Rehabilitation of a Dentate Mandible Requiring a Full Arch Rehabilitation. Immediate Loading of a Fixed Complete Denture on 8 Implants Placed With a Bone-Supported Surgical Computer-Planned Guide: A Case Report
The use of technologies that merge computerized tomography X-ray imaging and 3-dimensional (3D) planning software allow the surgeon to digitally elaborate on the computer the position, length, and diameter of every implant to be placed. Following this approach, the placement is guided in a 3D digital model, and the implants are placed in the final position avoiding eventual anatomic structures. In this case report, the patient's remaining mandibular teeth were extracted, and the patient received 8 implants with the help of a computer surgical guide. The case was planned using SimPlant and a bone-supported guide. Because of the high precision of the planning, it was possible to realize a provisional rehabilitation before the actual surgery. The planning allows placement of parallel implants to optimize the prosthetic procedure and outcome. An immediate provisional implant was fixed with a flow composite on the temporary abutments and then refined in the dental laboratory. The patient received the provisional rehabilitation the same day of the surgery. After 6 weeks of healing, the final impression was taken and the prosthesis was finalized with a computer-aided design/computer-aided manufacturing titanium full-arch screwed framework with composite veneering. A 6-month follow-up showed good integration of the prostheses and success of all 8 implants. The use of surgical computer-guided planning changes the surgeon's approach: whereas before the use of conventional guides permitted a certain degree of offset from what was planned, the use of computer guides allows the implant to be inserted in a far more precise way. It is obvious that careful planning is the key factor to avoid implant misplacement.

Figure 1 . Intraoral aspect before treatment. Figure 2. OPG before treatment.

The planning software shows several views to allow a correct implant placement.

Figure 6 . The surgical guide and the stereolithographic reconstruction of the mandible. Figure 7. Clinical view of the patient after removing part of the dentition. Figure 8. All teeth are removed and the flap has been elevated, showing the postextractive sites. Figure 9. The surgical guide is positioned on the bone. Figure 10. Implants are placed according to the surgical guide.

Figure 11 . The provisional is glued to the provisional abutments with flow composites. Figure 12. After polishing, the provisional is screwed to 6 implants. Figure 13. Occlusal view of the 8 implants 9 weeks after the surgery. Figure 14. Clinical view of the final prosthesis in place.

Figures 15–18 . Intraoral radiographs showing good integration of all implants after 6 months. Figure 19. Clinical view of the final prosthesis 6 months after loading.
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