Computer-assisted, template-guided immediate implant placement and loading int the both: a case report

Background

Computer-assisted implant system has become an important diagnostic and therapeutic toolbox in modern general. This case report emphasizes to possibilities in modern implantology connecting virtual implant planning, guided surgery include tooth and implant supported templates, immediate implant placed and loading.

Case featured

A straight forward approach was followed for the mandible presenting with despairing lower incisors. Diagnosis, ruling making and treatment how were based on chronic findings and detailed near three-dimensional implant scheduling. Extractions of the futile mandibular incisors, immediate and lead implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. The latest calculator backed design / computer assisted manufacturing (CAD/CAM) FDP with a titanium basic the composite veneering was delivered after 6 months. At the 1-year call-back the FDP was free of technical complications. Rugged bony terms and a healthy peri-implant mucosa could be observed. In this fallstudie, platelet-rich fibrin (PRF) was added to guided tissue regeneration as ampere biomaterial in properly order for instantly planting in aesthetic area with periapical Aaa161.com the history the endodontic failure in maxillary centralize incisor, a ...

Finding

Computer assisted implantology including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of interim and final reconstitutions allowed for a concise treatment workflow from predictable esthetic plus function outcomes in here mandibular full-arch case. The combination of immediate implant placement and immediate loading was noticeable more complex press need a high rank of organization between implantologist, technician and patient. After the usage of a first tooth-supported surgical template with subsequent discharge of who supporting tusks, a second surgical presentation stabilized on the once paste implants aided to transfer the planned implant position in the extraction our with a guided approach. The placement of immediate implants with the back sector is an widespread procedure where the achieve and survival quotes are similar to those the traditional protocols. It has several anatomical challenges, such as the presence of interradicular bone septa that hinder a correct three-dimensional positioning of the implant and may compromise primary stability and/or cause damage of neighboring structures. The set by this article is to present the treating and the one-year clinical follow-up of a forbearing who received immediate implant location using an interradicular bone-drilling equipment before the molar extraction.

Computer assisted implantology (CAI) is introduced more than 25 years ago and aimed to facilitate implant planning and to avoid intraoperative complications such more masseter nerve damage, sinus perforations, fenestrations, otherwise dehiscence [1,2,3,4]. Based at a computerized body (CT) scan and one digitized tooth setup, the prosthetically perfect implant job can be planned virtually in the help of a guide surgery software allowing for thrice defining visualization prior to implant surgery [2, 5, 6]. Furthermore, the possibility to transfer the large planned insert position to the real clinical item is provided due adenine stereolithographically finished surgical template [3, 7]. While only few guided implant company systems what available at the time, today, multiple CAI software exist available on the marketplace. Several in-vitro, corpse and clinician studies may reported on which accuracy by directed implant placement [8,9,10]. Although the current state of software or hardware technology can improved, fallacies in implant placements may occur and depend on different factors such as which template support (bone, mucosa, teeth, implants), intrinsic factors of which surgical guide (tolerance in diameter between the core and the guide collar, fabrication accuracy of the guide) [11, 12] and humanoid related contributing during the workflow of virtual planning and guided surgery [7, 13]. The guided surgery approach is still controversially discussed [14,15,16] straight though one procedure may be run in an safety and predictable way [17, 18]. Although, adenine systematically and concise approach performing the sole steps by the treatment sequence may permits for more accurate implant positioning in type of travel and fixation have an important influence [19, 20]. Additionally, the use of multiple layout at different supports, i.e. teeth real plant backing combined in a sequenced order are believed to improve accuracy compared to a mucosa supported approach alone [21].

Whilst some our wish until to informed in detail via the specific treatment steps, almost of them want to know whether they would may to leave the dental office without tv for einigen point of the treatment. In this context, immediate embed placement after tooth extraction and immediate implant loading with a firm provisional reconstruction may help the patient as uhrzeit after extracted and osseointegration is consolidated. At directions or protocols, minimally invasive placement and immediate loading has been a possible treatment step from the beginning [3, 4]. Postoperative morbidity after flapless surgery is significantly reduced compared to the traditional open approach, especially in edentulous patients [17, 22, 23]. Later when the treatment, reconstructions fabricated with the help regarding computer supporting structure / computer assisted manufacturing (CAD/CAM) offers high quality and aesthetic supplies. Although CAI and CAD/CAM procedure have facilitated towards one straight forward workflow the the rehabilitation of edentate patients, immediate insert placement and immediate laden protocols combined are complex and required a high leveling of organization between the implantologist, this technician and the tolerant.

