A Staged Digital Protocol for the Terminal Dentition for Immediate Loading Using a Provi-guide
This report describes a step-by-step staged digital protocol for the terminal dentition patient using a Provi-guide. This protocol will improve implant placement accuracy, shorten treatment time, and assure an implant-supported fixed complete denture immediately loaded after extraction of the remaining terminal dentition and complete edentulism. The novelty of the Provi-guide technique described is that it serves 2 objectives: (1) a nonlimiting surgical guide, and (2) a fixed interim prosthesis. Implants placed in the described digital stagged protocol can serve both the interim and the final prosthesis.
(a and b) After diagnosing terminal dentition in both cases, a decision was made to use a Provi-guide to facilitate implant placement and assure fixed interim prostheses after complete edentulism. In Case A (top), implants were placed in missing tooth sites 19, 20, 29, and 30. In Case B (bottom), implants were placed in missing tooth sites 19, 22, 27, and 30. All sites were considered sites to be used to support future implant-supported fixed complete dentures (ISFCD).
Case A (top) and Case B (bottom). After sufficient healing time and acceptable implant stability confirmed using resonance frequency analysis (RFA), scan bodies were secured on the implants.
(a and b) Case A (top) and B (bottom). Scanned Standard Tessellation Language (STL) images.
(a and b). Case A (top) and Case B (bottom). Using design software, full-arch screw-retained interims were designed after the digital extraction of remaining teeth and creating windows in planned additional implant sites to replace teeth to be extracted in the interim design.
Case A. Pontic sites created in extraction sites.
(a and b) Case A (top) and B (bottom). Poly-methyl-methacrylate (PMMA) was milled per the designs, with windows in planned additional implant sites, creating what the author refers to as Provi-guide. Nonengaging temporary abutments were cemented into the PMMA interims in previously healed implant sites.
Case B. Remaining teeth extracted.
The Provi-guide secured into the healed implant sites with respective screws. The secured Provi-guide was used as a nonlimiting surgical guide to facilitate implant placement in previously selected sites by drilling osteotomies through windows created on planned remaining implant sites.
(a and b) Case B. (a) After placing the remaining implants of the overall treatment plan and if primary stability was established with insertion torque exceeding 35 Ncm, nonengaging temporary abutments were secured on the recently placed implants. The Provi-guide, in this case, was sectioned to facilitate seating. (b) The temporary abutments connected to the Provi-guide using cold cure acrylic intraorally and screw access holes covered.
Case A. If primary stability was not established or the insertion torque was below 35 Ncm, the Provi-guide was unscrewed and removed from the patient’s mouth. Then, secured on the model or master cast, the windows created in the extracted teeth sites were filled with cold cure acrylic, and ovate pontic intaglio surfaces were created using the previously designed pontic sites on the model (or cast).
Case A (a and b) and Case B (c and d). The PMMA provisional delivered, and screws torqued to 35 Ncm. Screw access holes covered with PTFE (Teflon) tape and flowable composite.
Case A and Case B. (a) Final Prosthesis delivered for Case A. (b) Final panoramic radiograph of Case A. (c) Final prosthesis delivered for Case A. (d) Final panoramic radiograph for Case B.
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