Title

Positioning guide for provisionalization in the esthetic zone

Purpose:

Describe a technique for placing the provisional precisely, matching the exact position of the implant planned digitally.

Introduction:

 A 23-year-old female with missing tooth #9, wanted to be rehabilitated with implant therapy.
 The implant placement was planned to be fully guided and restored immediately, therefore, a positioning guide was designed to facilitate the fabrication of the provisional.

Methodology:

 Intraoral scanning and CBCT were taken.
 Both files were aligned and a digital wax-up was designed with CAD/CAM software mirroring the contralateral tooth number 8.
 A 3.5x10mm implant was planned to be placed based on the new tooth (wax-up) position and a tooth-supported surgical guide was designed.
 After that, a positioning guide was designed overlaying the incisal edges of the planned provisional and the adjacent teeth (#8 and #10) to ensure the provisional position.
 Finally, the screw access hole was designed for both the guide and the provisional following the implant axis. 

Results:
 The provisional 3D position was successfully maintained by the guide.
 The cylinder pick-up was easy and fast to perform.
 Chairside fabrication was facilitated by the guide.

Discussion:

 Immediate implant loading has been reported to reach consistently high success rates, comparable to conventional loading protocol in both the mandible and maxilla.
 Some of the critical advantages of immediate restoration are significantly shortened treatment time, fewer surgeries, and immediate esthetic rehabilitation.
 The use of a provisional restoration at the time of implant placement may provide a platform to promote peri-implant soft tissue healing.
 The positioning guide can be used as a predictable option to fabricate the provisional in the planned 3D position.

Conclusions:

 The positioning guide has been shown to be an extremely useful tool for esthetic zone provisionalization when immediate loading.
 It makes the provisionalization easier and faster.