Digitally Guided Root Membrane Preparation Using a Dedicated Apex Guide for Immediate Implant Placement: A Retrospective Case Series.

Objective

To assess the clinical feasibility and 1-year outcomes of a static computer-assisted workflow using a dedicated Apex Guide for root membrane (RM) preparation and immediate implant placement.

Methods

Fifteen consecutive patients with nine anterior and six posterior single-tooth sites were included. Cone-beam computed tomography and intraoral scans were registered for planning. A tooth-supported Apex Guide guided a 2.0-mm drill along a root-oriented trajectory; implant placement used a separate prosthetically driven guide. Feasibility, complications, survival, Pink Esthetic Score (PES), probing depth (PD), bleeding on probing (BOP), recession and peri-implant marginal bone level (PIMBL) were assessed.

Results

Guided access and RM preparation were completed in all sites without intraoperative RM or facial bone damage. One RM became mobile and required removal; another developed internal exposure requiring reduction. RM retention was 93.3% (14/15), and implant and prosthetic survival were 100%. Between 6 months and 1 year, PES (12.13 ± 0.74 vs 12.20 ± 0.77; P = 0.317), PD (2.22 ± 0.15 vs 2.21 ± 0.10 mm; P = 0.655), BOP (3.34 ± 6.91% vs 2.23 ± 5.88%; P = 0.317) and PIMBL (0.280 ± 0.039 vs 0.281 ± 0.035 mm; P = 0.387) showed no significant changes. One screw loosening reduced prosthetic success to 93.3%.

Conclusions

The Apex Guide workflow was clinically feasible in this small series. RM-related complications occurred despite complete implant survival; comparative accuracy and long-term safety remain unestablished. CLINICAL RELEVANCE Static guidance may assist apical access during RM preparation while allowing independent, prosthetically driven implant placement.