Introduction: The innervation of the hard and soft tissues of the maxillary anterior area depends on the nasopalatine nerve. Due to its anatomy and closeness to implants in the esthetic area, it is essential to fully comprehend its traits and possible effects while performing implant placement procedures. Objective: To assess the prevalence of neurosensorial alteration and the survival and success rate of dental implants in a relationship with the nasopalatine canal. Material and methods: A comprehensive search of the literature was conducted in the following databases: MEDLINE, Web of Science, and Scopus. The articles included had to be case series, studies conducted in patients undergoing dental implant procedures in the incisive canal region or undergone dental implant procedures with incisive canal deflation or neurovascular lateralization. A quantitative synthesis using a meta-analysis software program was performed. Fixed- or random-effect models were applied based on the heterogeneity among studies. Results: Four studies were included. Neurosensorial alterations were presented in three out of four articles included. The range of neurosensorial alterations varied from 30% to 60%. A weighted mean of 29 % ± 13 % of neurosensorial alterations was calculated from the meta-analysis meanwhile a mean of 100 % of implant survival and 100% of implant success were found. In the results, please clarify that "29%±13%" represents the weighted mean calculated from the metaanalysis. Conclusions: Implants in the nasopalatine area are associated with high rates of survival and success being a safe procedure, however, clinicians should be aware that neurosensorial alterations may be present when placing implants in this area.

Introduction: The presence of adequate keratinized mucosa (KM) around dental implants and natural dentition is pivotal for the long-term success of dental restorations. Despite various techniques to augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in the context of significant muscle pull or compromised tissue conditions. This study introduces a novel application of titanium pins for the fixation of free gingival grafts (FGG) and apically repositioned flaps (APF) during vestibuloplasty, aiming to overcome important limitations associated with traditional suturing methods and shorten the treatment time and patient morbidity. Methods: Three patients with insufficient KM width, presenting discomfort during oral hygiene and inflammation around implant restorations and natural teeth, underwent soft tissue augmentation using titanium pins traditionally used in guided bone regeneration (GBR) for the stabilization of FGGs and APFs. This method ensures intimate contact between the graft and the periosteum, facilitating proper graft perfusion and revascularization, minimizing shrinkage and the risk for necrosis of the graft. Results: Postoperative follow-up revealed successful integration of the grafts, with minimal shrinkage and increased width and depth of KM. The use of titanium pins allowed for reliable fixation in challenging surgical sites, where traditional suturing methods were impractical due to the presence of extensive muscle pull and an unstable recipient bed. Conclusion: The application of titanium pins for the fixation of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This method simplifies and shortens the procedure, offering a predictable outcome with increased mechanical stability and minimal shrinkage of the graft. Randomized clinical trials are recommended to further evaluate the efficacy of this technique. Schlagwörter: Free Gingival Graft, Dental Implants , Apically repositioned flap, Titanium pins, Vestibuloplasty, Graft Survival, Periodontal Surgery, Titanium Pins, Transplants

Introduction: The interforaminal region is considered more favorable for implant placement than the posterior mandible in edentulous patients, mainly because of the interference of the inferior alveolar nerve with implant placement in the severely resorbed posterior mandible. However, complications in the interforaminal region may occur due to the presence of the mandibular incisive nerve. Objective: This scoping review aims to describe the mandibular incisive nerve anatomy related to the potential interference in implant therapy. Material and methods: A comprehensive literature search was conducted in the following databases: MEDLINE (via PubMed), Web of Science, and Scopus. This scoping review was structured according to the Joanna Briggs Institute method. Results: Thirteen studies were included in the review. All the studies were observational cohort anatomical studies, carried out mainly by CBCT and on cadavers. A total of 1471 patients/cadavers were studied. The mandibular incisive nerve was presented in 87-100% of the cases, with an average length of 9.97 mm and an average diameter of 1.97 mm. The mandibular incisive nerve may be damaged during drilling and implant placement, especially using implant lengths larger than 12 mm. Conclusions: Damage to the mandibular incisive nerve due to implant placement could be present, however, it is necessary to conduct more studies focusing on assessing mandibular incisive nerve damage to understand the clinical relevance of this nerve and its associated morbidities such as neurosensorial alterations. Due to the different anatomical characteristics of this nerve, CBCT analysis is recommended for implant therapy in the anterior mandible to prevent the described complications.

