Dr. Luigi Ciacci, Odt. Andrea Sessa
Introduction:
Modern dentistry depends on comprehensive diagnostics and careful planning to achieve the desired result and meet the expectations of both the patient and the dentist.
Digital planning and guided surgery based on three-dimensional X-ray data and digitized intraoral recording are of great help. They provide valuable information and allow for accurate backward planning to optimize the implant-prosthetic outcome, making the restoration more predictable in terms of function, aesthetics and biology.
In modern dentistry, the development of the workflow has focused on implant planning through the use of TAC Cone Beam from which accurate diagnostics and efficient programming and structuring of the therapeutic plan are fundamental elements.
The resulting advantages are high precision, predictable aesthetic results, often with fixed temporary prostheses at the same time as implant surgery, and a consequent high degree of patient satisfaction.
Guided surgery operates according to a workflow based on reverse engineering: we start with prosthetic rehabilitation and then we derive the ideal position of the dental implants.
Case study:
– placement of two EL implants on the maxilla (EL-5 x 9);
– use of the C-Guide guided surgery;
– immediate temporary loading on T-BASE.
Emanuela has edentulousness on the upper jaw in correspondence with the teeth 26 and 27.She wishes to have the temporary elements in the same session as the implant surgery. After radiographic examination performed via CBTC, the raw DICOM files are sent to the specialist technician in guided surgery together with the intraoral impression taken from the patient via scanner. The digital specialist technician performs the matching of the two sets of files (DICOM and STL) and continues with an initial planning.Digital case planning is then performed by the clinician together with the technician in remote locations. 2 ESTETHIC LINE implants are chosen, measuring 5.1X 9mm.The digital planning software provides an evaluation of bone density traceable to the Hounsfield scale, this density is compatible with immediate non-functional loading. The design is carried out using 3Shape’s Implant Studio software and the CAD-designed temporary crowns, and then milled in 5-layer pmma and glued on a T-Base with a 2mm high mucous collar.
Surgery:
Once the template has been positioned, the first step is to use the mucotome. In order to remove the gingival operculum, the template is removed and will be repositioned to take advantage of the sequence of guided surgery drills C-Guide.
Having also inserted the implants, again using the template, and obtaining a more than satisfactory initial stability both axial and rotational, we decide to place the provisionals and satisfy our patient.
Total duration of the surgery: about 45 min.
