Digital workflow to provide an immediate interim restoration after single-implant placement by using a surgical guide and a matrix-positioning device

A digital workflow for the fabrication of an immediate implant-supported interim restoration

Immediate interim restorations in the esthetic region are usually fabricated in situ by using the pick-up technique, which is time-consuming and has a potential for cross-infection. This article describes a rapid and precise workflow for the fabrication of an immediate implant-supported interim restoration. A cast with gingival contours and an extended tube to accommodate the implant analogs is generated preoperatively based on the virtual implant planning and a predesigned restoration. After guided osteotomy and implant insertion, the actual three-dimensional (3D) implant position is transferred precisely from the mouth to the printed cast by using the surgical guide. This technique can achieve the rapid and precise fabrication of the interim restoration with guidance immediately after the surgery, decreasing the risk of cross-infection and reducing clinical steps and time.

A double-blind randomized within-subject study to evaluate clinical applicability of four digital workflows for the fabrication of posterior single implant crown

OBJECTIVE

To compare efficiency and clinical efficacy of posterior single implant crowns (PSIC) fabricated using four digital workflows.

MATERIALS AND METHODS

Twenty-two patients with one missing first molar were included. Each patient received four screw-retained implant crowns fabricated through four different workflows including a fully digital workflow with immediate digital impression (Group i-IOS), a fully digital workflow with digital impression after implant osseointegration (Group d-IOS), a model-based hybrid workflow using immediate analogue impression (Group i-AI), and a model-based hybrid workflow with conventional analogue impression after implant osseointegration (Group d-AI). The crown delivery sequence was randomized and blinded. The efficiency for each workflow and clinical outcome of each crown were recorded.

RESULTS

The average clinical working time in fully digital workflows (i-IOS 46.90 min, d-IOS 45.66 min) was significantly lower than that in the hybrid workflows (i-AI 54.59 min, d-AI 55.96 min; p < .001). Significantly more laboratory time was spent in hybrid workflows (i-AI 839.60 min, d-AI 811.73 min) as compared to fully digital workflows (i-IOS 606.25 min, d-IOS 607.83 min, p < .01). No significant differences in the chairside time at delivery were found. More crowns in Group i-AI (15%) needed additional laboratory interventions than in the other groups (p = .029).

CONCLUSION

Digital impression and model-free fully digital workflow improved prosthetic efficiency in the fabrication of PSIC. With the limitation that the results were only applicable to the implant system used and the digital technologies applied, findings suggested that workflows integrating immediate impression with implant surgery procedure was clinically applicable for restoration of PSIC.

Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial

PURPOSE

This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates.

MATERIALS AND METHODS

Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test.

RESULTS

Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048).

CONCLUSIONS

Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome.

CLINICAL RELEVANCE

The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

A full digital workflow to prefabricate an implant-supported interim restoration: case report and a novel technique

This article describes a case with a full digital procedure to prefabricate an implant-supported interim restoration based on the preoperative digital implant planning. A fully guided surgical template is designed and printed, and then an interim restoration is fabricated based on the planned implant position through a dental computer-aided design (CAD) software. Once the implant was placed at the predetermined position through the fully guided surgical guide, the prefabricated interim restoration could be inserted immediately after the surgery, which can guide the healing of the soft tissue and enhance the esthetic outcomes. This novel technique eliminates the conventional impression making to insert an implant-supported interim restoration immediately after the implant placement surgery, which can guide the healing of the soft tissue, minimize the chairside time and optimize the clinical workflow.

A straightforward protocol for designing an interim hollow shell with open-source software

BACKGROUND

An interim hollow shell (IHS) is a temporary prosthesis that adapts like a cap over a prepared tooth abutment. Using a conventional protocol to fabricate IHS from casts of the initial situation or the wax-up can be challenging, time-consuming, and sometimes frustrating. A digital workflow makes this process quicker and more convenient. The IHS must be first designed with computer-aided design (CAD), then fabricated with computer-aided manufacture (CAM). Proprietary dental software is commonly used for the design process but needs to be purchased.

OBJECTIVE

To describe a step-by-step technique for designing an IHS for posterior relining with open-source software.

METHODS

This paper describes a straightforward procedure to design an IHS from a dental scan of the initial situation or a digital wax-up for an esthetic and functional temporary rehabilitation.

RESULTS

An IHS can be quickly designed using open-source software by copying an existing restoration or a conventional or digital wax-up. Then, the design can be 3D printed using a biocompatible resin.

CONCLUSIONS

The clinician can use open-source software to design IHSs, which are then 3D printed using a biocompatible resin.

CLINICAL RELEVANCE

The clinician can design IHSs from a dental scan of the initial situation or a wax-up using open-source software by following the step-by-step protocol outlined in this paper. The restoration can then be 3D printed using a biocompatible resin.

A cast-free approach to fabricating an implant-supported interim restoration: A dental technique

A cast-free approach is described to fabricate an implant-supported interim restoration by using the postoperative cone beam computed tomography (CBCT) scan to locate the placed implant. A postoperative intraoral scan was aligned to the postoperative CBCT scan through a dental implant planning software program. An attached interim abutment and implant analog complex was then scanned and superimposed on the placed implant in the postoperative CBCT scan. Once the best alignment was achieved, a virtual cast was generated, and an interim restoration with bilateral positioning wings was fabricated on the interim abutment and inserted during the second-stage surgery. This technique offers a cast-free approach to inserting an implant-supported interim restoration immediately after the second-stage surgery to guide the healing of the soft tissue that can minimize chairside time and optimize the clinical workflow.

