Transitional implants in computer-assisted implant surgery and fixed complete-arch provisionalization: A retrospective case series

Abstract

Introduction: Using mini implants as transitional implants (TIs) for complete arch implant-supported rehabilitations may overcome limitations associated with mucosa-supported surgical guides and facilitate immediate fixed provisionalization. This study aimed to assess the success of TIs in supporting surgical guides for implant placement and fixed provisional prostheses.

Methods: Patients who received TIs between 2012 and 2023 for a complete arch implant-supported prosthesis were evaluated retrospectively. Patient demographic data, TI functionality in supporting a surgical guide and supporting a complete arch provisional prosthesis, and dates of TI placement and regular implant placement were collected. Descriptive statistics were used to determine the survival rate and success rate for TIs.

Results: Twenty-six patients, 35 jaws, 136 TIs, and 216 regular implants were included. The survival rate of TIs was 74.26%; however, the use of TIs yielded success in 97% of jaws for supporting a surgical guide and a fixed complete-arch provisional prosthesis throughout the complete provisional phase. An average of 4 TIs per maxilla and 3 TIs per mandible supported surgical guides. Thirty-five provisional prostheses were placed on an average of 4 TIs in the maxilla and 3 TIs in the mandible. Thirty-four provisional prostheses were successfully supported by TIs and regular implants until final restoration delivery. The survival of regular implants placed in conjunction with the use of TIs was 98%.

Conclusions: Using TIs to support a surgical guide and provisional prosthesis may be a predictable approach with a high success rate. All surgical guides planned to be supported on TIs were successful. Despite premature loss or replacement of TIs, this approach was able to support most provisional prostheses until the regular implants could be loaded.

Keywords: edentulous mandible; edentulous maxilla; fixed implant prostheses; full‐arch; retrospective; survival rate.

FIGURE 1

Clinical example of a flapless maxillary case: (A) Mucosa‐supported stackable guide; (B) Surgical guide for regular implant surgery, shown here tried in on top of (A) stackable guide; (C) Surgical guide for TI placement, shown here tried in on top of (A) stackable guide; (D) TI position after guided placement; (E) Surgical guide for regular implant placement supported on TIs; (F) Regular implant position after guided placement; (G) Position of provisional prosthesis; (H) Provisional prosthesis retained on TIs.

FIGURE 2

Clinical example of a TI‐ supported guide that allows for a flap to be raised for bone reconstructive purposes. Note that this is one of the main benefits compared to a mucosa supported guide where a flap can’t be raised. (A) TI‐supported guide (B) Regular implant placement on a TI‐supported surgical guide.

FIGURE 3

(A) Mucosa‐supported stackable guide used to support (B) and (C) for implant surgery; (B) Surgical guide for TI placement; (C) Surgical guide for regular implant placement; (D) Provisional prosthesis with holes to be picked up on TIs.

FIGURE 4

(A) Initial panoramic radiograph (pretreatment); (B) Position of regular implants and TIs postsurgery in the maxilla and mandible; (C) Loading of provisional prostheses onto maxillary TIs and onto mandibular TIs and one regular implant that was already in the jaw pretreatment; (D) Final fixed prostheses in the maxilla and mandible supported by regular implants.

FIGURE 5

TI provisional prostheses support success distribution

FIGURE 6

(A) Distribution of TI use for surgical guide support. (B) Distribution of TI use for provisional prosthesis support.

FIGURE 7

Kaplan‐Meier curve representing TI cumulative survival toward days of TI function depending on number of TIs supporting the provisional. Censored events represent the exit of the monitoring period due to definitive loading of the prosthesis and therefore the extraction of the TI.