Afsheen T abassum 1,2. In the present case report, two CAD/CAM surgical templates were combined in this partially dentate patient with extraction of the teeth 42/33 and immediate implants performed in a sequenced order. From a surgical standpoint, computer-guided surgery can be utilized to enhance primary implant stability and to improve the precision of implant placement. He has given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Cassetta M, Stefanelli LV, Giansanti M, Calasso S. Accuracy of implant placement with a stereolithographic surgical template. The template was then removed and the teeth 42 and 33 previously supporting the guide were extracted. Thereafter, the second surgical template was positioned and stabilized on the four posterior implants with the help of specific abutments and the same anchor pins (Fig. Different factors contributed to this insertion torque such as the depth of the planned implant position in a more apical area than the extraction site, the minimally invasive tooth extraction, the macroscopic implant geometry and the osteotomy protocol with a smaller drilling diameter compared to the implant diameter (as proposed by the company), the accurate performance of the single steps in the pre- and intraoperative phases, and the bone density in the anterior mandibular area. The solution that consists of a Simplant Guide, an Atlantis Abutment and a temporary crown based on the Atlantis Abutment Core File is currently indicated for single implant restorations. @article{Finelle2017GuidedII, title={Guided Immediate Implant Placement with Wound Closure by Computer-Aided Design/Computer-Assisted Manufacture Sealing Socket Abutment: Case Report. Prior to the start of. The subsequent two anterior immediate implants were thus placed perfectly guided. Frontal view showing the screw retained post at impression taking 24 weeks after implant placement, Occlusal view showing CAD of the final FDP (a) and detailed screen-shot of the interface geometry (b), CAD/CAM fabricated one-piece cobalt-cromium framework before (a, b) and after veneering with composite (Nexco Ivoclar) i.e. Although CAI and CAD/CAM procedures have facilitated towards a straight forward workflow in the rehabilitation of edentulous patients, immediate implant placement and immediate loading protocols combined are complex and required a high level of organization between the implantologist, the technician and the patient. After extraction of the painful and extremely mobile lower front teeth 41/31/32 and adaptation of the existing RPD, a cone beam computed tomography (CBCT) (Pax-Uni 3D, orangedental GmbH & Co. KG, Biberach, Germany) with a 5 × 8 cm field of view and 85KV/5.5 mA/0.2 mm Voxel was performed to proceed with the detailed implant planning (Fig. The patient was a non-smoker and -with the help of antihypertensive (Candecor comp. Thus, focusing on the lower jaw, the single tooth prognosis was fair for the teeth 47, 42 and 33 and hopeless for the teeth 41/31/32 [24]. While only few guided implant placement systems were available at the time, today, multiple CAI software are available on the market. Periodontology 2000. From a prosthetic standpoint, computer-aided design/computer-assisted manufacture (CAD/CAM) technology has brought about various restorative options, including the fabrication of customized abutments through a virtual design based on computer-guided … Spielau, T., Hauschild, U. During decision making for the final treatment plan different options were discussed with the patient. Tallarico M, Esposito M, Xhanari E, Caneva M, Meloni SM. One of the exciting things that propelled Dr. McKay and I to invest in this technology was the ability to do an immediate guided implant. She asked for a comprehensive treatment and did not accept to be edentulous at any stage of the treatment. Thomas Spielau. From a surgical standpoint, computer-guided surgery can be utilized to enhance primary implant stability and to improve the precision of implant placement. Extractions of the hopeless mandibular incisors, immediate and guided implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. Int J Oral Maxillofac Implants. 2006;21(2):298–304. Part of However, a systematic and concise approach performing the single steps in the treatment sequence may allow for more accurate implant positioning as type of guide and fixation have an important influence [19, 20]. This video shows how to do immediate implant placement with the X-Guide optimal. That was one of the things we found very appealing about this technology. Springer Nature. He has been involved in drafting the manuscript or revising it critically for important intellectual content. Once the dental implant is inserted into the jaw bone, a biological process called osseo - (greek word for bone)-integration (joining together) takes place. Zhou W, Liu Z, Song L, Kuo CL, Shafer DM. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. By using this website, you agree to our The staff of Drs. No funding body was involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. 2018;11(2):203–13. The immediate post-extraction placement of an implant in the esthetic zone should satisfy the esthetic and functional demands. With this approach the passive fit of the FDP was maximized, the clinical chairside efforts (in terms of abutment connection and occlusal adaptations) were minimal and the predictability was very high compared to different limitations and problems reported in a recent review [32]. Various treatment options including a removable dental prosthesis were discussed with the patient. These implants are grade IV titanium with an 11 degree conical connection. After the usage of a first tooth-supported surgical template with subsequent extraction of the supporting teeth, a second surgical template stabilized on the previously inserted implants helped to transfer the planned implant position in the extraction sites with a guided approach. Vasak C, Watzak G, Gahleitner A, Strbac G, Schemper M, Zechner W. Computed tomography-based evaluation of template (NobelGuide)-guided implant positions: a prospective radiological study. 2014;66(1):214–27. 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