Background
Screw-retained implant-supported bridges are considered a valid therapeutic option to replace missing teeth. A virtual planning and a computer-guided implant surgery might be considered to better determine a correct implant placement according to the outline of the permanent restoration.
Aim/Hypothesis
Aim of this paper is to describe a case treated with guided flapless implant surgery and delayed multi-unit screw-retained bridge restoration in the partially edentulous maxilla. The definitive framework was obtained with customized cobalt-chrome CAD/CAM anatomically shaped superstructure which provided the base for ceramic layering techniques.
Material and Methods
A 53-year-old healthy female patient, with a quite low smile line and medium thick-flat gingival biotype, complained about aesthetics, mobility and chewing discomfort related to a bridge in position 21-17. After clinical and radiological examinations, compromised teeth affected by periodontitis and one implant affected by peri-implantitis were extracted with a minimally invasive approach. The patient was temporarily restored with a multi-unit removable partial denture. She refused any bone augmentation procedures to regenerate the residual vertical bone defect in the posterior right maxilla. A diagnostic wax-up was performed. A computer-guided surgery associated with a flapless approach was chosen. One-stage surgical procedure was adopted and 6 cylindrical implants (OsseoSpeed™ EV, ASTRA TECH™, Dentsply, Mölndal, Sweden) were placed in position 21,12,13,15, and 17 using a tooth-supported surgical guide. Three months after surgery, appropriately sized abutments were positioned and a definitive abutment-level impression was taken. A cobalt-chrome CAD/CAM patient-specific suprastructure (ATLANTIS™ ISUS, Dentsply Implants, Hasselt, Belgium) was virtually designed in accordance with the previous virtual planning, and subsequently milled to obtain the core of a screw-retained bridge. The case was then finished with a porcelain fused to metal multi-unit restoration.
Results
This clinical approach was applied to satisfy the aesthetic demands of the patient, who preferred to avoid more complex surgical treatments, such as guided bone regeneration, onlay bone grafting or sinus floor augmentation. Thanks to the digital workflow, the access holes of the prosthetic rehabilitation exited through the central fossa of posterior teeth and through the cingulum area of the anterior teeth. The angulated screw access (ASA) improved the aesthetics of the restoration. After 1-year follow-up from bridge application, all the implants are still osseointegrated, as confirmed by clinical and radiographic assessments, and no prosthodontic complication has occurred.
Conclusions and clinical implications
Computer guided implant placement allowed the clinician to avoid complex bone augmentation procedures and favoured a correct implant placement in order to obtain the optimal final prosthetic rehabilitation.
Background
Screw-retained implant-supported bridges are considered a valid therapeutic option to replace missing teeth. A virtual planning and a computer-guided implant surgery might be considered to better determine a correct implant placement according to the outline of the permanent restoration.
Aim/Hypothesis
Aim of this paper is to describe a case treated with guided flapless implant surgery and delayed multi-unit screw-retained bridge restoration in the partially edentulous maxilla. The definitive framework was obtained with customized cobalt-chrome CAD/CAM anatomically shaped superstructure which provided the base for ceramic layering techniques.
Material and Methods
A 53-year-old healthy female patient, with a quite low smile line and medium thick-flat gingival biotype, complained about aesthetics, mobility and chewing discomfort related to a bridge in position 21-17. After clinical and radiological examinations, compromised teeth affected by periodontitis and one implant affected by peri-implantitis were extracted with a minimally invasive approach. The patient was temporarily restored with a multi-unit removable partial denture. She refused any bone augmentation procedures to regenerate the residual vertical bone defect in the posterior right maxilla. A diagnostic wax-up was performed. A computer-guided surgery associated with a flapless approach was chosen. One-stage surgical procedure was adopted and 6 cylindrical implants (OsseoSpeed™ EV, ASTRA TECH™, Dentsply, Mölndal, Sweden) were placed in position 21,12,13,15, and 17 using a tooth-supported surgical guide. Three months after surgery, appropriately sized abutments were positioned and a definitive abutment-level impression was taken. A cobalt-chrome CAD/CAM patient-specific suprastructure (ATLANTIS™ ISUS, Dentsply Implants, Hasselt, Belgium) was virtually designed in accordance with the previous virtual planning, and subsequently milled to obtain the core of a screw-retained bridge. The case was then finished with a porcelain fused to metal multi-unit restoration.
Results
This clinical approach was applied to satisfy the aesthetic demands of the patient, who preferred to avoid more complex surgical treatments, such as guided bone regeneration, onlay bone grafting or sinus floor augmentation. Thanks to the digital workflow, the access holes of the prosthetic rehabilitation exited through the central fossa of posterior teeth and through the cingulum area of the anterior teeth. The angulated screw access (ASA) improved the aesthetics of the restoration. After 1-year follow-up from bridge application, all the implants are still osseointegrated, as confirmed by clinical and radiographic assessments, and no prosthodontic complication has occurred.
Conclusions and clinical implications
Computer guided implant placement allowed the clinician to avoid complex bone augmentation procedures and favoured a correct implant placement in order to obtain the optimal final prosthetic rehabilitation.
