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. 2020 Jun 22;13(12):2806.
doi: 10.3390/ma13122806.

Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series

Luigi V Stefanelli  1 , George A Mandelaris  2 , Alessio Franchina  3 , Dario Di Nardo  1 , Massimo Galli  1 , Michele Pagliarulo  4 , Luca Testarelli  1 , Stefano Di Carlo  1 , Gianluca Gambarini  1
Affiliations

Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series

Luigi V Stefanelli et al. Materials (Basel). .

Abstract

The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.

Keywords: atrophic maxilla; computer aided implantology; dynamic navigation implantology; pterygoid implants; totally edentulous patients.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Implant planning using stereolithography (STL) files as reference for a prosthetic driven implantation (a). Panoramic (b), axial (c), bucco-lingual (d), and parasagittal (e) view.
Figure 2
Figure 2
Head tracker used in the upper jaw for dynamic navigation Trace and Place (TaP).
Figure 3
Figure 3
The figure shows the mini screws automatic recognition by the software and the related tracing progress.
Figure 4
Figure 4
The surgeon (a) can then verify the registration accuracy (b) by touching with the tracer’s ball tip one of the patient’s landmark (mini screw used in this case) (c). The matching quality can be verified from each view (d,e).
Figure 5
Figure 5
Clockwise from up left. The figure indicates the several views on the screen during surgery: tracker video stream (a), panoramic view (b), target view and depth indicator (c), bucco-lingual section view (d), and mesio-distal section view (e).
Figure 6
Figure 6
OT-bridge abutments use the “Extragrade™” feature, a system allowing to compensate up to 80° of the divergence between two implants (a,b). Pictures c and d show the clinical (c) and X-ray (d) view of the provisional prosthesis using OT-bridge abutments.
Figure 7
Figure 7
Opt X-ray (a) and clinical (b) view of the provisional prosthesis realized using conventional straight and angled multi-unit abutment (M.U.A.).
Figure 8
Figure 8
The preoperative surgical plan (a) and the postoperative cone beam computerized tomography (CBCT) (b) were superimposed using accuracy evaluation software (c,d). The registration was performed directly between the two volumetric images.
Figure 9
Figure 9
The software automatically fits an implant model to its appearance in the post-operative image (a) and computes the angular axis corrected between the planned and actual implant locations (implant inserted with dynamic guidance) (b–d).
Figure 10
Figure 10
Mucosa thickness linear measurement using the implant centric view of the CBCT.
See this image and copyright information in PMC

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