Five-Year Follow-Up of Immediate Fixed Restorations of Maxillary Implants Inserted in Both Fresh Extraction and Healed Sites Using the NobelGuide™ System

BACKGROUND: Transition from a hopeless dentition to an implant prosthesis, without wearing a removable denture, requires adaptation with guided surgery in postextraction cases. PURPOSE: The study aims to evaluate mid-term follow-up of patients with compromised dentition treated with immediate fixed restorations on maxillary implants inserted in fresh extraction and healed sites by using NobelGuide™ (Nobel Biocare AB, Gothenburg, Sweden) in combination with a specially designed radiographic stent. MATERIALS AND METHODS: Twenty-seven patients (females 20, males 7) aged 34 to 71 years (mean 55.8) were treated with flapless surgery. Immediate full-arch (n = 19) or partial (n = 10) restorations were delivered. Patients were followed both clinically (mean 61.3 months, 48-77) and radiologically for up to 5 years (mean 46.5 months, 12-61). Cumulative survival rate (CSR) was assessed. Marginal bone remodeling was evaluated at implant insertion, after 2 and 4/5 years. Soft tissue parameters as well as biological and mechanical complications were also recorded. RESULTS: One-hundred sixty implants were assessed. Four implants in two patients failed and were removed (overall CSR 97.33%), and two were replaced. All final prostheses were stable and in good function throughout the study. Bone loss from insertion to 2 years, for implants placed in both extraction and healed sites, was 0.85 mm (SD 1.28, n = 130); from insertion to last radiological control (4-5 years), 1.39 mm (SD 1.88, n = 127); and between 2 years and last control, 0.64 mm (SD 1.66, n = 111). No bone loss difference was found between extraction and healed sites at any time (p > .05). At the last visit, most implants showed normal mucosa. No other complications occurred. CONCLUSIONS: This 5-year retrospective study demonstrated a good outcome with regard to implant survival, marginal bone changes, and soft tissue conditions.