Novel complete-arch pillar system (CAPS) to register implant position and maxillomandibular relationship in one single visit

• Published in: Journal of dentistry 2024-04, Vol.143, p.104885-104885, Article 104885
• Main Authors: Nuytens, Philippe, Grande, Francesco, D'haese, Rani, Salameh, Ziad, Lepidi, Luca
• Format: Article
• Language: English
• Subjects: Complete-arch; Computer-Aided Design; Dental Implants; Dental Impression Technique; Dental Prosthesis, Implant-Supported; Humans; Imaging, Three-Dimensional; Intraoral scanner; Jaw, Edentulous - diagnostic imaging; Jaw, Edentulous - surgery; Mouth, Edentulous; Occlusal pillar; Pillar; Scan body; Scan body attachment
• ISSN: 0300-5712; 1879-176X
• DOI: 10.1016/j.jdent.2024.104885

This article presents a novel complete-arch pillar system (CAPS) to register implant position and maxillomandibular relationship in one single visit for implant-supported fixed complete dental prostheses (IFCDPs). The novel system presents a 3-unit toolset comprising intraoral scan bodies (ISBs), lateral pillar attachments (LPAs) and occlusal pillar attachments (OPAs). A 2-stage single visit workflow by an intraoral scanner (Trios 5) was introduced. The first stage “Screw-Scan-Done” was used to describe complete-arch intraoral implant scanning using LPAs. The second stage “Screw-Occlude-Done” involved virtual occlusal recording using OPAs. Two patients with one single edentulous arch were selected for this study. In the first patient, 6 bone level implants (Bone Level Tapered, Straumann) were placed in the edentulous maxilla at positions 12, 14, 16, 22, 24 and 26. In the second patient, 4 bone level implants (NobelActive CC, Nobel Biocare) were placed in the edentulous mandible at positions 32, 35, 42 and 45. A CAD-CAM procedure was initiated with the acquired IOS data to fabricate an interim IFCDP at the same day. Periapical radiographs were obtained of the implant-prosthetic connection of the definitive IFCDPs to verify the passive fit. Metrology software (Geomagic Qualify, 3D Systems – Matlab, Mathworks) was used to assess the implant analogs position in the 3D-printed casts used for fabricating the definitive IFCDPs. A quantitative occlusal relationship analysis was performed with IOS. Radiographic examination revealed no gaps at implant-prosthetic connection of the definitive IFCDPs. The 3D-printed casts showed an overall average distance deviation within the clinically acceptable range of errors of 150 µm. Quantitative occlusal relationship analysis with IOS showed well-distributed contacts. Within the limitations of this study, the following conclusions can be drawn: (1) A 3-unit toolset with ISBs, LPAs and OPAs allows to register the implant position and maxillomandibular relationship in one single visit; (2) the 2-stage clinical workflow with the CAPS system facilitates the IOS data acquisition for fabrication of an interim IFCDP at the same day; (3) a passive fit was demonstrated for the interim and the definitive IFCDPs. The CAPS system can help clinicians to register the implant position and the maxillomandibular relationship in one single visit for the fabrication of an IFCDP.