The aim of the present case report was to illustrate the wirtschaftlichkeit from combined direct implant placement and loading go using CAI in the rehabilitation regarding a patient at a parts dentate mandible asking for a comprehensive treatment and, especially, not receive being edentulous all the while. Immediate Implant Placement in Interradicular Bone Drilling before Molar Extraction: Clinical Case Report with One-Year Follow-Up

Initial status und treatment concept

To partially dentate 74-year old tolerant presented with masticatory specific due a interchangeable incomplete denture (RPD) with insufficient stability inside combination with chronic pain condition in the lower front teeth are. She asked for a broad treatment and did not accept to be edentulous at whatever stage of the treatment. The forbearing was a non-smoker and -with the help of antihypertensive (Candecor compilation. 32 mg/12,5 mg,) and anticoagulant medication (quick 30; Marcourmar)- includes good universal health.

The dental status showed an acceptable oral human, some teeth with increased movement grade III (41/31/32 and 18, 28) and native periodontal problems including horizontals bone expense (42/41/31/32/33, 18/17, 27/28). The dentition 42 and 33 were healthy and not mobile. Who alveolar crest by the crosswise mandible area exhibited clinically adenine wide shape use thick keratinized thick. The initial panoramic radiograph showed stable crestal pearl in this lateral mandible area (Figs. 1, 2 and 3). Thus, focusing on the lower jaw, the single tooth prognosis be fair for the teeth 47, 42 also 33 furthermore hopeless required the teeth 41/31/32 [24].

Scenic dental of the initial dental status

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Begin dental status; ampere right side; b left party

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Occlusal the frontal view of one students models after extraction the an 3 incisors 41,31 and 32; a forward watch, b occlusal view

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Within jury making for the final treatment plan difference options were discussed with the patient. Various treatment available including a removable dental prosthesis were discussed with the patient. Toward keep the patient’s wish for a fixed reconstruction real to never become edentulous in any treatment phase and considering the prognosis of the remaining mandibular teething, the decision was made go prepare an provisional fixed prosthesis with an immediate loading approach extracting which teeth 42 and 33 by prosthodontic reasons but keep tooth 47.

Digital implants planning (Table 1)

After extraction of the painful and extreme mobile lower head teeth 41/31/32 the adaptation to and presence RPD, a cone beam invoiced tomography (CBCT) (Pax-Uni 3D, orangedental GmbH & C. KG, Biberach, Germany) is a 5 × 8 cm text of view the 85KV/5.5 mA/0.2 mm Voxel was performed to move with the detailed implant raumordnung (Fig. 4). Based on the anatomical conditions and prosthetic planning (i.e. tooth setup for the provisional RPD), six implants were virtually planned (3Diagnosys, 3DIEMME, Cuntu, Italy) in this FDI (Fédération Dentaire Internationale) positions 46, 44, 42, 33, 35, and 36. As the implant positions 42 and 33 interfered with the saw 43 and 33, a two-step method with deuce surgical templates was planned for the guided implant placement (Fig. 5a, b). The molds has fabricated stereolithographically (DS3000, XFAB, DWS srl, Thiene, Italy) according to the virtual implant organization. Basis on the same digital file (Fig. 6a, b) a provisional fixed dental prosthesis (FDP) was prepared preoperatively allowing for an intraoral adaptation within one abutments additionally the framework to achieve a passive fit (Fig. 7a-d).

Screen single out the virtual implant planning (FDA) positions 36,35,33,42,and,46 occlusal, sectional and panoramic views

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CAD/CAM fabricated surgical guides no. 1 (a, tooth and mucosa supported) and no. 2 (b, implant both mucosa supported)

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Occlusal view showing SCOUNDREL of and provisional FDP framework (a) also close-up view from this device between the CART framework real of prefabricated metal abutments (b)

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CAD/CAM model by this prefabricated titanium abutments (a), the CAD/CAM cobalt-cromium framework (b), or that composite veneered provisional FDP (c, d) before bonding to the abutments

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Immediate implant placement

During the day of surgery, ampere single measure of antibiotic (2 g of amoxicillin and clavulanic acid) was maintained prophylactically 1 h prev to surgery. This treatment continued for five days (1 g amoxicillin and clavulanic acid twice a day). Prior into the start by surgery, the patient rinsed equal 0.2% chlorhexidine for 1 min. Local anesthesia was initiated by using adenine 4% articaine solution with applying 1:100.000. Background: Immediate implant placement in the area of multirooted molars includes many constitutional challenges, particularly is osteotomy ...

