Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report

Abstract

Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report

“…Some works have stated that the template-guided implantation offers a high degree of accuracy, even in the presence of different configurations of the residual dentition or the edentulous arch. Recent preliminary studies [23] show a degree of accuracy of the templates in the presence of total edentulism, comparable to that achievable with intercalated edentulism. Similar data are due to the management of the exclusively mucosal support through digitally preconfigured anchor pins.…”

“…Studies have been published which confirm that guided implant placement increases the implant survival rate, compared to the freehand method [52]. Other studies also believe that the digital workflow in the implant-prosthetic field can effectively and predictively improve the immediate load rehabilitation process of completely edentulous arches [23]. From an analysis of the current literature available, it is indisputable that the greatest challenge to overcome is the capacity for reliable and efficient digital recording of the maxilla-mandibular relationship [53].…”

3D-Printed Dental Implants Immediately Loaded to Support a Full-Arch Fixed Rehabilitation: 24 months Follow-up

“…The advances in digital dentistry and implantology are not exclusive for planning implant positions, producing computed surgical guides, or preparing prosthetic rehabilitation even before the surgery, with reliable accuracy [41][42][43][44][45]. In this clinical report, we placed titanium dental implants produced by 3D printing or additive manufacturing technology.…”

Lower Jaw Full-Arch Restoration: A Completely Digital Approach to Immediate Load

“…Research has not only delved into new biomaterials, but has also driven the evolution of implant technologies and sophisticated prosthetic devices, thus significantly transforming the dental care landscape compared to just a few years ago [4]. This digital wave has indelibly transformed every aspect of clinical practice, from the initial stages of diagnosis and meticulous planning of treatment protocols to complex and sensitive procedures conducted in complex clinical and surgical contexts [5,6]. The production of prosthetic devices has undergone a profound transformation due to the pervasive influence of digitalization.…”

“…The presented case study vividly illustrates the latest methods in managing intricate dental scenarios, emphasizing prosthetic design and the use of modern manufacturing practices. These techniques, characterized by precision, attention to detail, and pre-production capabilities, have progressively gained validation within the scientific community [5,[12][13][14][15].…”