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Background
The growing interest in minimally invasive surgery combined with the possibility of delivering prostheses with immediate function, has led to the development of software and digital workflows, allowing for the planning and manufacturing of a surgical guide and provisional restoration that can be loaded immediately after implant placement. The linkage of computer navigation systems with the prefabrication of provisional prostheses, has many advantages concerning surgical and prosthetic aspects for the dentists and patients as well. The optimal implant positioning in accessible bone with a prosthetically driven manner avoids or reduces bone augmentation procedures and affects positively the final restoration’s function, speech and aesthetics. The surgical technique is minimally invasive, due to flapless procedure, leading to less postoperative discomfort, swelling and pain. Nevertheless, this procedure requires precise sequence of all the steps in order to prevent complications.
Aim/Hypothesis
The aim of this case report is to present a new approach to implant dentistry for the rehabilitation of the edentulous maxilla where the implant placement is computer-guided template-based and flapless. The surgical procedure is followed by immediate loading of the implants using provisional prosthesis prefabricated by CAD-CAM technology. All the factors affecting the outcome of this approach, the basic principles, advantages and possible complications will be discussed.
Material and Methods
A 67- year -old man presented in order to replace the maxillary complete denture with a fixed reconstruction. The selected treatment plan was guided implant surgical procedure with immediate loading of the implants. A new denture was fabricated to determine the exact position of the teeth ensuring esthetics, phonetics and vertical dimension. An acrylic replica of this denture was manufactured with six reference points (holes filled with gutta-percha) and the patient was referred for CBCT scan. The CBCT scan data were transferred to the software program for 3D diagnostic analysis and virtual implant planning and were used for manufacturing a surgical template with hollow metallic sleeves for guided implant placement. Based upon the surgical guide, a CAD-CAM polymethyl methacrylate (PMMA) provisional restoration was prefabricated. The surgical template was fixed and stabilized intra-orally with three anchor pins. Six implants were inserted using the flapless technique in the regions of #16,14,12,22,24,26 with a present insertion torque of 35 to 50 Ncm. Straight multi-unit abutments of 1-2mm height were then placed upon all the implants. Immediate loading of the implants with prefabricated CAD-CAM provisional prosthesis was followed by using titanium temporary cylinders and acrylic resin material. Occlusion adjustments were made and the screw holes were filled with cotton and temporary filling material.
Results
In general, healing period was uneventful without any biological or mechanical complications. The patient reported mild postoperative pain and swelling with no discomfort. The surgery and treatment times as well as the healing period were reduced. During the provisional phase, there were no phonetic, esthetic and functional problems and the prosthesis fitted exactly onto the implants. The patient reported that his quality of life improved and the whole procedure was worthwhile.
Conclusions and clinical implications
Computer-aided implant placement is a new approach providing predictable results and high success rates. Careful surgical and prosthetic planning is valuable in order to avoid implant misplacement. The benefits of this new procedure are related to the reduced surgical time, flapless technique and the immediate delivering of a fixed temporary restoration. However, long-term studies have to be conducted concerning this new treatment option.
Background
The growing interest in minimally invasive surgery combined with the possibility of delivering prostheses with immediate function, has led to the development of software and digital workflows, allowing for the planning and manufacturing of a surgical guide and provisional restoration that can be loaded immediately after implant placement. The linkage of computer navigation systems with the prefabrication of provisional prostheses, has many advantages concerning surgical and prosthetic aspects for the dentists and patients as well. The optimal implant positioning in accessible bone with a prosthetically driven manner avoids or reduces bone augmentation procedures and affects positively the final restoration’s function, speech and aesthetics. The surgical technique is minimally invasive, due to flapless procedure, leading to less postoperative discomfort, swelling and pain. Nevertheless, this procedure requires precise sequence of all the steps in order to prevent complications.
Aim/Hypothesis
The aim of this case report is to present a new approach to implant dentistry for the rehabilitation of the edentulous maxilla where the implant placement is computer-guided template-based and flapless. The surgical procedure is followed by immediate loading of the implants using provisional prosthesis prefabricated by CAD-CAM technology. All the factors affecting the outcome of this approach, the basic principles, advantages and possible complications will be discussed.
