Chairside Protocol for Posterior Single-Unit Implant Restorations in a Complete Digital Workflow

Case Report

Austin J Dent. 2018; 5(2): 1104.

Chairside Protocol for Posterior Single-Unit Implant Restorations in a Complete Digital Workflow

Joda T¹*, Ferrari M² and Zitzmann NU³

¹Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Switzerland

²Department of Prosthodontics & Dental Materials, School of Dental Medicine, University of Siena, Italy

³Department of Reconstructive Dentistry,University Center for Dental Medicine Basel, University of Basel, Switzerland

*Corresponding author: Joda T, Head, Section for Digital Reconstructive Technology and Implant Dentistry, Department of Reconstructive Dentistry School of Dental Medicine, University of Bern, Switzerland

Received: December 22, 2017; Accepted: January 19, 2018; Published: January 31, 2018


Aim: Introduction of a step-wise sequence for chairside treatment with a posteriorsingle-unit implant restoration in a complete digital workflow.

Materials and Methods: The clinical case report describes the surgical andprosthodontic workflows for the rehabilitation with an implant crown using Computer-Assisted Implant Dentistry (CAID): starting with digital data acquisition and virtual treatment planning, following by guided implant placement including digital impression-taking, and finally CAD/CAM-processing and -production of the implant crown.

Results: The entire treatment protocol plus technical work steps are integrated in avalidated seamless process using original-to-original implant components for in-house production.

Conclusion: Surgical and prosthodontic protocols for the treatment with monolithicimplant crowns using CAID in a complete digital workflow without any physical models have to be considered in place of conventional manufacturing.

Keywords: Implant dentistry; Digital workflow; Chairside dentistry; Computer-Assisted Implant Dentistry (CAID); Guided implant surgery; Monolithic restoration


Restoration driven implant placement is a key factor for successful implant therapy. In this context, Computer-Assisted Implant Dentistry (CAID) offers a powerful instrument for treatment planning, surgical placement and prosthodontic rehabilitation in an interdisciplinary approach.

A prerequisite for a complete digital implant rehabilitation concept is the use of monolithic CAD/CAM-processed restorations combined with pre-fabricated abutments based on a restorative driven backward planning by 3D radiographic imaging and optical surface scanning to digitalize the individual patient situation for virtual implant simulation in order to guarantee a predictable outcome [1]. This simplified prosthodontic protocol avoids demanding laboratory work steps and ensures a streamlined production with materialspecific advantages as a result of standardized fabrication quality [2].

The clinical case shows the step-wise sequence for chairside treatment with a posterior single-unit implant restoration in a complete digital workflow. Surgical and prosthodontic work steps as well as technical fabrication are integrated in a validated seamless protocol using original-to-original implant components for in-house production.

Clinical Case

A 32-yrs old male patient was referred to our department for single-tooth replacement with an implant-supported crown. The patient was diagnosed with tooth agenesis in position FDI 45 after extraction of the resisting milk tooth (second primary molar) by the general practitioner.

The entire implant treatment for surgical and prosthodontic steps was planned and performed in a complete digital approach applying CAID:

(6) Starting with digital data acquisition; following by (2) virtual treatment planning; and consecutively (3) guided surgical implant placement; (4) digital impression; CAD/CAM-processing using a chairside milling approach for (5) designing and (6) production of the implant crown including (7) post-processing as well as prosthodontic rehabilitation with the (8) final restoration.

Step 1: Data acquisition

After clinical assessment, Cone Beam Computed Tomography (CBCT) and Intraoral Optical Scanning (IOS) were performed to digitalize the individual patient situation, and secondary processing of the 3D anatomical DICOM- and STL-files. Neither physical models nor a radiographic template was necessary during the phase of digital data acquisition.

Step 2: Planning

The DICOM-file was transferred to the virtual implant planning software (coDiagnostiX, Dental Wings, Montreal, Canada). Initially, the individual patient coordinates, the occlusal plane and the 3D visualization of the N. alveolaris inf. were prepared prior to the implant planning.

Then, the STL-file of the pre-operative intraoral situation was implemented in the computer system. Based on a point-to-point superimposition technique, both datasets were matched to each other using an automatic algorithm of the software. A virtual set-up of the prospective implant reconstruction as well as a surgical guide with optimal 3D implant positioning was realized using a restoration driven backward planning concept, whilst considering the individual anatomical situation. Once the planning phase was finished in the planning software, a 3D printer plotted the virtual construction of the surgical guide with the rapid prototyping technique based on the STLfile gathered from the IOS without the need of any physical models. Finally, the implant planning software delivers a case-specific drilling protocol with sequenced instruments for a safe and predictable 3D implant placement (Figure 1).