Int J Comput Dent. 2022 Jul 19;25(2):221-231.
Treatment of the edentulous maxilla with a fixed full-arch prosthesis on four immediately loaded implants has been discussed as a treatment option, although generally five implants are recommended for that indication. The precise transfer of the virtually planned position by 3D-guided implant placement is an essential prerequisite for delivering the prefabricated temporary restoration at the time of surgery. Three-point support on the teeth or implants ensures that the template for the guided surgery is soundly seated during the operation.
In the described case, the three-point support was carried out by teeth and temporary implants in the molar region inserted prior to the CBCT. The virtual implant planning determined the best prosthetic implant position while using the available bone to avoid extensive augmentation. Following this, a metal-reinforced provisional restoration was prepared using a drilling template. Four implants were placed in the planned position with the aid of a tooth-/implant-supported guide. The prosthetic axis of the angulated distal implants is balanced by 17-degree angled abutments. After transferring the implant position to the dental laboratory, the prepared restoration was finalized. The remaining teeth were extracted and the temporary restoration was delivered 3 h after implant placement. The definitive fixed full-arch zirconia restoration with micro layering was placed 9 months later in a stable situation.
The remarkable accuracy of the implant placement with a surgical template generated from preoperative virtual implant planning ensures a relatively short treatment time and an uneventful and fast recovery with minimal discomfort. The immediate prosthodontic rehabilitation is a benefit, not only for the patient but also for the dental team. Micro-layered monolithic zirconia seems to be a promising option for screw-retained full-arch prostheses.
在四颗即刻负重种植体上制作固定全口义齿已被讨论为一种治疗选择，尽管通常建议在该适应证中使用五颗种植体。通过 3D 引导种植体放置精确转移虚拟计划位置是在手术时交付预制临时修复体的必要前提。在牙齿或种植体上进行三点支撑可确保在手术过程中导板稳固就位。
在描述的病例中，三点支撑是通过在 CBCT 前插入磨牙区的牙齿和临时种植体来实现的。虚拟种植体规划确定了最佳的修复体种植位置，同时利用可用的骨量避免广泛的增强。在此之后，使用钻孔模板制备了金属增强的临时修复体。在牙齿/种植体支撑导板的辅助下，将四颗种植体放置在计划位置。倾斜远中端种植体的修复体轴通过 17 度角基台平衡。将种植体位置转移到牙科技工室后，完成了准备好的修复体。其余牙齿被拔除，并在种植体放置后 3 小时交付临时修复体。9 个月后，在稳定的情况下，放置了带有微层的最终固定全口氧化锆修复体。
术前虚拟种植体规划生成的手术模板的显著种植体放置精度确保了相对较短的治疗时间和无并发症的快速恢复，最小化不适。即刻修复体的即刻修复不仅对患者而且对牙科团队都有好处。微层整体氧化锆似乎是一种有前途的螺丝固位全口修复体选择。
