Three-Year Outcome of Full-Arch Fixed Prosthetic Rehabilitation through the All-on-4® Concept Using Dynamic 3D Navigated Surgery (X-Guided™): A Retrospective Study

Abstract

Background/Objectives: The insertion of dental implants using dynamic 3D navigated surgery while applying immediate function protocols for full-arch rehabilitations warrants further research. This study aimed to evaluate the outcomes of All-on-4^® rehabilitations using 3D Dynamic navigated surgery (X-Guide™). Methods: This study included 10 patients (women: 7; men: 3; average age: 59.9 years) rehabilitated with full-arch prostheses through the All-on-4^® concept, with 48 dental implants inserted using navigated surgery. The primary outcome evaluation was prosthetic/implant cumulative survival (CS), estimated using life tables. Secondary outcome evaluations were marginal bone resorption (MBR), biological complications, and mechanical complications. The evaluation parameters were measured between 1 and 3 years. Results: No patients were lost to follow-up. Two implants (4.2%) were lost in one patient (10%) with smoking habits, resulting in an implant CS rate of 95.8%. The average MBR was 0.51 mm ± 0.62 mm at the 1-year follow-up. The incidence rate of mechanical complications was 40% (n = 4 patients), all occurring in provisional prosthesis. No biological complications were registered. The patients maintained their prostheses in function throughout the follow-up of the study. Conclusions: Within the limitations of this study and based on the results, it can be concluded that the insertion of dental implants assisted by dynamic navigation for full-arch rehabilitation through the All-on-4^® concept may be a valid treatment alternative in the short-term follow-up. However, more studies are necessary to validate this treatment modality.

Keywords: all-on-4; dental implants; digital; edentulous jaw; immediate loading; navigated surgery.

Figure 1

Planning a full-arch bimaxillary rehabilitation through the All-on-4 Concept: (a) Pre-treatment orthopantomography; (b) Pre-treatment intraoral photograph of the maxilla; (c) pre-treatment intraoral photograph of the mandible; (d) DTX Studio image exhibiting the pre-treatment condition in the maxilla and mandible with superimposition of CBCT and Intraoral Scanner (smart fusion); (e) DTX Studio image of the planning exhibiting the bone regularization to achieve a stable platform for implant insertion in the maxilla and mandible; (f) DTX Studio image of the final planning exhibiting the implant planning (diameter and length) in the maxilla and mandible.

Figure 2

Peroperative bimaxillary full-arch rehabilitation through the All-on-4 Concept with implant insertion assisted by navigated surgery: (a) Connection of the X-Guide clip receptor and array; (b) Superimposition of the implant planning (performed in DTX Studio Implant Software) with the patient’s jaw was achieved through the selection of points in three teeth on the software (virtual) matched with a calibration probe on the real patient’s teeth at the same points (X-Mark); (c) 2 mm twist-drill during osteotomy for insertion of implant in position 15 (tilted implant); (d) Insertion of implant 15 (note the live feedback provided by the navigation in degrees and depth); (e) Intraoral photograph after implant insertion and abutment connection in the maxilla; (f) Intraoral photograph after implant insertion and abutment connection in the mandible.

Figure 3

Prosthetic restoration of the bimaxillary full-arch rehabilitation: (a) Post-operative orthopantomography immediately after surgery; (b) Intraoral frontal photograph with the immediate provisional prostheses; (c) Final orthopantomography at 2 years of follow-up with the definitive prostheses (Maló Clinic Acrylic Bridge—titanium infrastructure, acrylic artificial gingiva and acrylic crowns); (d) Patient smiling with the definitive prostheses in place at 2 years of follow-up; (e) Intraoral occlusal view of the maxillary definitive prostheses at 2 years of follow-up; (f) Intraoral occlusal view of the mandibular definitive prostheses at 2 years of follow-up.

Figure 4

Cumulative survival rate for the implant-supported fixed prostheses: A 95.8% cumulative success rate was registered during the follow-up of the study (up to 3 years).

Figure 5

Boxplot illustrating the marginal bone loss measured in millimeters at 1 year of follow-up. The median is represented by the horizontal black line inside the box; the lower box edge represents the 25th percentile; the upper box edge represents the 75th percentile; whiskers represent the standard deviation; dots represent outlier values.