Background
Screw-retained implant-supported bridges are considered a valid therapeutic option to replace missing teeth. A virtual planning and a computer-guided implant surgery might be considered to better determine a correct implant placement according to the outline of the permanent restoration.
Aim/Hypothesis
Aim of this paper is to describe a case treated with guided flapless implant surgery and delayed multi-unit screw-retained bridge restoration in the partially edentulous maxilla. The definitive framework was obtained with customized cobalt-chrome CAD/CAM anatomically shaped superstructure which provided the base for ceramic layering techniques.
Material and Methods
A 53-year-old healthy female patient, with a quite low smile line and medium thick-flat gingival biotype, complained about aesthetics, mobility and chewing discomfort related to a bridge in position 21-17. After clinical and radiological examinations, compromised teeth affected by periodontitis and one implant affected by peri-implantitis were extracted with a minimally invasive approach. The patient was temporarily restored with a multi-unit removable partial denture. She refused any bone augmentation procedures to regenerate the residual vertical bone defect in the posterior right maxilla. A diagnostic wax-up was performed. A computer-guided surgery associated with a flapless approach was chosen. One-stage surgical procedure was adopted and 6 cylindrical implants (OsseoSpeed™ EV, ASTRA TECH™, Dentsply, Mölndal, Sweden) were placed in position 21,12,13,15, and 17 using a tooth-supported surgical guide. Three months after surgery, appropriately sized abutments were positioned and a definitive abutment-level impression was taken. A cobalt-chrome CAD/CAM patient-specific suprastructure (ATLANTIS™ ISUS, Dentsply Implants, Hasselt, Belgium) was virtually designed in accordance with the previous virtual planning, and subsequently milled to obtain the core of a screw-retained bridge. The case was then finished with a porcelain fused to metal multi-unit restoration.
Results
This clinical approach was applied to satisfy the aesthetic demands of the patient, who preferred to avoid more complex surgical treatments, such as guided bone regeneration, onlay bone grafting or sinus floor augmentation. Thanks to the digital workflow, the access holes of the prosthetic rehabilitation exited through the central fossa of posterior teeth and through the cingulum area of the anterior teeth. The angulated screw access (ASA) improved the aesthetics of the restoration. After 1-year follow-up from bridge application, all the implants are still osseointegrated, as confirmed by clinical and radiographic assessments, and no prosthodontic complication has occurred.
Conclusions and clinical implications
Computer guided implant placement allowed the clinician to avoid complex bone augmentation procedures and favoured a correct implant placement in order to obtain the optimal final prosthetic rehabilitation.
Background
Screw-retained implant-supported bridges are considered a valid therapeutic option to replace missing teeth. A virtual planning and a computer-guided implant surgery might be considered to better determine a correct implant placement according to the outline of the permanent restoration.
Aim/Hypothesis
Aim of this paper is to describe a case treated with guided flapless implant surgery and delayed multi-unit screw-retained bridge restoration in the partially edentulous maxilla. The definitive framework was obtained with customized cobalt-chrome CAD/CAM anatomically shaped superstructure which provided the base for ceramic layering techniques.
Material and Methods
A 53-year-old healthy female patient, with a quite low smile line and medium thick-flat gingival biotype, complained about aesthetics, mobility and chewing discomfort related to a bridge in position 21-17. After clinical and radiological examinations, compromised teeth affected by periodontitis and one implant affected by peri-implantitis were extracted with a minimally invasive approach. The patient was temporarily restored with a multi-unit removable partial denture. She refused any bone augmentation procedures to regenerate the residual vertical bone defect in the posterior right maxilla. A diagnostic wax-up was performed. A computer-guided surgery associated with a flapless approach was chosen. One-stage surgical procedure was adopted and 6 cylindrical implants (OsseoSpeed™ EV, ASTRA TECH™, Dentsply, Mölndal, Sweden) were placed in position 21,12,13,15, and 17 using a tooth-supported surgical guide. Three months after surgery, appropriately sized abutments were positioned and a definitive abutment-level impression was taken. A cobalt-chrome CAD/CAM patient-specific suprastructure (ATLANTIS™ ISUS, Dentsply Implants, Hasselt, Belgium) was virtually designed in accordance with the previous virtual planning, and subsequently milled to obtain the core of a screw-retained bridge. The case was then finished with a porcelain fused to metal multi-unit restoration.
Results
This clinical approach was applied to satisfy the aesthetic demands of the patient, who preferred to avoid more complex surgical treatments, such as guided bone regeneration, onlay bone grafting or sinus floor augmentation. Thanks to the digital workflow, the access holes of the prosthetic rehabilitation exited through the central fossa of posterior teeth and through the cingulum area of the anterior teeth. The angulated screw access (ASA) improved the aesthetics of the restoration. After 1-year follow-up from bridge application, all the implants are still osseointegrated, as confirmed by clinical and radiographic assessments, and no prosthodontic complication has occurred.
Conclusions and clinical implications
Computer guided implant placement allowed the clinician to avoid complex bone augmentation procedures and favoured a correct implant placement in order to obtain the optimal final prosthetic rehabilitation.