A fully guided digital workflow for predictable implant planning and placement

Upon receiving approval from the insurance company for the proposed treatment plan, all four teeth were extracted. After the extractions, the extraction sockets were meticulously debrided with EthOss degranulation burs and filled with EthOss grafting material to promote primary closure and healing of the wound (Fig. 5).

To preserve both the aesthetic and functional aspects for the patient during the time  between extraction of the teeth and the new bridgework, a temporary removable prosthesis was fabricated (Fig. 6). The patient’s general dentist has also been working fully digitally for years, and the temporary prosthesis was made from a digital impression and printed models.

Two months after the extractions, we obtained a CBCT scan of the maxilla (Fig. 7) and captured digital impressions using our DEXIS IS 3800 intra-oral scanner (Fig. 8). These scans were essential for commencing the implant planning process and creating the surgical guide.

During the implant planning phase, we created a preliminary plan using 3D imaging software with a prosthetically driven implant planning approach (Figs. 9 & 10), and the plan was exported into surgical guide planning software for final planning and construction of the surgical drilling guide (Figs. 11a–c). The implants were planned in all four positions with the object of identifying the two most optimal and accessible sites for the placement of two implants and the corresponding bridge restoration.

After completion of the planning and drilling reconstruction, the surgical guide was 3D-printed with a Stratasys printer using MED610 resin (Stratasys). The two implants (4.1 × 12.0 mm Straumann Bone Level Tapered, Regular CrossFit, SLActive, Roxolid) were then placed utilising the Straumann guided surgery kit for precise guidance. The remaining piece of amalgam in the bone of tooth #21 was carefully removed—only a small piece in the gingiva remained (Fig. 12). The buccal bone was again thickened with EthOss, and the wound was closed with a semi-submerged technique, facilitating proper healing and integration of the implants (Figs. 13a & b).