Digital implant planning for a minimally invasive surgery approach: a case letter of a full-arch rehabilitation.

P rosthetically directed implant placement using computer software ensures precise fixture placement and predictable prosthetic outcomes. Computer-guided implant dentistry allows the clinician to position specific implants into presurgically determined sites, taking into account both the jawbone anatomy and the planned prosthesis within the computerized tomography (CT) images. In addition, to obtain the optimal final tooth position, the appliance should be scanned. The use of an appliance scan is essential to digitally plan the treatment and to design and then fabricate a surgical template. The planned prosthesis is integrated with anatomical data using singleor dual-scan protocols. In the single-scan appliance, a radiopaque template allows the teeth to be identified as well as the soft tissue in the CT study. However, scatter from neighboring restorations can obscure the view of teeth in the scan appliance. Also, the use of radiopaque templates reduces the image quality of the jaw bone. In the dual-scan protocol, the patient is scanned with the scan appliance and then the scan appliance is scanned alone with different exposure parameters. The planning software converts the CT scan files and merges the 2 scans by matching radiopaque markers, so that the prosthesis will be visible over the available osseous anatomy, avoiding the image’s noise. In totally edentulous patients, it is possible to use the existing denture as a scan appliance. If the prosthesis is not well fitting and the teeth are not in the correct positions, a new appliance should be fabricated. The potential for patient satisfaction is increased if the patient’s acceptance of the prosthesis is obtained before CT scans are done. The transfer of the virtual planning by means of a surgical drilling guide provides significant benefits in the simultaneous placement of multiple implants, especially in large edentulous areas. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology allows safe flapless surgery to be performed via mucosa-supported guides. The opportunity for an immediately loaded prosthesis can be facilitated by such protocols. In this case letter, a detailed clinical treatment protocol using CAD/CAM computer-guided technology for a maxillary full-arch rehabilitation is presented.