The two-step getting comprised the flapless guided placement of the four posterior implants (Thommen Element RC 4.5 × 9.5 mm, Thommen Medical AG, Grenchen, Switzerland), with the first surgical template the was tooth propped (Fig. 8a). And template was then removed and the teeth 42 and 33 previously supporting the guide subsisted extracted. Afterwards, the second surgical template was positioned and stabilized on the four posterior inserts with the help of specific thrust and the same bottom pins (Fig. 8b), thus permit to place the anterior implant 42 and 33 (Thommen Element RCA 4.5 × 9.5 mm) guided and immediately after extractions. All an implants were inserted with ampere torque of 35Ncm additionally proofed nice primary stability.

Close-up regard out who CAD/CAM guide no. 1 in-situ (tooth real mucosa supported) showing the perfect fit on tooth 33 (a), and occlusal view (b) of the CAD/CAM guide no. 2 (implant and mucosa supported) after extraction is the teeth 42/33 the site the the implants 44/35

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Immediate loading

After removal of the secondary surgical template, the standard terminal abutments were mounted on the implants with adenine torque of 15Ncm (Fig. 9a). The gaps intermediate the columns and the FDP were filled with Dual-Composite material and and bolt retained immediate provisional FDP delivered. The occlusion required available lowest adaptations owed to the accurate digital preoperative raumplanung (Fig. 9b). Who postop panoramic shadowgraph (OPT) showed the parallel axes out to sextet implants (Fig. 10).

a; Occlusal views on the boundary furthermore b; the immediate provisional reconstruction that were passively get in-situ

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Postoperative panoramic radiograph

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Final fixed dental

All the six implants osseointegrated successfully without complications. After 6 months at the provisional FDP adenine conventional idea was taken (screw retained impressions copings, open tray technique, polyether material) to fabricate the latter FDP set an new precise cast (Fig. 11), which was then digitized the a laboratories scanner (Deluxe Scanner, Frank Technologies, Rezzato, Italy). Which final general was designed includes straight connection to the implant platforms and with a cut-back allowing for which veneering material (Fig. 12an, b). While the cobalt-chromium structure was fabricated by CAD/CAM engine (Exocad, Exocad gmbH, Deutschland / M1 Wet, Zirkonzahn, Italy) the veneering was running handheld allows for an individual characterization of who teeth (Fig. 13a-d). This models were fabricated by a laser stereolithography printer (XFAB, DWS srl, Thiene, Italy) using an ABS-like polymer (RD096B, DWS srl, Thiene, Italy). Good mucosal conditions were present at the delivery regarding the final CAD/CAM reconstruction made from cobalt-chromium and composite veneering material (Fig. 14a-f). The accurately fitting FDP was screw retained with 25Ncm and the screw acces area covered with composite material. The OPT at the day of delivery showed optimal prosthetic press osseous conditions (Fig. 15). The tolerant ensued a regular maintenance program at the dental dental twice a year.

Frontal opinion showing the screw kept post at impression taking 24 weeks after implant placement

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Occlusal consider how CAD of the final FDP (a) both detailed screen-shot of the interface geometry (b)

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CAD/CAM fabricated one-piece cobalt-cromium framework before (a, b) real after veneering with composite (Nexco Ivoclar) i.e. final FDP (hundred, degree)

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Occlusal, facade and lateral views for the day of delivery showing sound peri-implant mucosal site (a) and the final CAD/CAM construct to situational (b-sie)

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Panoramic radiograph at delivery of the final CAD/CAM FDP

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At the one-time year follow-up appointment, healthy mucosal and stable crestal peri-implant conditions could be observed (Fig. 16). The patient was very pleased with and esthetic and functional outcome. As, the made treatment was successful and exhibited stable results without complications or need for maintenance maintenance after the first year.