Digital implant planning, utilizing the convergence of digital surface scanners, cone beam computer tomography (CBCT) scans, and advanced planning software, has transformed dental implantology. The merging of these data sets through triangulation of landmarks provides a detailed digital model of the jaws, facilitating precise implant positioning in edentulous areas. A critical step in this digital workflow is the accurate merging of DICOM files with STL/PLY/OBJ files, which underpins the design and fabrication of surgical templates for accurate implant placement. Errors in this phase can lead to implant mispositioning or damage to adjacent structures. Particularly in partial edentulism, the merging is based on the occlusal topography of the remaining teeth but scattering in the CBCT data—caused by interactions of radiation with radiodense materials—can complicate this process or even render it impossible. The manuscript presents a technique utilizing radiopaque markers to overcome scattering effects, ensuring accurate dataset superimposition in the mandible. Schlagwörter: Implants, Scattering, CBCT, Guided Surgery

Computer-assisted implant planning allows for a comprehensive treatment plan by combining radiographic data provided by a Cone Beam Computed Tomography (CBCT) with surface optical scan (IOs) data that includes patient intraoral situation and the intended restorative planning. Integrating a tailored restorative design with the patient’s anatomical conditions through virtual implant planning allows for an ideal bio-restorative treatment planning to maximize biological, functional, and esthetic outcomes. This article discusses dataset registration techniques that combine radiographic CBCT data with restorative information as the main path to create a virtual patient. The described techniques include the use of removable radiographic templates with radiopaque markers, dual scan technique, and direct digital file registration of intra-oral scans using anatomical references. Depending on the individual clinical situation, different factors must be considered to appropriately select methods that achieve an optimal registration of diverse datasets. An inherent challenge lies in the presence of scattering artifacts in CBCT scans. Two approaches are proposed for these situations – the use of chairside-fabricated composite resin markers or adhesive spot-markers fabricated for the use with CBCT scans. Both techniques exhibit limitations that need to be taken into consideration. Further approaches should be developed for situations involving scattering in CBCT. Schlagwörter: computer-assisted surgery, data superimposition, digital imaging processing, digital workflow, dual technique, scattering

Introduction: Maxillary sinus floor augmentation is a procedure known for its long-term success and predictable outcomes. However, the perforation of the Schneiderian membrane remains the most common complication associated with this procedure. Objective: This systematic review aims to determine the presence of complications during maxillary sinus floor augmentation procedures using CAD-CAM surgical templates. Material and methods: An electronic search was carried out in MEDLINE (via PubMed), Web of Science, and Scopus. A descriptive analysis of the data was performed. Studies that have performed lateral sinus floor augmentation were included in the inclusion criteria. The CAD-CAM surgical template design and the intraoperative complications were registered. Results: A total of 13 studies were included. Seven were case reports, four were case series, and two were randomized clinical trials. A total of 94 lateral SFA procedures were included (84 using CADCAM templates and 10 without using templates). Three of the 84 maxillary sinus floor augmentation procedures using a CAD-CAM template presented intraoperative complications. Conclusions: Maxillary sinus floor augmentation performed by using CAD-CAM surgical templates could be related to low rates of complications, however, due to the heterogeneity of the articles included, more standardized studies are needed to confirm these outcomes.

Die computergestützte Implantatchirurgie gehört zu den Verfahren, die in den letzten Jahren stark an Popularität gewonnen haben. Die Menge an Informationen, die sich in der virtuellen Umgebung verarbeiten und berücksichtigen lässt, ermöglicht eine schnellere, sicherere und präzisere Implantatsetzung. In manchen Fällen sind für eine adäquate implantatgetragene Rehabilitation ergänzende chirurgische Maßnahmen nötig. Der vorliegende technische Bericht zeigt einen klinischen Fall, in dem die Operationsschablone für eine Knochenreduktion sowie eine „stapelbare” Implantatschablone digital konstruiert und 3-D-gedruckt wurden, die bei einer simultanen Kamm-Ostektomie und statisch geführte Implantatsetzung zum Einsatz kamen. Schlagwörter: computer-assistierte, computergeführte, 3-D-Druck, Implantatchirurgie, Implantatsetzung, Knochenreduktion

The incorporation of virtual engineering into our profession and the digitalization of information are allowing us new perspectives and innovative alternatives for dental treatment modalities. The use of computer-guided implant-planning software allows the radiographic, prosthetic, surgical, and laboratory fields to be combined under a common virtual scenario, permitting complete virtual treatment planning. Different alternatives for the digital workflow have been described for computer-guided implant placement. In this article, we present a recommendation for selecting the appropriate digital workflow depending on the clinical situation to achieve precise computer-guided implant planning and a predictable treatment outcome. Schlagwörter: computer-guided implant surgery, digital planning

Passive fit between prosthesis and implants or abutments is a significant factor in preventing mechanical and biologic failures of implant-supported prostheses. Therefore, impression techniques must transfer the 3D implant position as accurately as possible for a correct superstructure fabrication. A novel impression protocol that uses an individualized open tray design is proposed. It allows the clinician to splint the transfers between the copings, outside the impression area, and to the tray itself to create a rigid monoblock. Thus, distortions produced by the tear of impression material or by transfer abutments' micromovements during tray retrieval are limited and superstructure misfits are minimized. This technique is specifically recommended for long spanning or completely edentulous patients.