Material and Methods
A 67- year -old man presented in order to replace the maxillary complete denture with a fixed reconstruction. The selected treatment plan was guided implant surgical procedure with immediate loading of the implants. A new denture was fabricated to determine the exact position of the teeth ensuring esthetics, phonetics and vertical dimension. An acrylic replica of this denture was manufactured with six reference points (holes filled with gutta-percha) and the patient was referred for CBCT scan. The CBCT scan data were transferred to the software program for 3D diagnostic analysis and virtual implant planning and were used for manufacturing a surgical template with hollow metallic sleeves for guided implant placement. Based upon the surgical guide, a CAD-CAM polymethyl methacrylate (PMMA) provisional restoration was prefabricated. The surgical template was fixed and stabilized intra-orally with three anchor pins. Six implants were inserted using the flapless technique in the regions of #16,14,12,22,24,26 with a present insertion torque of 35 to 50 Ncm. Straight multi-unit abutments of 1-2mm height were then placed upon all the implants. Immediate loading of the implants with prefabricated CAD-CAM provisional prosthesis was followed by using titanium temporary cylinders and acrylic resin material. Occlusion adjustments were made and the screw holes were filled with cotton and temporary filling material.
Results
In general, healing period was uneventful without any biological or mechanical complications. The patient reported mild postoperative pain and swelling with no discomfort. The surgery and treatment times as well as the healing period were reduced. During the provisional phase, there were no phonetic, esthetic and functional problems and the prosthesis fitted exactly onto the implants. The patient reported that his quality of life improved and the whole procedure was worthwhile.
Conclusions and clinical implications
Computer-aided implant placement is a new approach providing predictable results and high success rates. Careful surgical and prosthetic planning is valuable in order to avoid implant misplacement. The benefits of this new procedure are related to the reduced surgical time, flapless technique and the immediate delivering of a fixed temporary restoration. However, long-term studies have to be conducted concerning this new treatment option.
Background
The growing interest in minimally invasive surgery combined with the possibility of delivering prostheses with immediate function, has led to the development of software and digital workflows, allowing for the planning and manufacturing of a surgical guide and provisional restoration that can be loaded immediately after implant placement. The linkage of computer navigation systems with the prefabrication of provisional prostheses, has many advantages concerning surgical and prosthetic aspects for the dentists and patients as well. The optimal implant positioning in accessible bone with a prosthetically driven manner avoids or reduces bone augmentation procedures and affects positively the final restoration’s function, speech and aesthetics. The surgical technique is minimally invasive, due to flapless procedure, leading to less postoperative discomfort, swelling and pain. Nevertheless, this procedure requires precise sequence of all the steps in order to prevent complications.
Aim/Hypothesis
The aim of this case report is to present a new approach to implant dentistry for the rehabilitation of the edentulous maxilla where the implant placement is computer-guided template-based and flapless. The surgical procedure is followed by immediate loading of the implants using provisional prosthesis prefabricated by CAD-CAM technology. All the factors affecting the outcome of this approach, the basic principles, advantages and possible complications will be discussed.
Material and Methods
A 67- year -old man presented in order to replace the maxillary complete denture with a fixed reconstruction. The selected treatment plan was guided implant surgical procedure with immediate loading of the implants. A new denture was fabricated to determine the exact position of the teeth ensuring esthetics, phonetics and vertical dimension. An acrylic replica of this denture was manufactured with six reference points (holes filled with gutta-percha) and the patient was referred for CBCT scan. The CBCT scan data were transferred to the software program for 3D diagnostic analysis and virtual implant planning and were used for manufacturing a surgical template with hollow metallic sleeves for guided implant placement. Based upon the surgical guide, a CAD-CAM polymethyl methacrylate (PMMA) provisional restoration was prefabricated. The surgical template was fixed and stabilized intra-orally with three anchor pins. Six implants were inserted using the flapless technique in the regions of #16,14,12,22,24,26 with a present insertion torque of 35 to 50 Ncm. Straight multi-unit abutments of 1-2mm height were then placed upon all the implants. Immediate loading of the implants with prefabricated CAD-CAM provisional prosthesis was followed by using titanium temporary cylinders and acrylic resin material. Occlusion adjustments were made and the screw holes were filled with cotton and temporary filling material.
