Current knowledge about stackable guides: a scoping review

Abstract

Purpose: The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of the temporary prosthesis at the time of implant placement. This scoping review aimed to assess the current knowledge available on stackable guides.

Methods: The review focused on fully edentulous or requiring total edentulism patients. The procedure studied was the use of stackable guides for edentulous patients in order to place immediate temporary prostheses. The clinical endpoint was immediate placement of the provisional prosthesis after surgery combined with a prior bone reduction using a stackable guide.

Results: 12 case reports or case series articles met inclusion criteria, which did not allow an analysis by a systematic review. The included studies were case reports or case series. Most of the articles showed a base stabilized by 3 or 4 bone-pins, anchored in buccal or lingual part. Regarding the accuracy of bone reduction (ranged from 0.0248 mm to 1.98 mm) and implant placement when compared to planned, only 4 articles reported quantitative data. 11 articles showed an immediate loading with the transitional prosthesis after implant placement.

Conclusions: There are as yet no prospective or comparative studies on the efficiency of this technique. In a reliable way, stackable guides seem to be able to guide the practitioner from the flap elevation to the placement of the temporary screw-retained implant supported prosthesis. Given the lack of studies in this specific field of guided surgery, further studies are needed to confirm the clinical relevance of this technique.

Keywords: Computer-guided surgery; Dental implants; Dental prosthesis; Digital; Prosthodontics.

Fig. 1

Conventional stereolithographic surgical guide (pilot drill guide)

Fig. 2

Stackable guide: base

Fig. 3

Stackable guide: base + 1rst stage (base positioning using remaining teeth)

Fig. 4

Stackable guide: base + 2nd stage for fully guided implant placement

Fig. 5

Stackable guide: base + 1rst stage (base positioning) in a clinical situation

Fig. 6

Anchored base before multiple extractions

Fig. 7

Anchored base after multiple extractions

Fig. 8

Stackable guide: base + 2nd stage for fully guided implant placement

Fig. 9

Fully guided osteotomies

Fig. 10

Implants placed at the end of fully guided surgery