Full digital implant workflow utilizing the one-abutment one-time concept

Abstract

This case presentation aims to demonstrate a full digital implant planning, surgical and prosthetic workflow utilizing the one-abutment one-time (OAOT) concept. Type III implant placement after socket preservation with platelet-rich fibrin (PRF) was scheduled for a patient at location 46. Initial intraoral scans with a corresponding digital wax-up and CBCT data were imported into implant planning software (SMOP). The surgical template was 3D printed, while a digital scan-body representing implant position was extracted and uploaded into CAD software (EXOCAD) in order to plan and mill a definitive custom hybrid zirconia abutment and a PMMA temporary crown prior to surgery. Static navigation for implant placement utilizing a pouch roll flap technique together with the placement of the definitive abutment and the temporary crown were used in order to achieve an immediate non-functional loading supplemented with the OAOT protocol. Four months postoperatively, a prefabricated zirconia framework (designed in the CAD software on top of the custom abutment) was porcelain veneered after rescanning the abutment intra-orally for 3D printed models and was delivered. The implant healed uneventfully resulting in a favorable soft tissue marginal contour without any buccal recession. Periapical X-rays showed no signs of marginal bone loss at the 1 and 2 years postoperative controls. The OAOT concept together with the utilized flap technique for soft tissue thickening resulted in zero bone loss and marginal gum stability. Digital technologies can help to preplan and fabricate individualized abutments prior to surgery to fulfill OAOT protocols.