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. 2023 Aug 18:12:Doc06.
doi: 10.3205/iprs000176. eCollection 2023.

Prosthetically guided oral implant surgery. A retrospective cohort study evaluating the 5-year surgical outcome

Andreas Sakkas  1   2 , Stefan Westendorf  1 , Oliver Christian Thiele  3 , Alexander Schramm  1   2 , Frank Wilde  1   2 , Sebastian Pietzka  1   2
Affiliations

Prosthetically guided oral implant surgery. A retrospective cohort study evaluating the 5-year surgical outcome

Andreas Sakkas et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

Purpose: This study primarily evaluated the 5-year implant survival and success rate of prosthetically guided inserted implants. The secondary aim was to evaluate the impact of clinical variables on the development of mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure.

Materials and methods: An observational retrospective single-centre study was conducted on patients who were treated with dental implants in the department of oral and plastic maxillofacial surgery of the military hospital of Ulm University between 2008 and 2010. In all patients, computer-assisted 3D planning after wax-up of the prosthetic restoration and template-guided surgery with titanium implants were performed. Bone augmentation procedures were performed primarily if needed. Intraoperative and postoperative complications as well as technical and mechanical complications after prosthesis loading were evaluated. In a 5-year clinical and radiological follow-up, implant success and implant survival were assessed using descriptive statistics. A multivariable regression analysis evaluated the potential impact of augmentation procedures, wound healing complications, smoking, history of periodontitis, and preoperative API (approximal plaque index) and SBI (sulcus bleeding index) values on peri-implant mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure.

Results: In this study, 466 implants in 283 patients were considered for inclusion, and sufficient data were obtained for analysis from 368 (78.9%) implants in 229 (80.9%) patients. An overall implant survival rate of 98.1% (n=361/368) at the 5-year follow-up was revealed. According to the success criteria of the study, the 5-year success rate was 97.04% (n=263/271). An early implant failure of 1.07% (n=5/466) was recorded. 48.2% of the implants were affected by peri-implant mucositis (n=122/253), while peri-implant bone resorption was detected in 21.7% of the radiologically examined implants (n=59/271). Fifteen cases of peri-implantitis (5.5%) were detected. Peri-implant bone resorption increased significantly after bone augmentation procedures (p=0.028). Wound healing complications after implantation significantly increased the prevalence of late implant failure in the maxilla (p<0.001). Peri-implant bone resorption and peri-implantitis were significantly more prevalent in smokers (p=0.022/p=0.043). Implants in patients with API>20% presented significantly higher rates of peri-implant mucositis (p=0.042). Wound healing complications after augmentation, history of periodontitis, and SBI>20% had no significant impact on the study parameters.

Conclusions: The study confirms the reliability of prosthetically guided implant surgery, showing a high implant survival and success rate in a 5-year follow-up. Intraoperative complications and technical or mechanical complications after prosthesis loading remain within acceptable clinical limits. The rate of peri-implant mucositis, peri-implant bone resorption, and peri-implantitis was within the current literature range. Optimizing periodontal health and reducing smoking would improve the outcome. Further studies need to clarify the clinical indications and investigate the long-term surgical outcome of this treatment concept.

Zielsetzung: Diese Studie bewertete in erster Linie die 5-Jahres-Überlebens- und Erfolgsrate von prothetisch-geführt inserierten Implantaten. Das sekundäre Ziel bestand darin, den Einfluss klinischer Variablen auf die Entwicklung von Mukositis, periimplantärer Knochenresorption und Periimplantitis sowie frühes und spätes Implantatversagen zu evaluieren.

