Complete Digital Workflow for Complex Rehabilitation of Full Arch Immediate Implant Placement and Immediate Loading, Transforming Class II Deep-bite into Class I Profile. A dream or reality? A Case Report

Mario Hertanto DDS,  Shengtao Yang MS, Berna Saglik DDS MS FACP,  Fei Liu  DDS MS PhD FACP, Junying Li DDS MS PhD

Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry

 

Background

• Nowadays, immediate loading of full-arch implant-supported fixed prostheses has become a popular treatment option when treating edentulous patients as it increases patient comfort and acceptance with comparable outcomes to conventional and early loading protocols ¹.
• Traditional approach can be challenging to quantify how much bone is to be removed. Through a digitally made virtual patient, the operator can see “the end in mind” and confirm if the outcome will satisfy the patient.
• This report presents a complete digital workflow using a virtual patient approach to determine the relationship between a future prosthetic prototype and the patient’s smile line. This relationship forms the basis of the entire treatment, facilitating the seamless execution of full arch immediate placement and loading.
• Virtual patient is a unique approach to digital implant planning and prosthetic design². It is a numerous superimposition of patient 3D images to produce 3D volume rendering of the patient’s face, teeth, soft tissue, and bone. With the integration of CBCT, Intra Oral Scanner (IOS), and Face scans as modern diagnostic tools, the fabrication of virtual patients becomes more accessible².

 

Clinical Report

• A 63-year-old healthy male, non-smoker patient suffered partial edentulism with the chief complaint: “I cannot eat or smile. I want dental implants to replace my missing teeth.”
• Clinical examinations showed a few terminal maxillary teeth, a class II profile, and an anterior deep bite. After discussing the risks and benefits of various treatment options, the patient chose a full-arch implant-supported fixed prosthesis.

 

Discussion

1. Virtual patient planning is beneficial for treating complex cases. The surgical planning and prosthetic design can be facilitated by having bone, intraoral soft tissue, and face at one framework².
2. In this case, we use a tooth-supported guiding stent as a reference to guide the fixation of the bone reduction guide as it is proven a good level of accuracy for immediate implant placement and loading ³.
3. The virtual patient provides the benefit of diagnosis and treatment planning even when the patient is absent, reduces visits, and maximizes treatment care ².

 

Summary

1. This report describes a step-by-step procedure guide and highlights the accuracy of a fully digital workflow using virtual patient approach to meet complex rehabilitation needs, successfully transforming a class II deep bite into a class I.
2. The outcome demonstrating precision translation of the planning, accuracy in occlusion, superior smile, and patient-reported high satisfaction.

 

References

1. Makarov N, Pompa G, Papi P: Computer-assisted implant placement and full-arch immediate loading with digitally prefabricated provisional prostheses without cast: a prospective pilot cohort study. International journal of implant dentistry 2021;7:1-9
2. Li J, Chen Z, Dong B, et al: Registering maxillomandibular relation to create a virtual patient integrated with a virtual articulator for complex implant rehabilitation: a clinical report. Journal of Prosthodontics 2020;29:553-557
3. Baruffaldi A, Baruffaldi A, Baruffaldi M, et al: A suggested protocol to increase the accuracy of prosthetic phases in case of full-arch model-free fully guided computer-aided implant placement and immediate loading. Oral and Maxillofacial Surgery 2020;24:343-351