Abstract:
Introduction. Placing a dental implant to replace a central maxillary incisor can be a challenge in many
ways. Many factors need to be considered in order to generate an optimal treatment plan. An important
aspect is the degree of soft and hard tissue atrophy that often requires augmentation and bone grafting
procedures. At the same time, correct implant positioning represents one of the main challenges from
biomechanical and esthetical points of view. In this context, the anterior zone could be crucial for early
rehabilitation of the patient due to the particularities of teeth positioning.
Case presentation. The case study focused on a 32-year-old patient who was clinically and para-clinical
(CBCT) examined, at which was established the D3 (by Misch) bone density, for the following planning of
implant-prosthetic treatment. Previously, the bone addition procedure was performed. In order to achieve
a good result, the examination was performed with the prosthodontist. Following the conventional
impression and the virtual planning of the cast model, the stereolithographic model was obtained (scanned
in the laboratory) and superimposed on the CBCT, after which the surgical template for partial drilling was
made (using 3D printer ASIGA Pro 3D). The surgery was performed using partial drilling through the
surgical guide followed by osseous densification in free hand mode (Versah Drills system) and installation
of the implant followed by immediate screw retained restoration.
Discussion. A single missing central incisor is often the most difficult surgical and prosthetic challenge due
the ambition to obtain good aesthetics, but also the difficulties for the surgeon to make the ideal direction
of osteotomy. In the research it was proposed to place the implant in axial position, which allows the use
of a screw retained restoration (hiding the fixation screw channel in palatal side) as well as to obtain an
axial loading. An important role is also played by the accuracy of the guide and checking of its fitting with
the teeth. The postoperative result evaluated on the CBCT as well as in the oral cavity showed the implant
in the desired position, according to the preoperative plan.
Conclusion. Guided surgery allows us to obtain predictable results related to implant position. The use of
this technology requires additional experience due to the risks that occur both in the planning stage and in
the positioning of the guides in the oral cavity.
