Full Arch Implant Provisionalization Using Magnet-Stackable Surgical Guides: A Dental Technique
Objectives
The utilization of a digital approach in fully-guided implant placement protocols enables the consolidation of surgical and prosthetic steps into a single-visit procedure.1,2,3,4,5 This new digital surgical and prosthetic protocol allows for prosthesis fabrication using magnet-stackable guides.6,7,8,9 This protocol utilizes magnets that ensure accurate alignment of the stackable surgical guides. The presented protocol can be used without a digital scan during surgery, thus providing precise prosthesis placement on the same day.
Additionally, magnet-incorporated guides offered easy removal and placement of the stackable guides.
Technical Steps
1.The patient underwent an intraoral scan with and without an overlay wax rim at the proposed vertical dimension of occlusion (Fig. 1, 2, 3).
2.The intraoral scan and CBCT were merged, and three guides were designed using BlueSkyBio, Exocad, and Meshmixer:
oTooth-borne positioning guide for anchorage pins.
oImplant drilling and placement guide.
oMagnet-stackable prosthesis loading guide.
3.The final magnetically retained loading guide was used to deliver a full-arch implant-supported prosthesis without the need for additional scans or impressions on the day of surgery.
4.The first guide was utilized over the teeth to drill anchorage pin osteotomies (Fig. 4).
5.After teeth extraction, the second fully-guided implant placement guide was secured into the same anchorage pin osteotomies (Fig. 5).
6.Multi-unit abutments were placed on the implants to achieve the desired parallelism as designed (Fig. 6).
7.Temporary abutments were placed on the multi-unit abutments.
8.The third two-piece magnet-stackable guide was secured into the same anchorage pin osteotomies (Fig. 7).
9.The prosthesis and the magnet-stackable guide assembly were secured intraorally using magnets and guiding pins (Fig. 8, 9).
10.PMMA was used to connect temporary abutments to the prosthesis, which was then finished extraorally while surgical sites were sutured.
11.The completed interim prosthesis was inserted, and the patient was followed up at two weeks (Fig. 10, 11, 12).
Discussion
The guided approach presented requires thorough analog and digital planning before surgery. A magnet-stackable guide enables the use of a single-pin anchorage guide for bone reduction, implant placement, and prosthesis loading. This guide ensures more predictable spatial and axial placement of implants and the pre-planned prosthesis. Additionally, magnet-stackable guides offer easy access and clear visualization of the surgical site during the procedure.
Conclusion
The presented protocol allows for predictable and time-efficient accurate positioning of implants and implant-supported provisional prostheses.
References
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