Guided and definitive full arch with conometric prosthesis

Abstract

To test a new 3D-printing technology (Hi-Fiber), associated with cono-morse connection implants and conometric caps for retention, to build a final prosthesis to deliver the same day of the computer-guided and immediate loading implant surgery. Male patient (57 years) needed to rehabilitate his masticatory function due to terminal dentition in the lower jaw. We used implants with cono-morse internal connection and the final prosthesis was delivered the same day of the surgery, connected to the immediate implants through conical caps with conical connection, without any screw or cement. The surgery was computer-guided until the implant insertion, then the conical abutments were inserted manually using special instruments to make them parallel for the conical caps. The final prosthesis was built from the initial data (CBCT and 3D printed models) using a new 3D printed fiber glass fiber as a structure for the full arch, that was delivered the same day. Currently, surgical planning software gives the opportunity to export a Standard Triangle Language (STL) format file that contains the information of the location of the implant in a virtual master model. This is possible through an advanced virtual subtraction of implant bodies from digital oral reconstruction. Utilizing a 3D printing process, it is possible to obtain a physical master model with the spaces for the implants or abutments replicas, avoiding the conventional pour in cast process. Once printed, analogs can be positioned easily and accurately into the prototype, and this model can be used to fabricate the immediate prosthesis to utilize after the surgery, a very useful tool, especially if we want to deliver a final one in the same day, reaching a definitive full arch, as in this particular case report we used implants with cono-morse connection (1.5° each side), conometric abutments and conometric caps to fix the full-arch prosthesis (built with a new 3D printed glass-fiber technology and composite). This concept allows us to minimize micro gaps between implants and abutments, and micro-movements of the prosthesis, stabilizing the peri implants environments. The use of a prefabricated - 3D printed glass fiber framework - provisional prosthesis for full-arch immediate loading created from a new printing technology using a patented software and a 3D printed master model seems to be a predictable treatment option when computer-guided implant surgery is performed. This new material, with the possibility to cement the conical caps (as far as the cylinders for the screw-retained prosthesis), allows the clinicians to deliver the same day final prosthesis with optimal mechanical properties (low weight and strength) to ensure comfort and durability to the patients, maintaining aesthetic due to the natural color of the fibers under the composite resins. Cono-morse conometry at the implant/abutment connection ensures a stable interface between the components and conometry at the prosthetic interface ensures a stable environment against the occlusal forces and the micro-movements, allowing us to detach the prosthesis in a few seconds if we want to evaluate (or rebase and fix) the situation of the soft tissues underneath.