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International Journal of Dentistry
Volume 2018 (2018), Article ID 2672549, 7 pages
Clinical Study

Double Guided Surgery in All-on-4® Concept: When Ostectomy Is Needed

San Gerardo Hospital, Department of Maxillofacial Surgery, University of Milano-Bicocca, Milan, Italy

Correspondence should be addressed to Raquel Saez Vigo

Received 27 June 2017; Revised 28 November 2017; Accepted 11 December 2017; Published 4 February 2018

Academic Editor: Silvio M. Meloni

Copyright © 2018 Gabriele Tonellini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The rehabilitation of edentulous jaws with guided and flapless surgery applied to the All-on-4 concepts is a predictable treatment with a high implant and prosthetic survival rates, but there are several contraindications for this technique like when bone reduction is needed due to a high smile line in the maxilla or when there is an irregular or thin bone crest. Purpose. To report a technique with double guided surgery for bone reduction and implant placement with the All-on-4 concept. Materials and Methods. 7 patients were included in the study. Guided implant planning was performed using CBCT, and the virtual templates were created with three dedicated software. Custom surgical templates were made for the ostectomy and for implants positioning. Results. 28 implants were placed using a double bone-supported surgical guide. The mean angular errors between the preoperative-planned implant and the postoperative-placed implant were 2.155° ± 2.03°; the mean distance errors between the planned and the placed implants were 0.763 mm ± 0.55 mm on the shoulder implant and 0.570 mm ± 0.40 mm on the apex implant. Conclusions. The results of our study indicate that this treatment is predictable with an excellent survival rate allowing excellent results even when bone reduction is mandatory.