15h00 Guided versus unguided All-on-4 implant placement: a retrospective study and future perspectives.

Keywords: Implantology, All-on-4, Dynamic navigation, X-Guide.

Objectives: the evolution of implantology has significantly transformed dental rehabilitation, offering reliable solutions for edentulous patients. Atrophic edentulous jaws, however, often present compromised bone quality and quantity, making implant placement challenging. Full-arch rehabilitation using the All-on-4 concept has emerged as a milestone in implantology, eliminating the need for extensive bone augmentation by tilting posterior implants. As implantology has advanced, guided systems, both static and dynamic, have been developed to enhance the accuracy of implant placement, particularly in complex cases. Dynamic navigation systems, such as X-Guide, enables real- time control and precision, potentially improving outcomes in challenging scenarios. This study compares outcomes of All-on 4 implants placed with and without dynamic navigation, highlighting its utility in complex cases and discussing future directions for improving accuracy.

Material and Methods: this retrospective study evaluated the outcomes of All-on-4 implants placed in the upper and lower jaws by a single surgeon (KS). Simpler cases, involving straightforward anatomy, were completed without dynamic navigation, while more complex cases, requiring precise control due to anatomical limitations, utilized X-Guide (Nobel Biocare). Primary outcomes were implant survival and success, while secondary outcomes included marginal bone loss and biological or mechanical complications. Cases placed since November 1, 2023, were analysed. 

Results: implants placed without dynamic navigation demonstrated high survival and success rate, with minimal complications. In more complex cases, dynamic navigation facilitated precise placement and similarly favorable outcomes were observed. Marginal bone loss, and biological or mechanical complications were low across all cases, with detailed results to be presented.

Conclusion: the history of implantology reflects a continuous effort to improve outcomes in edentulous patients, with the All-on-4 concept addressing challenges posed by atrophic jaws. While unguided implant placement can achieve good results in simpler cases, dynamic navigation offers a critical advantage in complex scenarios, enhancing accuracy and predictability. This study confirms the effectiveness of dynamic navigation for All-on-4 implants and highlights opportunities for further advancements in guided implantology to refine surgical workflows, improve accuracy, and optimize outcomes in the future.