Dr.Baruffaldi presents a guided surgery protocol for the rehabilitation of a full lower arch through fixed prostheses on implantsIn modern dentistry, numerous technologies have increasingly taken hold that allow us to make our workflow more predictable.In the specific case of implantology, we can rely on the various guided surgery techniques that integrate a CAD drawing of the prosthesis and the subsequent design of the implant position.The case presented here involved rehabilitation of the lower arch using the DIGIT protocol (Digitally Guided Implant Therapy, "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 ”, by A. Baruffaldi, M. Baruffaldi, C. Maiorana, PP Poli).In-depth technique in the Edra book just published "Digital techniques in surgery and implementing prostheses - From the chair-side to the DIGIT-Skyn concept technique"Clinical case The 72-year-old patient reported only a controlled hypothyroidism in therapy.At the level of the upper arch she presented a previous rehabilitation on implants carried out by a colleague, while below there was a situation of partial edentulism with second and third degree mobility of the residual elements.It was therefore decided to opt for a remediation of the compromised elements and to proceed with a fixed rehabilitation on implants.On the basis of an optical impression and a CBCT, a virtual diagnostic wax-up was made using as a reference the vertical dimension and the occlusion of the patient which, as can be seen, were still preserved.Based on the wax-up, the positions of the six implants that would support the prosthesis were planned.As regards the type of prosthetic connection, the conometric solution was chosen, thus coupling the implant abutments to secondary cups incorporated in the prosthesis by friction.Therefore, using the virtual wax-up and implant planning, the following were produced before the intervention:The combination of the DIGIT technique and the conometric prosthesis has many advantages:The following images illustrate the development of the case.Figs.1-4 Intraoral photos showing the high degree of periodontal compromise of the residual elements and the vertical dimension which is still preservedFig. 5 Radiographic image of the initial situationFig. 6 Virtual diagnostic wax-up based on optical impression and CBCTFigs.7-9 Components of the surgical template: the guide for positioning the pins, the one for inserting the implants and, finally, the temporary prosthesis, whose position is always guided by the ball attachments on the base templateFigs.10-13 Once the base template has been inserted, we proceed with the extractions and the positioning of the implants followed by the conometric abutments.A vestibular regeneration is performed with biomaterials to the implants of the 4th quadrant, and it is chosen not to load the implant in area 46 for reasons of insufficient primary stabilityFigs.14-16 The temporary prosthesis is lowered onto the conometric caps and, once finished and polished, it is inserted into the patient's mouth and the conometry is activatedFig. 17 The preservation of a correct occlusal relationship is guaranteed by the guide of the template with the pins, which allows to faithfully transpose what previously planned into the patient's oral cavity.Figs.18, 19 Healing at 6 months and packaging of the final prosthesis with reduced flanges in the distal area to facilitate home hygiene maneuvers, in agreement with the patientFig. 20 1-year control orthopanoramic showing good stability of bone levelsinsights 30 May 2022insights 30 May 2022On the occasion of World No Tobacco Day, the Straumann Group together with the 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