22 November 2022

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Digital versus conventional techniques for immediate restoration

Lorenzo Breschi

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In recent years, digital technologies have significantly changed clinical practice with regards to diagnosis, prosthetic planning, guided surgery and implant-supported rehabilitations. Using advanced digital technology, static computer-assisted implant surgery (s-CAIS), it is possible to pre- operatively plan the implant position and the prosthetic rehabilitation. This allows for immediate restoration using a one-abutment one-time approach and a fully digital workflow.

Although s-CAIS is gaining popularity in implant dentistry and several recent studies were published, the results encompass a wide range of outcomes, as different settings have been utilized, making it necessary to compare implant accuracy and reliability with the conventional workflow. Hanozin et al. conducted a randomized clinical trial to evaluate the short-term outcomes after immediate restoration of a single implant in the esthetic zone with a one-abutment one-time approach, comparing a conventional workflow vs. a fully digital workflow.

Materials and methods: Eighteen patients were recruited and randomly divided into two groups. One dentist performed digital implant planning for all patients. In the test group, a custom-made zirconia abutment and a CAD–CAM provisional crown were prepared prior to surgery. Implants were placed with the aid of a s-CAIS guide, allowing immediate restoration after surgery using a one-abutment one-time approach. In the control group, the implant was placed free hand with the aid of a conventional surgical guide. A custom-made zirconia abutment to support a stratified provisional crown was placed after 10 days, based on a conventional impression. Implant accuracy, provisional restoration outcomes and patient-reported outcome measures were assessed. Results were considered significant at 5% uncertainty level (p<0.05).

Results: The implant positioning showed higher accuracy with the s-CAIS surgical guide compared to free-handed surgery [angular deviation (AD): 2.41±1.27° vs. 6.26±3.98°, p<0.014; entry point deviation (CGD): 0.65±0.37 mm vs. 1.27±0.83 mm, p<0.059; apical deviation (GAD): 1.36±0.53 mm vs. 2.42±1.02 mm, p<0.014, respectively]. The occlusion and interproximal contacts showed similar results for the two workflows (p=0.7 and p=0.69, respectively). Also, the patient-reported outcome measure results were similar in both groups except for the comfort during the impression: the intra-oral scanning was found to be significantly more comfortable compared to the conventional impression (p=0.014).

Conclusion: The authors concluded that both conventional workflow and fully digital workflow were accurate, predictive and displayed similar clinical and esthetic outcomes, allowing reliable implant placement and immediate restoration. The results showed that the fully digital workflow using s-CAIS provided a more accurate implant position relative to planning.

Brieuc Hanozin, Lou Li Manni, Geoffrey Lecloux, Miljana Bacevic and France Lambert. "Digital vs. conventional workflow for one-abutment one-time immediate restoration in the esthetic zone: a randomized controlled trial." International Journal of Implant Dentistry (2022) 8:7. https://doi.org/10.1186/s40729-022-00406-6