THE ROLE OF VIRTUAL PLANNING AND COMPUTER-GUIDED SURGERY IN IMMEDIATE LOADING OF POST-EXTRACTIVE IMPLANTS : A CASE REPORT

Objectives: in recent years, an increasing interest is emerging about computer-guided implant surgery, flapless surgery and immediate prosthetic loading. The extreme accuracy to replicate the patient's anatomical features of the computer-guided implant surgery shows great relevance in clinical conditions where a small amount of bone volume and anatomical restrictions are present, improving the treatment predictability and encouraging the adoption of advanced therapy options. In this procedure the virtual planning, based on a three-dimensional digital system, and the surgery, guided by a computer designed stereolithographic template are used. Digital technology allows to create a virtual three-dimensional model of the jaw on which the implant placement has to be planned, according to anatomical features (e.g. bone volume and vital structures) and the prosthetic project. The reported case illustrates the clinical procedures performed to avoid a more invasive surgical approach, an interi

Objectives: in recent years, an increasing interest is emerging about computer-guided implant surgery, flapless surgery and immediate prosthetic loading. The extreme accuracy to replicate the patient's anatomical features of the computer-guided implant surgery shows great relevance in clinical conditions where a small amount of bone volume and anatomical restrictions are present, improving the treatment predictability and encouraging the adoption of advanced therapy options. In this procedure the virtual planning, based on a three-dimensional digital system, and the surgery, guided by a computer designed stereolithographic template are used. Digital technology allows to create a virtual three-dimensional model of the jaw on which the implant placement has to be planned, according to anatomical features (e.g. bone volume and vital structures) and the prosthetic project. The reported case illustrates the clinical procedures performed to avoid a more invasive surgical approach, an interim removable denture, and long treatment times. Case presentation: implant-prosthetic rehabilitation in a patient in which the extraction of the 1.3, 2.3, 1.5 and 1.6 is needed. The extraction of hopeless teeth and the immediate implant placement with a functionalized temporary prosthesis are planned on the same day of surgery. A diagnostic wax-up of the prosthetic restoration was made on articulator mounted plaster models, to allow the realization of a tripartite template (one base portion and two teeth set-up portions). Pre-operative high-resolution CT scans of patient and template applying the double-scan technique were performed. The multiplanar reconstructions and the virtual navigation system allowed to program three-dimensional implant positioning based on the pre-operative prosthetic study. The transfer of the implant position from the diagnostic phase to the flapless surgery was performed through the stereolithographic template NobelGuide ™ (NobelBiocare ®). Results: the final restoration, carried out after 6 months, allowed to achieve good functional and aesthetic results. Conclusion: the transfer of the virtual implant position from the diagnostic to the clinic phase by using stereolithographic template allows to adopt a minimally invasive surgical technique, to reduce operating times, to improve the post-operative position and to functionalize immediate temporary prosthesis.