Results
In general, healing period was uneventful without any biological or mechanical complications. The patient reported mild postoperative pain and swelling with no discomfort. The surgery and treatment times as well as the healing period were reduced. During the provisional phase, there were no phonetic, esthetic and functional problems and the prosthesis fitted exactly onto the implants. The patient reported that his quality of life improved and the whole procedure was worthwhile.
Conclusions and clinical implications
Computer-aided implant placement is a new approach providing predictable results and high success rates. Careful surgical and prosthetic planning is valuable in order to avoid implant misplacement. The benefits of this new procedure are related to the reduced surgical time, flapless technique and the immediate delivering of a fixed temporary restoration. However, long-term studies have to be conducted concerning this new treatment option.
Background
The growing interest in minimally invasive surgery combined with the possibility of delivering prostheses with immediate function, has led to the development of software and digital workflows, allowing for the planning and manufacturing of a surgical guide and provisional restoration that can be loaded immediately after implant placement. The linkage of computer navigation systems with the prefabrication of provisional prostheses, has many advantages concerning surgical and prosthetic aspects for the dentists and patients as well. The optimal implant positioning in accessible bone with a prosthetically driven manner avoids or reduces bone augmentation procedures and affects positively the final restoration’s function, speech and aesthetics. The surgical technique is minimally invasive, due to flapless procedure, leading to less postoperative discomfort, swelling and pain. Nevertheless, this procedure requires precise sequence of all the steps in order to prevent complications.
Aim/Hypothesis
The aim of this case report is to present a new approach to implant dentistry for the rehabilitation of the edentulous maxilla where the implant placement is computer-guided template-based and flapless. The surgical procedure is followed by immediate loading of the implants using provisional prosthesis prefabricated by CAD-CAM technology. All the factors affecting the outcome of this approach, the basic principles, advantages and possible complications will be discussed.
Material and Methods
A 67- year -old man presented in order to replace the maxillary complete denture with a fixed reconstruction. The selected treatment plan was guided implant surgical procedure with immediate loading of the implants. A new denture was fabricated to determine the exact position of the teeth ensuring esthetics, phonetics and vertical dimension. An acrylic replica of this denture was manufactured with six reference points (holes filled with gutta-percha) and the patient was referred for CBCT scan. The CBCT scan data were transferred to the software program for 3D diagnostic analysis and virtual implant planning and were used for manufacturing a surgical template with hollow metallic sleeves for guided implant placement. Based upon the surgical guide, a CAD-CAM polymethyl methacrylate (PMMA) provisional restoration was prefabricated. The surgical template was fixed and stabilized intra-orally with three anchor pins. Six implants were inserted using the flapless technique in the regions of #16,14,12,22,24,26 with a present insertion torque of 35 to 50 Ncm. Straight multi-unit abutments of 1-2mm height were then placed upon all the implants. Immediate loading of the implants with prefabricated CAD-CAM provisional prosthesis was followed by using titanium temporary cylinders and acrylic resin material. Occlusion adjustments were made and the screw holes were filled with cotton and temporary filling material.
Results
In general, healing period was uneventful without any biological or mechanical complications. The patient reported mild postoperative pain and swelling with no discomfort. The surgery and treatment times as well as the healing period were reduced. During the provisional phase, there were no phonetic, esthetic and functional problems and the prosthesis fitted exactly onto the implants. The patient reported that his quality of life improved and the whole procedure was worthwhile.
Conclusions and clinical implications
Computer-aided implant placement is a new approach providing predictable results and high success rates. Careful surgical and prosthetic planning is valuable in order to avoid implant misplacement. The benefits of this new procedure are related to the reduced surgical time, flapless technique and the immediate delivering of a fixed temporary restoration. However, long-term studies have to be conducted concerning this new treatment option.