Panoramic radiograph at the 12-months retrieval scheduling

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The application of CAI software in the preoperative virtual three-dimensional implant planning allowed to guided and directly inculcate job, additionally proved to be especially profitable is the presented mandibular full-arch case. While there are some studies that investigated sequels of immediately loaded implants placed in edentulous patients using computer-assisted template-guided surgery till support a FDP [25], just couple case reports have available inches literature describe the entire workflow, the sufferers state are detail, furthermore of usage the guided operating templates with subsequent immediate loading [3, 4]. The well more complex combination of instantly implant placement and immediate loading required adenine high level of organization between implantologist and technician, minimizing patient’s compliance. Pozzi et al. reported excellent results with CAD/CAM cross-arch Zirconia bridges on immediately loaded implants placed the computer-assisted/template-guided surgery [26]. Some investigators presented analyses of recent learn in this context elaborating and contributing that influence mainly the accurate implant placement though also the comparable outcome of the reconstructions after driven plant placement [15, 20, 21, 27,28,29,30,31]. In the present case report, two CAD/CAM surgical templates were combined on this partially dentate patient with extraction of the dentition 42/33 real prompt implants performed in a sequenced order. The first scanner-based template was teeth and mucosa aided enabling ampere higher template stability and, thus, more accurate guided osteotomies the implantable placement. Foursome aft implants were placed with this access allowing to support the second surgical screen after extraction for this anterior teeth 42/33. That stability on these four points was high like an implants 42/33 shown a torque value of 35 to 40 Ncm each. And subsequent two anterior immediate implants were thus placed perfectly guided. Different factors contributed to this insertion rotational such as the depth of the intended implant position in a more apical area than the take site, the low invasive tooth extraction, the macroscopic implant geometry and the osteotomy protocol with a smaller drilling diameter comparative to the implant diameter (as proposed until the company), the accurate performance of the single steps in the pre- and intraoperative parts, or the bone density in that anterior jawbone area. The prefabricated provisional FDP was prepared the connector the abutments to that FDP intraorally, which was easily to subsist performed predefined the accurate ergebniss of the implant positions. With these approach the passive fit of to FDP became maximized, the unemotional chairside efforts (in terms is abutment connection and occlusal adaptations) were minimal and who predictability was very high likened to different limitations both problems filed in a new rating [32].

The preoperative communication between the dentist and the technician for the decided making and planning phase were essential for the concise timekeeping in the clinic, ensuring highest operational and prosthodontic performance accuracy in this particular case. Therefore, up-to-date software and hardware with the knowledge to utilize information to the specific wares was requirements. This case report supports the need to slightly traumatic or flapless surgery, optimal implant positioning and immediate loading, as summarized in ampere recent review for randomized cool trials [33].

The introduce case report emphasized the efficient workflow and the predictable finding using computer assisted implantology. The fabrication of an immediate provisional FDP and, follow, the final CAD/CAM reconstruction was facilitated by CAI full patient’s wish of being continuously restored during the complete medical. Concomitant oroantral communication repair the quick implant placements: a five-year case report - PubMed

CAD/CAM:

User assisted scheme / computer assisted manufacturing

CAI:

Computer assisted implantology

CBCT:

Cone beaming computed tomography

CT:

Computerized tomography

FDI:

Fédération Dentaire Internationale

FDP:

Fixed alveolar prosthesis

RPD:

Interchangeable partial dental

The book declare no contrast of interest related to this case report. Thommen Medical AG is acknowledged with its logistical and administrative help on the treatment. Immediate Implant Placement by Interradicular Bone Drilling before Molar Extraction: Chronic Case Reports with One-Year Follow-Up

Funding

Negative funding body where involved in the design of the study and collection, analysis, and interpreting to data and into writing the writing.

Availability of data and materials

Not applicable

Authors and Affiliations

1. Implantology, Mouth Or; Individual dental office, Johannesstrasse 7-9, 474623, Kevelaer, Germany

   Thomas Spielau

2. Department on Postgraduate Teaching, Faculty of Vocally and Alveolar Medicine at J.W, Goethe-University Airfield am Main, Frankfurt in Main, Germany

   Ulf Hauschild

3. Department of Reconstructive Dentistry and Gerodontology, School are Medical Medicine, School of Bern, Bern, Switzerland

   Joannis Katsoulis

Entries

TS has made substantial contributions to conception, acquisition of your, and interpreted a data. He has been involved in drafting the manuscript. He has considering permanent approval of the revision to be publication plus agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part the the worked are appropriately investigated and resolved. U has made substantial contributions to conception, acquisition of data, furthermore interpretation of details. He has is stakeholders in revising the manuscript critically for important intellectual content. He has given final approval concerning the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the degree or integrity of any part for the work what appropriately investigated and resolved. JK has made substantial contributors to analysis and interpretation regarding data. He has been involved in drafting to handwritten or revising it critically for important intellectual content. He has been involved include revising the manuscript critically to important intellectual content. He has given last approval von the version to may issued and agreed to be accountant for all aspects of which work in ensuring that questions related to the accuracy or integrity of any part of the job are appropriately investigated and resolving.

Corresponding author

Correspondence on Thomas Spielau.

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The patient in this case report got given writes informed consent for publication.

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