Material und methoden: : Eine retrospektive Beobachtungsstudie wurde an Patienten durchgeführt, die zwischen 2008 und 2010 in der Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie des Bundeswehrkrankenhauses der Universität Ulm mit Zahnimplantaten behandelt wurden. Bei allen Patienten wurden nach dem prothetischen Wax-up eine computergestützte 3D-Planung und eine schablonengeführte Implantatinsertion durchgeführt. Bei Bedarf wurden primär Knochenaugmentationen durchgeführt. Intraoperative und postoperative Komplikationen sowie technische und mechanische Komplikationen nach prothetischer Restoration wurden evaluiert. In einem klinischen und radiologischen 5-Jahres-Follow-up wurden der Implantaterfolg und das Implantatüberleben anhand deskriptiver Statistik ausgewertet. Eine multivariable Regressionsanalyse bewertete den potenziellen Einfluss von Augmentationsverfahren, Wundheilungsstörungen, Rauchen, anamnestische Parodontitis und präoperativen API- (Approximal Plaque Index) und SBI-Werten (Sulcus Bleeding Index) auf periimplantäre Mukositis, periimplantäre Knochenresorption, Periimplantitis sowie frühen und späten Implantatverlust.

Ergebnisse: In dieser Studie wurden 466 Implantate bei 283 Patienten berücksichtigt und von 368 (78,9%) Implantaten bei 229 (80,9%) Patienten wurden ausreichende Daten für die Analyse gewonnen. Bei der 5-Jahres-Nachbeobachtung ergab sich eine Gesamtüberlebensrate von 98,1% (n=361/368). Nach den Erfolgskriterien der Studie lag die 5-Jahres-Erfolgsrate bei 97,04% (n=263/271). Ein frühzeitiger Implantatvelust wurde bei 1,07% (n=5/466) verzeichnet. 48,2% der Implantate waren von periimplantärer Mukositis betroffen (n=122/253), während bei 21,7% der radiologisch untersuchten Implantate eine periimplantäre Knochenresorption festgestellt wurde (n=59/271). Fünfzehn Fälle von Periimplantitis (5,5%) wurden festgestellt. Die periimplantäre Knochenresorption nahm nach augmentativen Verfahren signifikant zu (p=0.028). Wundheilungsstörungen nach der Implantation erhöhten die Prävalenz des späten Implantatverlustes im Oberkiefer signifikant (p<0.001). Periimplantäre Knochenresorption und Periimplantitis waren bei Rauchern signifikant häufiger anzutreffen (p=0.022/p=0.043). Periimplantäre Mukositis trat signifikant häufiger bei Patienten mit API>20% auf (p=0.042). Wundheilungsstörungen nach Augmentation, anamnestische Parodontitis und SBI>20% hatten keinen signifikanten Einfluss auf die Studienparameter.

Schlussfolgerungen: Die Studie bestätigt die Zuverlässigkeit der prothetisch-geführten Implantatchirurgie und zeigt eine hohe Implantatüberlebens- und Erfolgsrate in einem 5-Jahres-Follow-up. Intraoperative Komplikationen und technische oder mechanische Komplikationen nach prothetischer Belastung bleiben innerhalb akzeptabler klinischer Grenzen. Die Rate der periimplantären Mukositis, der periimplantären Knochenresorption und der Periimplantitis lag im Rahmen der aktuellen Literaturwerte. Die Optimierung der parodontalen Gesundheit und die Reduzierung des Rauchens würden das Outcome verbessern. Weitere Studien müssen die klinischen Indikationen klären und das chirurgische Langzeitergebnis dieses Behandlungskonzepts untersuchen.

Keywords: autologous bone augmentation; computer-assisted planning; dental implants; guided implant surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests in regard to this article and no financial interests, either directly or indirectly, regarding the products listed in the study.