Accuracy and dimensional reproducibility by model scanning, intraoral scanning, and CBCT imaging for digital implant dentistry

Background

Recently, it has become possible to analyze implant placement position using the digital matching data of optical impression data of the oral cavity or plaster models with cone beam computed tomography (CBCT) data, and create a highly accurate surgical guide. It has been reported that CBCT measurements were smaller than the actual values, termed shrinkage. Matching of digital data is reliable when the plaster model or intraoral impression values show shrinkage at the same rate as the CBCT data. However, if the shrinkage rate is significantly different, the obtained digital data become unreliable. To clarify digital matching reliability, we examined dimensional reproducibility and shrinkage in measurements obtained with a model scanner, intra-oral scanner (iOS), and CBCT.

Materials and methods

Three implants that were arranged in a triangle were fixed in an acrylic plate. The distance between each implants were measured using model scanner, iOS, and CBCT. The actual size measured by electronic caliper was regarded as control.

Results

All values measured with CBCT were significantly smaller than that of model scanner, iOS, and control (p<0.001). The model scanner shrinkage was 0.37-0.39%, iOS shrinkage was 0.9-1.4%, and CBCT shrinkage was 1.8-6.9%. There were statistically significant differences among the shrinkage with iOS, CBCT, and model scanner (p<0.001).

Conclusion

Our findings showed that all measurements obtained with those modalities showed shrinkage as compared to the actual values. In addition, CBCT shrinkage was largest among three different measuring methods. They indicated that data matching between CBCT and scanner measurements requires attention in regard to the reliability of values obtained with those devices.

Full Digital Workflow for Anterior Immediate Implants Using Custom Abutments

The full digital workflow involves the combination of intraoral and cone beam computerized tomography scans. In the present case report, a second intraoral scan is performed after soft tissue management facilitated by the use of a 3-dimensional-printed interim implant restoration. The new STL file resulting from the second intraoral scan can be associated with the previous STL from the initial intraoral scan. The custom abutment was also digitally designed as an STL file, and no implant scan bodies were required for intraoral scanning.

Fabricating a dual-material, vat-polymerized, additively manufactured static implant surgical guide: A dental technique

Protocols with static computer-aided implant placement provide more tangible clinical advantages than conventional implant placement methods. A technique to manufacture a dual-material implant surgical guide by using a vat-polymerization printer is described. The implant surgical guide combined a resilient intaglio and hard exterior surface. The technique should minimize the clinical adjustments needed to ensure fit and improve patient comfort.

Three dimensionally printed surgical guides for removing fixation screws from onlay bone grafts in flapless implant surgeries

The present technique report describes a digital workflow for flapless implant surgery after onlay block bone graft healing in the esthetic area. Virtual removal of block fixation screws and optimal single-tooth implant position and digital crown waxing were planned from cone beam computed tomography (CBCT) and intraoral scans. Two different surgical guides were digitally designed and 3D-printed to allow for flapless implant surgery. The first surgical guide was used to remove all 3 fixation screws from a healed onlay block graft, whereas the second guide was used to determine the implant position and direction. The present methodology may be considered a time-efficient flapless approach for placing implants in sites with block grafts.

Fabrication technique for a custom implant emergence profile on 3D printed casts

A procedure is described for fabricating a removable resilient soft-tissue replica that accurately replicates the contoured emergence profile of an interim implant-supported restoration on a cast fabricated by 3D printing. The technique uses digital scanning and 3D printing technologies to produce a 3D printed replica of the implant-supported interim crown, which is then used to fabricate the custom soft-tissue replica. This straightforward technique allows the accurate replication of the emergence profile without retaining the interim crown or fabricating a new one. No additional clinical appointments are needed.

Accuracy of Customized Prefabricated Screw-Type Immediate Provisional Restorations after Single-Implant Placement

Limited evidence is available comparing the differences between pre-operative and post-operative 3D implant positions from the viewpoint of prosthetics. We aimed to investigate the differences between preplanned positions of virtual provisional restorations and their actual positions following fully guided single-implant placement. Ten maxillary typodonts with missing right central incisors were imaged using cone-beam computed tomography, and digital impressions were obtained using an intraoral scanner. These data were imported into implant-planning software, following which the provisional restorations were designed. After data superimposition, an appropriate implant position was determined, and a computer-assisted implant surgical guide was designed for each typodont. Orders generated from the implant-planning software were imported into relevant computer-aided design software to design the custom abutments. The abutments, provisional restorations, and surgical guides were fabricated, and each restoration was cemented to the corresponding abutments, generating a screw-type immediate provisional restoration. The implants were placed using the surgical guides, and the screw-type provisional restorations were engaged to the implants. The typodonts were then rescanned using the intraoral scanner. The restorations designed at the treatment planning stage were compared with those in the post-operative scan using metrology software. The angular deviation around the central axis of the implant was measured, and the differences in the crown position were converted to root mean square (RMS) values. The post-operative provisional restorations exhibited an absolute angular deviation of 6.94 ± 5.78° and an RMS value of 85.8 ± 20.2 µm when compared with their positions in the pre-operative stage. Within the limitations of the present in vitro study, the results highlight the potential application of customized prefabricated immediate provisional restorations after single-implant placement.