Digital planning and guided surgery in oral rehabilitation

a case report

Authors

  • Larissa Braga dos Santos Pontifícia Universidade Católica PUC- Rio
  • Adriano Relvas Barreira de Oliveira Pontifícia Universidade Católica PUC - Rio
  • Mauro Lefrançois Pontifícia Universidade Católica PUC - Rio
  • Marcos Venício Azevedo Pontifícia Universidade Católica PUC - Rio
  • Pablo Sotelo Pontifícia Universidade Católica PUC - Rio
  • Laura Sotelo Pontifícia Universidade Católica PUC - Rio

DOI:

https://doi.org/10.11606/issn.2357-8041.clrd.2020.172078

Keywords:

Digital Planning, Guided Surgery, Zirconia, CAD/CAM

Abstract

Digital planning of the prosthesis associated with surgical planning increased predictability, since surgical guides indicate the best place for implant installation, thus reducing the number of complications, and the CAD/CAM system provides predictability in the preparation of final restorations, according to the procedure previously planned. Our study reported a digital workflow used for the guided installation of two dental implants in regions 14 and 16, extraction of tooth 15 and installation of a fixed prothesis over implants. After anamnesis and clinical evaluation, intra- and extra-oral photographs of the patient were performed, molding the upper arch with polyvinylsiloxane (2-step putty/light-body technique) and requesting computed tomography. The plaster model obtained was sent to the laboratory and scanned. The generated file (STL) was used to create a diagnostic wax-up that was aligned to the tomography (in DICOM format), enabling the three-dimensional planning of the implants, which generated a partial printed surgical guide after approval of the dentist. After six months, the patient received the provisional fixed prosthesis printed in PMMA (polymethylmethacrylate) on an intermediate in PEEK (polyetheretherketone) aiming to condition an emergency profile to receive a definitive prosthesis two months later, with zirconia-milled infrastructure on a ti-base. The correct understanding of the operator about the steps of the digital workflow (diagnosis, prosthetic planning, surgical planning, guide preparation, temporary and final restorations) gives the operator improved predictability at the time of surgery as well as satisfactory aesthetic and functional result of definitive restorations.

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Author Biographies

  • Larissa Braga dos Santos, Pontifícia Universidade Católica PUC- Rio

    DDS, graduate student, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

  • Adriano Relvas Barreira de Oliveira, Pontifícia Universidade Católica PUC - Rio

    DDS, MSc, Associate Professor, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

  • Mauro Lefrançois, Pontifícia Universidade Católica PUC - Rio

    DDS, Associate Professor, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

  • Marcos Venício Azevedo, Pontifícia Universidade Católica PUC - Rio

    DDS, Associate Professor, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

  • Pablo Sotelo, Pontifícia Universidade Católica PUC - Rio

    DDS, MSc, Associate Professor, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

  • Laura Sotelo, Pontifícia Universidade Católica PUC - Rio

    DDS, MSc, PhD. Associate Professor, School of Dentistry, Department of Prosthodontics, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil

References

Alves LM, Hidalgo LR, Conceição LS, Oliveira GM, Borges KRF, Passos WG. Complicações em implantodontia: revisão de literatura. J Orof. 2017;4(1):20-29.

Tai C‐J, Tatakis DN, Chien H‐H. The applications and limitations of advanced (three‐dimensional) radiographic imaging techniques. In: Tai C‐J, Tatakis DN, Chien H‐H. Clinical maxillary sinus elevation surgery. Ames: John Wiley & Sons; 2014. p. 31‐56.

Rosenfeld AL, Mandelaris GA, Tardieu PB. Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes. Part 2: rapid-prototype medical modeling and stereolithographic drilling guides requiring bone exposure. Int J Period Rest Dent. 2006;26(4):347-53.

Hämmerle CH, Chen ST, Wilson TG Jr. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int J Oral Maxillofac Impl. 2004;19(Suppl):26-8.

Al Yafi F, Camenisch B, Al-Sabbagh M. Is digital guided implant surgery accurate and reliable? Dent Clin North Am. 2019;63(3):381-97.

Gargallo-Albiol J, Barootchi S, Salomó-Coll O, Wang HL. Advantages and disadvantages of implant navigation surgery. A systematic review. Ann Anat. 2019;225:1-10.

Rosentritt M, Rembs A, Behr M, Hahnel S, Preis V. In vitro performance of implant-supported monolithic zirconia crowns: influence of patient-specific tooth-coloured abutments with titanium adhesive bases. J Dent. 2015;43(7):839-45.

Teixeira Neto AD, Costa AJM, Choi IGG, Santos A, Santos JFD, Cortes ARG. Digital workflow for full-arch implant-supported prosthesis based on intraoral scans of a relative of the patient. J Oral Implantol. Forthcoming 2020. doi: https://doi.org/10.1563/aaid-joi-D-20-00095

Choi W, Nguyen BC, Doan A, Girod S, Gaudilliere B, Gaudilliere D. Freehand versus guided surgery: factors influencing accuracy of dental implant placement. Implant Dent. 2017;26(4):500-9.

Arisan V, Karabuda CZ, Ozdemir T. Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Impl Res. 2010;21(9):980-8.

Rosentritt M, Raab P, Hahnel S, Stöckle M, Preis V. In-vitro performance of CAD/CAM-fabricated implant-supported temporary crowns. Clin Oral Investig. 2017;21(8):2581-7.

Tekin S, Değer Y, Demirci F. Evaluation of the use of PEEK material in implant-supported fixed restorations by finite element analysis. Niger J Clin Pract. 2019;22(9):1252-8.

Pinhata-Baptista OH, Kim JH, Choi IGG, Tateno RY, Costa C, Cortes ARG. Full digital workflow for anterior immediate implants using custom abutments. J Oral Implantol. Forthcoming 2020. doi: https://doi.org/10.1563/aaid-joi-D-19-00249

Moilanen P, Hjerppe J, Lassila LVJ, Närhi TO. Fracture strength and precision of fit of implant-retained monolithic zirconia Crowns. J Oral Implantol. 2018;44(5):330-4.

Tabatabaian F. Color aspect of monolithic zirconia restorations: a review of the literature. J Prosthodont. 2019;28(3):276-87.

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Published

2020-09-24

Issue

2020

Section

Case report or technical report

License

Copyright (c) 2020 Larissa Braga dos Santos, Adriano Relvas Barreira de Oliveira, Mauro Lefrançois, Marcos Venício Azevedo, Pablo Sotelo, Laura Sotelo

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