Fully Guided Implant Placement and Immediate Provisionalization in the Maxillary Aesthetic Zone Using Prefabricated Restorations

Introduction: When replacing a single tooth in the aesthetic zone with an implant, alveolar ridge preservation is necessary in cases with extensive buccal bone defects. Prosthetically driven implant placement in the preserved ridge, followed by an immediate patient-specific temporary restoration, can be achieved with digital treatment planning. A digital workflow incorporates intraoral optical scanning and cone beam computed tomography, enabling a three-dimensional clinical and radiographic anatomy assessment. Furthermore, it facilitates fully guided implant placement by means of computer-assisted surgery and the prefabrication of temporary restorations with a CAD/CAM titanium abutment. 

Materials and Methods: Three patients with a failing tooth in the maxillary aesthetic zone and a buccal bone defect > 5 mm underwent alveolar ridge preservation. Four months later, a digital workflow was used to place the implant, which was restored with a prefabricated temporary restoration with a patient-specific titanium abutment. The definitive restoration was placed 3 months later. Clinical, aesthetic, radiographic, and patient-reported outcomes were assessed before treatment, 6 weeks after temporary restoration, and 1 month and 1 year following definitive restoration. 

Results: In all three cases, wound healing after alveolar ridge preservation was uneventful, and the implants could be placed and restored with a temporary restoration, as planned. At the final follow-up, healthy peri-implant tissues were observed with good aesthetics and high patient satisfaction. 

 Conclusion: The three reported cases demonstrate the potential of a digital workflow for delayed implant placement with provisionalization using prefabricated restorations in preserved ridges within the maxillary aesthetic zone.