A simplified digital workflow for the prosthetic finishing of implant rehabilitations: a case report

Abstract

The aim of this article is to describe how, during the provisional and definitive prosthetic phases, using new digital technologies, it is possible to improve the ergonomics of the prosthetists work and reduce the discomfort of patients, subjecting them to the fewest possible appointments at the dentist. The proposal of a full digital protocol, described by the following case report, for the realization of a definitive prosthetic rehabilitation supported by a reduced number of implants, in fact, allows to considerably reduce the number of appointments and reduce any bias. A 67-year-old male patient presents for the first visit to the Department of Dentistry of the San Raffaele Hospital, wearing a removable upper prosthesis and with the request to heal the aesthetic and functional situation through prosthetics fixed. An initial panoramic radiograph was performed, intra and extra oral photos were taken and also intraoral impressions. A stereo-lithographic models are obtained from intraoral scans, and two total prostheses, upper and lower, were packaged for the provisional post-surgical phase was performed. In accordance with the All-on-4 method 8 implant fixtures were placed. For the final prosthetic phase, the patient underwent only two operative sessions. In the first session, scans were taken with the provisionals in situ, of the patients mucous membranes and with the Scan-abutments in place. In the second session using specific CADSoftware the matching of the STL files of the three scans were created, the opposing arches of the patient were related on a digital articulator, and the milled titanium bars were immediately constructed and finished with the resin. Finally, the definitive prostheses were delivered to the patient without any other test. Digital technology has allowed a clear reduction in working times and costs and has allowed the reduction of stress for patients who undergo invasive and extensive treatments to recover aesthetics and function, and for clinicians who must manage complex cases with fewer appointments possible.