.9%) compared to 6 out of 9 (66.7%) smokers lost one or more implants. In total, 38.5% of the subjects with a full immediately loaded fixed dental prosthesis experienced implant failures compared with 15.4% of the partially delayed loaded cases. The overall mean bone loss based on all implants was 0.47 mm (SD, 0.94). Mean bone loss was 0.36 mm for nonsmokers and 0.62 mm for smokers. Conclusions: On the basis of the current case control study, it is tempting to suggest that smoking is an exclusion factor when placing implants using stereolithographic guided surgery in conjunction with immediate loading. There is still not enough scientific evidence to show if this method is as safe and predictable as the traditional method. Keywords: dental implants, stereolithography, guided surgery, smoking, clinical outcome