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Full Guided Surgery for Fully Edentulous Patients: A Case Series
Thursday, March 1 / 12:10-12:20pm / Monitor 8

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C. Cervellera, A. Long, R. Crockett, K. Shah, T-L. Chang, A. Moshaverinia, B. Cabariti, B. Javid, J. Pi Anfruns, P. Moy, T. Aghaloo

UCLA Dental Implant Center

Introduction :


Implant placement in fully edentulous arch is challenging :

-Restorative space -> Bone reduction

-Few anatomical landmarks

Bone anchored surgical guides are used to :

-Facilitate multiple implant placement

-Allow for easier delivery of a provisional prosthesis


The aim of this study was to evaluate benefits and difficulties of fully guided surgery in fully edentulous patients


Material and methods :


Retrospective chart review :

-At least one edentulous arch to restore

-Fully guided surgery under IV sedation or GA

-Fixated surgical template for implant placement

+/- bone reduction guide

-Computer-assisted planning and 3D printed guides


Outcomes noted :

-Number of implants per arch

-Simultaneous bone graft performed

-Immediate loading



Results :


16 patients - 19 surgeries - 29 arches


166 implants placed : 82 (49.4%) maxilla / 84 (50.6%) mandible


16 surgeries (84.2%) required simultaneous bone augmentation



7 implant failures (4.2%) = SUCCESS RATE : 95.8%


Immediate loading - 25 arches (86.2%) : 18 immediate implant supported prosthesis and 7 dentures delivered the day of surgery


Results :


Main complications cited in the literature


-Instability of the surgical template

-Fracture of the surgical template

-Difficulty removing components from template

-Metallic guide tubes detaching


-Implant instability

-Changing presurgical planning

-Limited mouth opening and posterior access

-Damage to vital anatomic structures



Complications encountered in the study


-Instability of the surgical template

-Fracture of the surgical template

-Difficulty removing drills from template

-Fracture of twist drill


-Implant instability (4 implants : 2.4%)

-Conversion to freehand implant placement


-Significant bleeding during bone reduction


Conclusion :


Fully guided surgery = extremely useful tool in planning prosthetic and surgical cases in edentulous patients :

-Team communication

-Accuracy in implant placement

-Multiple surgical and restorative procedures


Complications and challenges = Strong surgical and prosthetic team required


References :

Arisan V, Karabuda CZ, Ozdemir T. Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res 2010: 21: 980–988.

D’Haese, J., Van De Velde, T., Komiyama, A., Hultin, M. & De Bruyn, H. Accuracy and complications using computer-designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature. Clin Implant Dent Relat Res 2010: May 11.

Yong LT, Moy PK. Complications of Computer-Aided-Design / Computer-Aided-Machining-Guided (Nobel- GuideTM) surgical implant placement: an evaluation of early clinical results. Clin Implant Dent Relat Res 2008; 10: 123–127.

Rosano, G., Taschieri, S., Gaudy, J.F., Testori, T. & Del Fabbro, M. Anatomic assessment of the anterior mandible and relative hemorrhage risk in implant dentistry: a cadaveric study. Clin Oral Implants Res 2009; 20: 791–795. 




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