Figures

Table 1
Table 1. Study collective
Table 2
Table 2. Implant number regarding the recipient jaw, tooth region, and dental situation
Table 3
Table 3. Distribution of implant dimensions and implant system used
Table 4
Table 4. Cases of free-hand implantation due to intraoperative complications despite preoperative computer-assisted three-dimensional planning and surgical template support.
Table 5
Table 5. Success rate of the 271 implants examined at the 5-year follow-up with regard to peri-implant bone loss according to our success criteria, based on the criteria defined in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions [21]. The treatment success in our study was defined for a peri-implant bone resorption ≤2 mm.
Table 6
Table 6. Technical and mechanical complications in the 5-year period after prosthesis loading
Table 7
Table 7. Statistical correlation between variable factors and the prevalence of peri-implant mucositis, peri-implant bone resorption, peri-implantitis, and implant failure
Figure 1
Figure 1. Flow chart of the prosthetically guided implant surgery concept
t=time point, CT=computer tomography, CBCT=cone beam computer tomography
Figure 2
Figure 2. Technical way to manufacture the surgical drilling template, applying the prosthetically-guided planning concept by using digital planning software.
A: Radiographic template with barium sulfate tooth 014 and the radiopaque markers. B: The radiopaque markers in the software display. The correction of the automatic detection is done manually if necessary. C: Planning data of an implant regio 047. On the left in the upper the selected implant system with the corresponding length and diameter can be seen. On the right and bottom left, the data important for fabricating the surgical guide are displayed. D: After setting the drilling table in 4 planes (A, B, C, D) according to the planning data, the drill hole is made in the drilling template. The metal die is then glued in place. E: Planning interface of the software. The implants were selected according to manufacturer, type, and diameter and placed in the jaw in the ideal prosthetic position shown by the X-ray template. The position data were sent to the laboratory for fabrication of the surgical guide. If there was no bone available, the bone augmentation was planned or, as in the present example, inserted paranervally to avoid costly vertical augmentations. F: Representation of the Straumann Guide System. Similar to the Steco system, however, here the drill sleeves are located on a guide tray to simplify handling. © Institut Straumann AG
Figure 3
Figure 3. A: Postoperative radiograph after insertion of 3 implants in the posterior maxilla region with representation of the measurement procedure for determining the initial findings. B: Radiograph of the same area at the 5-year follow-up examination with representation of the measurement procedure for determining peri-implant bone resorption.
Green line: initial bone height; blue arrow: implant length; orange line: apical implant edge; pink arrow: measured distance from the crestal bone to apical implant edge; red line: crestal bone line after peri-implant bone resorption
Figure 4
Figure 4. Outcome of prosthetically guided implant surgery at a 5-year follow-up examination
Figure 5
Figure 5. Distribution of wound healing complications after augmentation and implantation procedures in correlation to the recipient jaw
Figure 6
Figure 6. Demonstration of the implant number inserted in total and implant number evaluated at the 5-year follow-up with regard to pre-implantological augmentation procedures
See this image and copyright information in PMC

References

    1. Tatakis DN, Chien HH, Parashis AO. Guided implant surgery risks and their prevention. Periodontol 2000. 2019 Oct;81(1):194–208. doi: 10.1111/prd.12292. - DOI - PubMed
    1. Bover-Ramos F, Viña-Almunia J, Cervera-Ballester J, Peñarrocha-Diago M, García-Mira B. Accuracy of Implant Placement with Computer-Guided Surgery: A Systematic Review and Meta-Analysis Comparing Cadaver, Clinical, and In Vitro Studies. Int J Oral Maxillofac Implants. 2018;33(1):101–115. doi: 10.11607/jomi.5556. - DOI - PubMed
    1. D'haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer-guided implant surgery. Periodontol 2000. 2017 Feb;73(1):121–133. doi: 10.1111/prd.12175. - DOI - PubMed
    1. Al Yafi F, Camenisch B, Al-Sabbagh M. Is Digital Guided Implant Surgery Accurate and Reliable? Dent Clin North Am. 2019 Jul;63(3):381–397. doi: 10.1016/j.cden.2019.02.006. - DOI - PubMed
    1. Happe A, Fehmer V, Herklotz I, Nickenig HJ, Sailer I. Possibilities and limitations of computer-assisted implant planning and guided surgery in the anterior region. Int J Comput Dent. 2018;21(2):147–162. - PubMed