Integration of Dicom and STL Files for Predictable Oral Rehabilitation with Implant Guided Surgery

Introduction: Guided surgery optimizes: the accuracy of implant placement in a more safe, predictable and efficient situation by using a flapless technique. Objectives: The aim is to present a multidisciplinary case report in a partially edentulous patient to whom a digital workflow has been applied, including the computer assisted implant planning and the placement with static guided surgery. Material and Methods: A 68-year-old male patient with a Kennedy class I in the maxilla and mandible was treated in the Master of Restorative Dentistry based in New Technologies of Complutense University (Madrid). After basic periodontal treatment, all the teeth except 3.4., 3.3 and 3.3. were extracted. SMOP Implant Planning System (Smop, Swissmeda, Zurich, Switzerland) was used to align and match CBCT (Cone Beam Computed Tomography) with the digital models obtained from 2 situations: the mouth after teeth extractions and from the diagnostic wax-up. The placement of ten Conelog Implants (Camlog, Biotechnologies AG, Switzerland) was planned according to the protocol for guided surgery. The surgical template was designed and printed to use a flapless procedure for implants placement. Patient's function and aesthetics were reestablished with provisional full-arch maxillary restoration. On the mandible, a tooth-supported PMMA (Poly Methyl Methacrylate) provisional restoration was cemented. After 6 months, the definitive zirconium oxide screw-retained prostheses were placed. Discussion: Digital implant planning and guided surgery demand more preoperative time for the dentist and could increase the cost of the treatment. However several studies suggest that guided surgery reduces post-surgical morbidity due to the possibility of performing flapless surgery , improves accuracy in implant placement, and increases the predictability of the prosthetic treatment. Results: The ten implants were predictably and satisfactorily placed, both from the patient's point of view and from the clinician. Function and aesthetics were reestablished as desired by the patient. Conclusions: Computer assisted implant planning and guided surgery may offer clinical advantages in terms of patient morbility, time, optimization of available bone and accuracy regarding implant position. Keywords: Guided implant surgery, digital workflow, flapless implant surgery, digital planning.