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Case Reports
. 2023 May 2;11(9):1301.
doi: 10.3390/healthcare11091301.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report

Claudia Todaro  1 , Michael Cerri  2 , Ruggero Rodriguez Y Baena  1 , Saturnino Marco Lupi  1
Affiliations
Case Reports

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report

Claudia Todaro et al. Healthcare (Basel). .

Abstract

Objective: complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis.

Methods: A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered.

Results: Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort.

Conclusions: Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.

Keywords: 3D printing; 3D surgical template; GBR; PRF; VOD; computer-aided design; digital smile design; digital technology; digital workflow; prosthodontics.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pre-operatory frontal picture.
Figure 2
Figure 2
Pre-operatory CBCT. Detail of the reabsorbed maxilla.
Figure 3
Figure 3
Pre-operatory facial scan.
Figure 4
Figure 4
Digital Implant Planning. The numbers identify the implants and pins.
Figure 5
Figure 5
The surgical guide.
Figure 6
Figure 6
L-PRF Membranes.
Figure 7
Figure 7
Surgical guide in place.
Figure 8
Figure 8
Elevation of the full thickness flap.
Figure 9
Figure 9
Detail of the implant positioning.
Figure 10
Figure 10
Detail of the collagen membrane.
Figure 11
Figure 11
Application of the sticky bone.
Figure 12
Figure 12
PRF membrane in place.
Figure 13
Figure 13
Suture of the full thickness flap with polylactic acid suture.
Figure 14
Figure 14
Seven days post-op.
Figure 15
Figure 15
The dots indicate the approximate position of the implants.
Figure 16
Figure 16
Re-entry surgery.
Figure 17
Figure 17
Seven days after the re-entry surgery.
Figure 18
Figure 18
One month healing after the re-entry surgery with the Flat One® abutments in place.
Figure 19
Figure 19
Lower and upper views of the provisional denture.
Figure 20
Figure 20
Frontal view of the provisional denture.
Figure 21
Figure 21
Digital Articulator Type A (Exocad®).
Figure 22
Figure 22
Digital Smile Design.
Figure 23
Figure 23
Digital design of the upper and lower substructures.
Figure 24
Figure 24
Passivization of the substructures.
Figure 25
Figure 25
Aesthetic and Functional try-in.
Figure 26
Figure 26
Finalized upper and lower prosthesis.
Figure 27
Figure 27
Screwed-in prosthesis.
Figure 28
Figure 28
Smile.
Figure 29
Figure 29
STL model obtained from the DICOM conversion.
Figure 30
Figure 30
Alignment of the STL to the DICOM file and relative accuracy color scale in mm.
Figure 31
Figure 31
Super imposition of the digital plan and the Post-op CT scan. The numbers from 0 to 5 identify the implants placed.
Figure 32
Figure 32
1-year control.
Figure 33
Figure 33
Soft tissues pre and post re-entry surgery.
Figure 34
Figure 34
Smile comparison.
Figure 35
Figure 35
Pre- and post-op facial scan profile comparison.
See this image and copyright information in PMC

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