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IMPLANTOLOGY

Fig 7: The surgical guide design in the exoplan/Guide Creator. Fig 8: Design of the provisional bridge for immediate restoration in
(Source: exocad) DentalCAD (Source: exocad)

Fig 9: A long-term provisional restoration made of a high- Fig 10: Atraumatic and tissue-preserving extraction of tooth 13 (Source:
performance PMMA-based resin was available at the time of surgery. exocad)
(Source: Dr. Jan Erik Jansohn)

was designed in DentalCAD using Immediate Load (Figure 8). reflected in the exact fit of the provisional restoration.
After a total treatment time of around 90 minutes, the patient left
SURGICAL INTERVENTION the practice pain-free with fixed teeth (Figure 15). As a prophylactic
The surgical guide and the prefabricated PMMA long-term provisional measure, she was prescribed a painkiller and an antibiotic. She was
restoration (Figure 9) were ready for the surgical appointment. Under also advised to favor the left side of the jaw when chewing for the first
local anesthesia, tooth 13 was first extracted atraumatically (Figure month after the surgery. However, she was able to use the implant-
10), then the surgical guide was positioned (Figure 11) and the supported long-term provisional bridge from day one.
implant was inserted in region 13 with navigated guidance. The gap
to the implant was filled with bone chips obtained during implant bed OUTCOME AND PATIENT SATISFACTION
preparation. This was followed by vestibular soft tissue augmentation The wound healing process was uneventful. Four months after implant
with a connective tissue graft from the palate. placement, intraoral scans were taken and the permanent bridge was
The two additional implants in the molar region were inserted designed in DentalCAD based on the scan data using the original
flaplessly after punching the gingiva. Using the surgical guide, they design at the start of treatment.
could be inserted bicortically exactly as digitally planned, ensuring On her fourth visit to the practice, around five months after the
optimal bone utilization (Figures 12 and 13) and achieving a high surgery, the patient received the permanent bridge. She was highly
primary stability of 40 Ncm. The surgical procedure itself lasted 30 satisfied with her new teeth, both esthetically and functionally. The
minutes. zirconium oxide bridge blends in harmoniously with the remaining
The long-term provisional restoration, a milled five-unit bridge natural dentition of the patient’s upper jaw (Figure 16). The patient
made of high-performance PMMA-based resin, was first checked was particularly satisfied with the minimally invasive procedure,
for fit and attached to the implants without the need for individual as she did not experience any pain or swelling at any stage of the
adjustment (Figure 14). The precision of the digital workflow was treatment.

56 Dental Practice I March-April 2025 I Vol 21 No 2