Digital Options for the Rehabilitation of the Atrophic Edentulous Maxilla

Objective: The aim of this study was to describe fully digital workflows for the Prosthetically Guided Reconstructive Surgery (PGRS) of edentulous patients affected by atrophic maxilla. Methods: The preoperative provisional removable full-denture was used as starting point to determine aesthetics parameters, occlusion of the final prosthetic rehabilitation as well as the respective maxillary implant positions using conventional softwares for the diagnosis of available bone and for the design of the full-arch prosthesis. The regenerative option (bone augmentation using customized titanium mesh), or the long implant option (navigated zygomatic implants) were both digitally projected depending on the patient needs. After implants healing, two sets of digital impressions were acquired: set #1 was the digital impression of implant positions; set #2 was the digitalization of the provisional full denture together with the impression of the rear side. The two sets were digitally combined into a single file. The metal framework of the final prosthesis was designed and manufactured using digital hybrid manufacturing technology and clinically evaluated with Sheffield test and radiographs; at the same time a resin prototype was produced for clinical try-in of aesthetic and functional parameters. Results: Aesthetic parameters and the occlusion of the provisional removable full-denture were digitally transferred to the provisional and definitive full-arch fixed prosthesis. The digital models were 3D-printed in occlusion to finalize in three steps the full-arch prosthesis. Conclusions: The workflows of PGRS allowed realizing the full process of the prosthetic and surgical rehabilitation of edentulous patients with atrophic maxilla using a complete digital CAD-CAM technology. 1: Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res. 2002 Feb;13(1):103-11. PubMed PMID: 12005140. 2: Pellegrino G, Lizio G, Corinaldesi G, Marchetti C. Titanium Mesh Technique in Rehabilitation of Totally Edentulous Atrophic Maxillae: A Retrospective Case Series. J Periodontol. 2016 May;87(5):519-28. doi: 10.1902/jop.2016.150432. Epub 2016 Jan 12. PubMed PMID: 26759078. 3: Tuminelli FJ, Walter LR, Neugarten J, Bedrossian E. Immediate loading of zygomatic implants: A systematic review of implant survival, prosthesis survival and potential complications. Eur J Oral Implantol. 2017;10 Suppl 1:79-87. Review. PubMed PMID: 28944370. 4: Ciocca L, Lizio G, Baldissara P, Sambuco A, Scotti R, Corinaldesi G. Prosthetically CAD-CAM-Guided Bone Augmentation of Atrophic Jaws Using Customized Titanium Mesh: Preliminary Results of an Open Prospective Study. J Oral Implantol. 2018 Apr;44(2):131-137. doi: 10.1563/aaid-joi-D-17-00125. Epub 2018 Jan 5. PubMed PMID: 29303418. 5: Ciocca L, Ragazzini S, Fantini M, Corinaldesi G, Scotti R. Work flow for the prosthetic rehabilitation of atrophic patients with a minimal-intervention CAD/CAM approach. J Prosthet Dent. 2015 Jul;114(1):22-6. doi: 10.1016/j.prosdent.2014.11.014. Epub 2015 Apr 7. PubMed PMID: 25862269.