#Immediacy 16. Nov 2021

Immediate provisional restorations and loading of Straumann® Tissue Level implants using the Straumann® Guided Surgery solution

A clinical case report by Dr A Bortsov, Russia

As dental implantation is steadily becoming a mainstream treatment option, most of the patients expect fast and successful results. Nowadays, many patients would like to leave the clinic with an esthetic and fully functional restoration. In this regard, immediate loading represents a time-efficient protocol and allows a patient to benefit from the restoration straightaway. For a surgeon, however, the main challenge is not immediate loading per se, but producing a precise and esthetically pleasing provisional restoration in an efficient, predictable and time-saving manner. Furthermore, bone atrophy poses additional risks and makes the procedure less predictable. In such situations, guided surgery based on fully digital workflows with pre-fabricated provisional restorations enables the surgeon to plan and place the immediate implants in deficient sites, as well as deliver esthetic provisional restorations efficiently in the same appointment. The following clinical case report describes a patient who had implants placed conventionally in the past, but who came into clinic asking for the new implants to be placed in such a way that “… I can smile and eat straightaway…”.

Initial situation

A non-smoker and systemically healthy 48-year-old female patient came to our clinic with partially edentulous areas in the upper and lower jaws (Fig. 1). Her dental history revealed implants that were conventionally placed and provisionally restored a year ago. She considered the experience to be rather prolonged, and this time she expressed a strong desire to have implants placed and restored immediately in the same appointment.

Treatment planning

The clinical examination and CBCT analysis revealed a significant deficit in the bone and soft tissue volume. Two years ago, eight implants had been placed in the upper jaw according to a conventional non-digital protocol. Since then, the patient has had a provisional restoration awaiting implantation in the lower jaw (Figs. 2-5). To meet the patient expectations, an immediate provisionalization and loading using a Straumann® Guided Surgery solution was planned. The color and shape of the provisionals were determined according to the patient’s requests and expectations. In cases with severe deficit of bone volume, the guided surgery approach can help achieve more precise positioning of the implants using a surgical guide. The surgical guide was planned based on the patient’s CBCT data using coDiagnostiX® software and then 3D printed. The same planning was used to plan provisionals, which were then pre-fabricated before the surgery so that the patient could leave the clinic with a fully functional temporary prosthesis (Figs. 7,8).

Surgical procedure

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