On the day of surgery, we prepared the surgical protocol provided by the implant planning software, which guided us on the drilling sequence and the use of the appropriate instruments for the implant bed preparation (Fig. 30a- 30b). After the fixation pins were allocated, the teeth # 17, #16, #15, #13, #12, #22, #23 and #24 were atraumatic extracted and followed by alveolectomy, using a bone reduction guide (Fig. 31-36). Four implants (Straumann® BLX ø 4.5 mm RB SLActive® 12mm Roxolid®) were placed, two straights in the anterior zone and two titled implants in the posterior zone. All implants were stabilized with a torque of 50 N/cm (Fig.37-43) and the SRAs were placed on top, with an angulation of 30º on the posterior implants (angled 30°, ø4.6 mm, GH 3,5) and 17º on the anterior implant (angled 17°, ø4.6 mm, GH 3,5) (Fig. 44-45).
The bite registration guide was fixed with pins and the open tray impression copings were placed on the SRAs of the anterior implants, which were fixed with the guide using flowable composite and then sent to the lab (Fig. 46-50). Afterwards, we checked the temporary CAD/CAM bridge which was designed before surgery (Fig. 51) and finally, protective caps were placed on the SRAs followed by bone grafting using Cerabone® Granulate with a 1-2mm grain size, on the extraction socket and suture (Fig. 52- 54).