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Received Nov 5, 2017; Revised Feb 8, 2018; Accepted Feb 20, 2018
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1. Introduction
Edentulism is prevalent worldwide among elderly people, and it is mainly attributed to dental caries and periodontal diseases. However, there is an association between sociodemographic factors, age, gender, low family-income, lifestyle, and tooth loss. In addition, earlier studies have shown edentulism to be a global issue, and it seems to be associated with systemic disorders [1].
When a condition of full-arch edentulism or preedentulism occurs, different rehabilitative options may be chosen: a complete removable denture, an implant-retained removable denture, and an implant-supported fixed prosthesis, either fixed or hybrid [1–4]. The increase in functional demand and social confidence, is leading more and more patients towards the fixed implant-supported options [5].
As regards implant fixtures inserted in edentulous areas, traditional Branemark’s protocols recommend 4 or 6 months of submerged and unloaded healing period, respectively, in the mandible and maxilla, after which it is possible to proceed to prosthetic loading, being the process of osseointegration completed [6, 7].
However, in the last few years, the chance to rehabilitate totally edentulous arches through immediately loaded implant-supported prosthesis was found to be a significant opportunity [6–8] due to good success rates and technical simplification introduced by such procedure as widely reported in previous studies [9–12].
Immediate loading is defined as a restoration placed in occlusion with the opposing dentition within 48 h of implant placement [13]. Integration between dental implants and host tissue is strictly dependent upon control of micromovement at the bone/implant interface during the first healing period, and it could be critical in case of immediate implant loading [9, 14, 15]. With full-arch immediate-loading prostheses, the control of micromovement could be achieved only when respecting some conditions: implants should have adequate primary stability at the time of placement, they should be subjected to rigid interimplant splinting, and occlusal forces should be appropriately controlled during the osseointegration period [16, 17].
Computer-aided design/computer-aided manufacturing (CAD/CAM) guided flapless surgery for implant placement using stereolithographic templates is gaining popularity among clinicians and patients [18, 19]. Its advantages are visualization...