Digital customized abutment planned before implant surgery: merging SS, 1A1T, Surgical stent, Prf an immediate crown on upper molar: A 4-year follow-up study

Abstract

The goal of the present study was to introduce a new entirely in-house technique, based on digital patient data, used to create customized abutment and temporary crown, according to the anatomical limits and virtual position of the implant. The entire design and production took place before the surgery time and was based on both digital accuracy and biologic healing pattern promoted by Socket Shield (SS). The surgical phase consisted of replicating the digital project by inserting the implant in same position with accuracy. The Dicom file from CBCT and the intraoral scanner.Stl files were combined to collect all specific data and measurements in order to create models of the abutment and crown. A good-quality surgical stent was implemented, centering the osteotomy on the inter-radicular bone septum, in order to allow optimal primary stability and to provide reference points for accuracy during implant insertion. The implant with suitable threads configuration and connection quality was inserted with a manual check, replicating the virtual planning of the implant and allowing the immediate mount of the abutment (one abutment one time (1A1T)) and a provisional crown, made in advance. The post-extraction spaces were filled with Prf. A digital copy of the initial crown, in lithium disilicate, was then cemented after 6 months. The SS, which included both vestibular and palatal laminae prevented the known phenomenon of tissue remodeling in the post-extraction phase. The gingival tissue matured favorably around the abutment, inserted in the surgical phase and never removed (1A1T) with the recovery of the gingival recession on the mesial root, also thanks to the contribution of the Prf. The clinical result was stable initially and over time, with a 4-year follow-up. This is a proof of principle case report: the possibility offered by the digital technology to collect true anatomical data, to be used on a difficult area such as the molar maxillae. Skills are required both on the digital planning side (including the valuation of biological data) and on the surgical sessions, and demanding in terms of the range of accuracy required for correct implant position. The introduction of dynamic guided implantology could simplify tremendously the procedure. Initial diagnosis, correct planning, and surgical approach are the key factors for immediate and long-term results.