Simultaneous Virtual Planning Implant Surgical Guides and Immediate Laboratory-Fabricated Provisionals: An Impressionless Technique

Figure 1. Intraoral preoperative frontal view showing a Seibart Class III combination defect. Figure 2. Placement of titanium mesh and stabilization with three 5-mm screws to the buccal bone. Note the 2-mm leeway distance at the junction at the teeth to prevent future mesh exposure. Figure 3. Before and after cone beam computerized tomography of the anterior mandible 6 months postoperatively. Note the buccolingual width bone augmentation.

Figure 4. Three-dimensional planning to place implants and virtual waxup for location of 4-unit fixed bridge. Figure 5. Design of guided surgical guide. Note the precise virtual path of the draw and parallelism of the implants. Figure 6. Crestal incision with vertical release. Visualization of titanium mesh with screws. Figure 7. Surgical guide in place. Note precise fit with inspection windows. Figure 8. Immediate placement of screw-retained provisional. No adjustment material was necessary. Figure 9. Occlusal view of screw-retained 4-unit immediately placed provisional prosthesis. Figure 10. The edentulous ridge after 4 months from the extraction and socket grafting procedure. Figure 11. (a) Frontal view of the iTero scan. (b) Occlusal view of the iTero scan.

Implants at sites 7, 8, and 9 virtually planned on the merged DICOM data from the cone beam computerized tomography with the Standard Tessellation Language file from the iTero scan.

Figure 13. (a and b) The surgical guide was used for all sequenced osteotomies as well as implant placement. Note the guide assisting placement of the implants to the correct depth. Figure 14. The provisional restoration seated and secured the implants with screws. Figure 15. Postoperative panoramic radiograph showing the implant alignment with the provisional restoration in place. Figure 16. (a) Intraoral view at 4 weeks postoperation. (b) Smile view at 4 weeks postoperation. Figure 17. (a) Soft tissue response 8 months after implant placement. (b) Final prosthesis delivered.