A randomized clinical trial in "All on four" rehabilitations with 6-years follow-up: digital versus traditional workflow

Aim The presentstudycompares and evaluates the "All on Four" type rehabilitations obtained through a traditional technique, with "All on Four" rehabilitations made using an entirely digital method, with a 6-years follow-up. Materials and methods The workflow displayed in this study analyzes in detail each design and clinical phase of both methods, which were applied to a total of 50 patients recruited by the Department of Dentistry of the University Vita e Salute San Raffaele. The selected patients were divided into two randomized groups of 25 people: in total, 100 implants were placed in 25 patients who received a full-arch rehabilitation performed using the traditional All on Four method and 100 implants in 25 patients who received a full-arch rehabilitation performed using a digital method. After 6 years, different percentages of success were obtained: 9846 of success for the group of patients treated with the traditional "All on Four" protocol and 10046 of success for the group treated with the digital protocol. At each time interval a significant difference (P <0.0001) in periimplant crestal bone loss between the two groups was detected, with an average Marginal Bone Level (MBL) at 6 years of 1.12 +/- 0.25 mm in patients treated with traditional method and 0.88 +/- 0.10 mm in patients treated with digital method. Patients belonging to the digital group have judged the immediate loading (9246), digital smile preview (9346), the mock-up test (9846) and guided surgery (9446) as very effective. All patients treated with a digital method reported a lower value of during-surgery and post-surgery pain compared to patients rehabilitated using traditional method. Conclusion The totally digital protocol described in the present study represents a valid therapeutic alternative to the traditional "All on Four" protocol for implant- supported rehabilitations of edentulous dental arches.