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. 2008 Apr;1(1):2-14.
Epub 2008 Jun 16.

CAD/CAM technologies in the surgical and prosthetic treatment of the edentulous patient with biomymetic individualized approach

A Pozzi  1 , M Gargari, A Barlattani
Affiliations

CAD/CAM technologies in the surgical and prosthetic treatment of the edentulous patient with biomymetic individualized approach

A Pozzi et al. Oral Implantol (Rome). 2008 Apr.

Abstract
in English, Italian

Background: The advent of modern endosseous implant design and improved surface technology has allowed the development of new restorative techniques that decrease patient's total treatment time. Utilizing the latest scanning, CAD/CAM and manufacturing technolgies we are able to manufacture individualized dental restoration with high accuracy and a perfect precision of fit.

Materials and methods: This report describes the rehabilitation of a completely edentulous patient utilizing a CT-based implant planning with computer-assisted surgical design, simultaneous CAD/CAM fabrication of a surgical template, a flapless surgical placement of the implants, and a prefabricated fixed complete denture for an immediately loaded restoration according to Nobel Biocare's Teeth-in-an-Hour™ (Nobel Biocare Goteborg, Sweden) protocol. This systematic approach to full mouth rehabilitation reduces the time necessary for an edentulous patient to go from severely atrophic alveolar support to implant retained prosthetic restoration. These aspects of minimally invasive and simplified surgery, along with reducing the treatment time and postsurgical discomfort, are beneficial to the patient, and allowing for rehabilitation with the same level of success as in flap surgery.

Conclusion: The Teeth-in-an-Hour protocol is a unique solution made possible by the Procera System. With the aid of the CT scans and a virtual planning software, a custom fabricated precision drill guide and a pre-manufactured prosthesis can be made before surgery. The execution of implant placement is performed with a flapless procedure that results in minimal surgical intervention. This results in a short and non-traumatic surgery with a minimum of postoperative complications, allowing the patient to leave the chair with a fixed prosthesis. Utilizing the latest scanning, CAD/CAM and manufacturing technologies the dental team is able to develop individualized zirconia full arch framework with high accuracy and precision of fit.

Background:: l’introduzione di nuovi design implantari e di nuove superfici finalizzate al miglioramento delle capacità osteoinduttive e d’integrazione delle fixture ha stimolato i clinici a sviluppare nuove procedure restaurative che aumentino il comfort del paziente e riducano il tempo complessivo di trattamento. Utilizzando le ultime tecniche di scansione, in associazione con la tecnologia CAD-CAM, siamo in grado di produrre restauri protesici individualizzati con un alto grado di accuratezza e con una perfetta precisione, anche nei casi di riabilitazioni complete.

Materiali e metodi:: questo articolo descrive un protocollo di trattamento per la riabilitazione implantare immediata delle arcate completamente edentule. Il protocollo Teeth-in-an-Hour (Procera System, Nobel Biocare) è una soluzione terapeutica unica, resa possibile da una piattaforma di produzione che mette a disposizione del team implantoprotesico, la tecnologia CAD/CAM nelle varie fasi di progettazione e realizzazione della riabilitazione su impianti. Il posizionamento dei pilastri implantari viene eseguito con una procedura chirurgica flapless mini-invasiva; questo approccio conservativo risulta in una chirurgia atraumatica, di breve durata rispetto alle procedure convenzionali e pertanto il dolore e le complicanze locali nell’immediato post-operatorio (sanguinamento e gonfiore) sono minime, con grande beneficio per il paziente, garantendo le stesse percentuali di successo della chirurgia a cielo aperto. Il team implantoprotesico utilizzando la tecnologia CAD-CAM è in grado di progettare e realizzare la riabilitazione implantoprotesica con un elevato grado di precisione e di accuratezza chirurgico-protesica. UtIlizzando le ultime tecniche di scansione tattile-meccanica, l’elaborazione CAD/CAM e tecnologie di produzione e controllo di tipo industriale, è possibile ottenere restauri in ossido zirconio estesi a tutta l’arcata dentaria con un alto grado di accuratezza e precisione.

Conclusioni:: questo nuovo protocollo attraverso la pianificazione computerizzata virtuale protesico-chirugica dell’implantologia e la realizzazione di strutture CAD/CAM estremamente precise ed accurate, semplifica le procedure operative necessarie alla riabilitazione delle arcate completamente edentule, facilitando il passaggio da una protesi totale insufficiente e scomoda per il paziente con grave riassorbimento osseo ad una riabilitazione fissa definitiva in circa 4 mesi di trattamento.

Keywords: CAD/CAM technology; Nobel Guide; zirconia full arch framework.

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Figures

Figure 1
Figure 1
Patient with a mandibular complete denture functionally inadequate.
Figure 2
Figure 2
Duplicate of transitional prosthesis used as radiographic guide with radio-opaque markers randomly positioned at different levels.
Figure 3
Figure 3
Procera Software Planning Program allows for prosthetic guided implant positioning.
Figure 4
Figure 4
A 3-dimensional Procera Cad-design of surgical template after implant virtual positioning.
Figure 5
Figure 5
CAD/CAM manufactured surgical template.
Figure 6
Figure 6
Surgical template oriented in the mouth using a surgical index fitted to the opposing arch and stabilized with anchor pins.
Figure 7
Figure 7
8 fixtures positioned and seated correctly on the sleeve of surgical template.
Figure 8
Figure 8
Minimally invasive guided surgery results in minimal postsurgical trauma of periimplant soft tissue.
Figure 9
Figure 9
The pre-fabricated temporary prosthesis framework passively fitted on implants.
Figure 10
Figure 10
Postoperative radiographs were made to confirm the fit of the prosthesis, with vertically adjustable abutments seated on implant platforms.
Figure 11
Figure 11
Periimplant soft tissue healing at 3 months after surgery and immediate loading.
Figure 12
Figure 12
Stone impression of the implants with an open top impression tray.
Figure 13
Figure 13
The full bridge framework was modeled with a wax-up procedure using an acrylic low shrinkage resin.
Figure 14
Figure 14
The CAD design of the framework obtained by tactile scan.
Figure 15
Figure 15
Procera Zirconia Implant Bridge made with CAD/CAM tecnology.
Figure 16
Figure 16
High precision and accuracy of fitting on implant platform of Zirconia implant Bridge.
Figure 17
Figure 17
Full arch Zirconia framework try-in.
Figure 18
Figure 18
Completed Procera Zirconia Implant Bridge interoc-clusal lateral and frontal view: ideal implant positioning respecting volume emergence profile of definitive prosthesis.
Figure 19
Figure 19
Periapical radiographs made to confirm the fit and the accuracy of definitive Procera Zirconia Implant Bridge prosthesi.
Figure 20
Figure 20
Final radiograph.
See this image and copyright information in PMC

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