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Fig 4: Implant positions planned digitally in the lower jaw

Fig 3: Implant positions planned digitally in the upper jaw

Fig 6: Implant placement using the surgical guide
Fig 5: Tooth and tissue supported surgical guide

Provisional Diagnosis in the upper and lower jaws by first performing virtual extractions
Chronic generalised periodontitis (Figures 3 and 4).

Overall Prognosis Surgical Guide
Questionable A surgical guide was made that was tooth and tissue supported. We
planned to retain a few teeth which were extracted after implant
TREATMENT PLAN placement in the same sitting. This approach made it easier to stabilize
Since the patient wanted a fixed solution, we planned to carry out the guide on firm teeth compared to fixing a guide in completely
full mouth implant treatment. After evaluating the prosthetic space, edentulous jaws (Figure 5).
we decided to rehabilitate with an FP1 type of prosthesis and place
implants using guided surgery: six implants each in the upper and Surgical Phase
lower arch, followed by immediate loading, if adequate primary The planning report and surgical guide were prepared before the
stability was achieved. He was informed of the steps of the procedure, surgical phase began. The surgical phase involved the administration
along with the risks and benefits. Written consent was obtained from of local anesthesia with epinephrine 1:200,000, followed by the
him before the surgical procedure was initiated. extraction of the remaining natural teeth except for those intended
to support the guide. The guide was stabilized with fixation pins, and
Preoperative CBCT and OPG implants were placed consecutively, starting with the lower arch and
Anatomic landmarks and vital structures were marked, and followed by the upper arch. Guide stabilization is crucial in guided
assessments in different regions of the jaw were carried out. exocad surgeries. If there is any misfit of the guide, ensure that the guide is
planning software was used to digitally plan the implant positions stabilized in the desired fixed position before proceeding with the

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Dental Practice I July-August 2024 I Vol 20 No 4 33