Guided implant surgery is considered as a safe and minimally invasive flapless procedure. However, flapless guided surgery, implant placement in post-extraction sockets and immediate loading of complete-arch fixed reconstructions without artificial gum are still not throughly evaluated. The aim of the present retrospective clinical study was to document the survival and success of complete-arch fixed reconstructions without artificial gum, obtained by means of guided surgery and immediate loading of implants placed also in fresh extraction sockets.
One hundred ten implants (65 of them post-extractive) were placed flapless through a guided surgery procedure and then immediately loaded by means of provisional fixed full arches. Successful implant stability at placement was achieved in all cases. After a provisionalization period of 6 months, 72 fixed prosthetic restorations were delivered. Only 2 implants failed to osseointegrate and had to be removed, in one patient, giving a 1-year implant survival rate of 98.2% (108/110 surviving implants); 8/12 prostheses did not undergo any failure or complication during the entire follow-up period. At the 1-year follow-up control, soft-tissue was stable in all patients and showed satesfactory aesthetic results.
In our present study, 12 patients received 110 implants (65 of them post-extractive), placed flapless through a guided surgery procedure and then immediately loaded by means of a provisional fixed full arch. After a provisionalization period of 6 months, 72 fixed zirconia-ceramic prosthetic restorations (53 single crowns, 17 bridges, and 2 fixed full arches) were delivered. The results showed a 1-year implant survival rate of 98.2% (108/110 surviving implants) and good soft-tissue stability.
Our present surgical and prosthetic approach presents several advantages. First, only one surgical session is required for tooth extraction, implantation and application of provisional prosthesis. For the patients social life, this concept allows a reduction of discomfort and facilite their return to professional life. For the dental rehabilitation, provisional restoration guides the soft-tissue healing for an optimal aesthetic result. Within the limitations of this study, combining a CBCT-derived surgical guide to an immediate implant placement in post-extraction sockets together with immediate provisionalization and loading seems to be a safe and predictable therapy, with high survival rates and excellent aesthetic results, when applied in indicated cases. Further studies on larger samples of patients and with longer follow-up controls are needed to draw more specific conclusions about the long-term results with the present technique.
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