Full Arch Delayed Implant Placement with Fully Guided Surgery

Aim: to present a case report of a prosthetically driven digital treatment planning and its subsequent execution, using the fully guided implant placement protocol, in a complex periodontal patient. Material and Methods: A 58-year old partially edentulous female patient was referred to the post-graduate clinic of Master of Periodontology program of Complutense University (Madrid, Spain) for periodontal and implants treatment. Her chief complaint was teeth mobility, in both upper and lower jaws. After a clinical and radiographic diagnosis, the strategic decision was made to extract all maxillary teeth due to the complex treatment plan with the goal to achieve functionally stable and esthetically pleasing results. The following treatment sequence was used: all maxillary teeth were extracted in a single session, with a fabrication of an immediate removable complete denture. No socket preservation was performed. 6 weeks after teeth extraction, a CBCT was obtained, and the dental stone model of the maxilla was optically scanned. Resulting DICOM and STL files were superimposed in the SMOP Implant Planning System (Smop, Swissmeda, Zurich, Switzerland). The placement of six Conelog implants (Camlog, Biotechnologies AG, Switzerland) was planned and the surgical guide was designed for the protocol of fully-guided implant placement. After printing the surgical guide, the metal guide sleeves were inserted in the corresponding locations, and the surgery performed. Four implants were placed according to the flapless implant placement protocol, and two implants were placed with a flap elevation and simultaneous sinus floor elevation. Six months after surgery, second stage surgery on two implants was performed, and a definitive full-arch restoration was fabricated. Conclusions: complex treatment planning using digital approach may facilitate the process of implants placement, making it more safe and predictable, and improve the long-term functional and esthetic result of the complex rehabilitation. Disclosure: Nothing to disclose. Keywords: Full arch, delayed implant, guided surgery