Completely Digital Two-Visit Immediately Loaded Implants: Proof of Concept
Implant dentistry has become a common treatment alternative, yet only a small percentage of patients missing teeth are receiving its benefits. Significant limitations are the small percent of practitioners placing implants due to the long learning curve, as well as the time commitment on the part of the patient. This proof of concept demonstrates clinical implant treatment requiring years of manual skill development on the part of the surgeon, restorative dentist, and technician can be accomplished in 2 visits, completely digitally, without the need for conventional impressions, laboratory procedures, and advanced manual skills. This technique results in reduced learning curve and treatment time. The first visit consists of consultation, diagnosis, CT and optical surface scans of the implant site to include: soft tissue, adjacent teeth, and opposing arch. This digital information is imported and interactively reconstructed in a 3-D open format implant planning software. The implant and restoration are now precisely planned into the optimal bone position with the ideal emergence profile for biologically and esthetically designed restoration. This information is then electronically forwarded to a production facility, where all necessary models are digitally printed and the immediate crown is digitally milled. On the second visit, the patient returns for guided implant insertion and immediate restoration. As digital procedures are refined, many more dental professionals will become involved in providing implant therapy earlier in their careers. This promises to result in reduced costs, making implants available to millions more patients who could benefit from them.
Figure 1. A 32-year-old male patient presents with a high smile line missing maxillary left lateral and canine. Figure 2. At the first visit, a CBCT scan was done (a) with an intraorally placed prefabricated appliance containing (b) fiduciary markers along with (c) an optical scan of the teeth.
(a and b) A CT scan with fiduciary markers in yellow, teeth in red. (c and d) The surface scan in green, teeth from the CT scan in red, and spheres at cusp tips to merge the digital CT images with surface scans in the software. (e and f) Merged images of teeth and soft tissue. (g and h) The surface scan of opposing arch in white is virtually articulated from the virtual interocclusal record.
Figure 4. (a and b) Using CAD software, a digital cuspid and lateral incisor from the contralateral teeth are positioned within the edentulous space. Figure 5. The planned implant (blue) in optimum position relative to bone and tooth crown (white) in the Codiagnostix planning program (Dental Wings, Montreal). Figure 6. Emergence profile in green, for the provisional restoration formed between crown cervix and implant platform.
(a) Digitally planned surgical template. (b) Resulting digitally printed surgical template. (c) Digital pre-implant model with the implant analog. (d) Printed model from this data.
Figure 8. (a) Maxillary and mandibular printed model articulated. (b) Implant replica in the printed maxillary model. (c) Milled restoration from digital data positioned on the printed maxillary model. Figure 9. Surgical template in position after incision and reflection of soft tissue.
Inspection windows at blue arrows permit confirmation of completely seated template.
The implant is seated through the template. Figure 12. (a) Temporary abutment seated on implant. (b and c) Provisional restoration seated in preparation for luting. (d) Abutment and crown are luted with autopolymerizing PMMA. (e) Emergence area between the implant platform and crown contoured with the same autopolymerizing PMMA resin, finished and polished. Figure 13. Provisional crown immediately inserted completely out of occlusion. Figure 14. (a) Initial presentation. (b) Final restoration at 4 months.
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