CLINICAL AND RADIOGRAPHIC EVALUATION OF MARGINAL BONE RESORPTION OF ONE-PIECE IMPLANTS IN FULL ARCH REHABILITATIONS WITH FULL DIGITAL APPROACH: A PROSPECTIVE COHORT STUDY.

Abstract This research investigates the clinical and radiographic outcomes of full-arch rehabilitations using one-piece implants implemented through a fully digital workflow. Conducted within the Department of Biomedical, Surgical, and Dental Sciences at the University of Milan, the study primarily evaluates the marginal bone stability and the long-term performance of monophasic implants subjected to immediate loading. These implants, characterized by the elimination of the abutment-fixture interface, aim to enhance mechanical stability and minimize the risks of peri-implant diseases, thus optimizing aesthetic and functional outcomes. The study encompasses a prospective observational cohort design involving patients with edentulism requiring full-arch implant-supported prostheses. Participants were classified into two groups: those with complete edentulism and those undergoing extraction of non-restorable teeth before implant placement. All cases adhered to a rigorous digital workflow, leveraging guided surgery and customized prosthetic planning facilitated by CAD-CAM technologies. A central focus of the research was the integration of digital tools in the surgical planning and prosthetic phases. Through the use of intraoral scanning, CBCT imaging, and modular templates, the study demonstrated a significant reduction in surgical invasiveness, increased procedural accuracy, and enhanced patient outcomes. Guided surgery protocols, supported by 3D-printed templates, enabled precise implant positioning, reducing complications and improving the predictability of results. The analysis of peri-implant tissues revealed insights into the dynamics of bone remodeling versus bone loss. The findings emphasized the importance of maintaining marginal bone stability, a critical indicator of implant success. The use of one-piece implants in immediate loading contexts showed promising results, with negligible bone resorption and no observed cases of peri-implantitis over a one-year follow-up period. In addition to the primary clinical outcomes, the study explored patient-reported outcomes, including pain, swelling, and overall satisfaction, through visual analog scales. Results indicated high levels of patient comfort and acceptance of the digital workflow, underscoring the benefits of integrating advanced technologies into clinical practice. This thesis contributes to the growing body of evidence supporting the efficacy of monophasic implants in digital implantology. By demonstrating the advantages of a full-digital approach in terms of precision, efficiency, and patient satisfaction, it sets the foundation for broader adoption of innovative techniques in implant dentistry. Future research should focus on long-term comparative analyses and the exploration of hybrid workflows to address complex cases requiring additional regenerative procedures.