A simple technique for immediate placement of definitive engaging custom abutments using computerized tomography and flapless guided surgery

This article describes a new technique using 3-D computerized tomography and virtual implant planning with flapless guided surgery and placement of prefabricated, custom-milled zirconia implant abutments. After extraction of the mandibular right first and second molars and healing of the sockets, a removable prosthesis replacing these teeth was fabricated and scanned. Implant placement was planned via interactive imaging and CAD/CAM software and then placed with a CAD/CAM fabricated surgical guide, using a flapless surgical technique. Custom zirconia abutments were fabricated on an altered master cast, placed, and torqued to 35 Ncm at the time of implant surgery. Abutment positions, contours, and soft tissue marginal adaptation were in close agreement with those on the master cast. Acrylic resin provisional crowns were cemented into position and left in passive occlusion during healing. Computerized tomography and interactive planning software can be used to allow precise placement of implants and the fabrication and immediate insertion of custom-made final abutments, providing clinicians with a surgically and prosthetically efficient clinical technique. Keywords: CAD/CAM, crestal bone, custom abutment, dental implant, immediate provisionalization, osseointegration