From guided surgery to final prosthesis with a fully digital procedure in 2 appointments – Report of 2 cases

Background

Several implant surgical and prosthodontic concepts are currently used for the treatment of the single tooth loss. The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics, in a complete virtual environment without any physical model situations. Regarding implant dentistry, the ìdigital workflowî, is associated with digital 3D imaging, digital guided surgery, digital impression and CAD CAM restorations.

Aim/Hypothesis

To demonstrate a guided implant placement, with digital impression during the surgery and the application of fixed, implant-supported prosthetic restorations with a fully digital workflow.

Material and Methods

A 28 years old female patient was referred to our clinic with missing the first two lower molars due to carries. After the clinical and radiological evaluation it was decided to insert two implants. The planning of treatment was made with digital implant planning software. The exact position of the implants and restorations were set. During surgery time two implants with diameter 4.1 and length 12 were placed fully guided and scan bodies were placed in implants for the digital impression. For this purpose 3 shape(Trios 4) intraoral scanner was used. After the removal of scan bodies, cover screws were placed and careful suturing was performed. Digital information was transferred to the lab and the final restorations were milled and prepared. The color of the final restoration was captured using customized white balanced photography (elab card) and used by the dental technician in order to make a digital try in.

Results

Postoperative time for osseointegration was estimated about 2.5 months. So 2.5 months later, after their uncover, the implants were ready for loading and the final restorations were delivered to the patients. Current technique, reduced chair time both for the patient and the clinician, which could increase acceptance of the treatment by the patients. Also, the presented protocol permits the use of the final abutment only one time, which seems to have a positive impact to bone resorption and soft tissue shift. The use of a digital workflow to achieve capturing implant positions immediately after their placements and transferring information from the patient to the laboratory was the key in order to deliver the final restoration to the patient, n 2 appointments.

Conclusion and Clinical Implications

Digital technology is useful in making the set-up of the final situation, checking the desired aesthetics, presenting the treatment plan to the patient and simplifying a lot of steps regarding prosthetics materials and design. The present procedure for fully digital planning of implants and short-span fixed implant-supported restorations in 2 appointments has been shown to be reliable. Further studies are needed to validate these results and report clinical outcomes, as also complications