(T13) Implant-supported Surgical Guide: Case Report of a Novel Prosthesis-integrated Approach

Purpose of the Study: To present a case report in which an implant supported, prosthesis-integrated surgical guide served a dual function by providing static guidance and enabling intraoperative verification of key prosthetic parameters.

Methods: Cone beam CT (DICOM) and maxillary–mandibular intraoral scans (STL) were acquired and merged in coDiagnostiX® to plan implant positions within a prosthetically driven envelope, with vertical dimension, occlusal plane, esthetic display, and restorative space derived from the provisional contours [1]. Provisional or template teeth were then generated using the Double Digital Scanning (DDS) technique by superimposing a scan of the trial prosthesis onto the intraoral scans to capture definitive esthetic and phonetic contours for full arch rehabilitation; the merged dataset informed tooth position, anterior–posterior relationship, and arch form [6,7]. The maxillary provisional was CAD/CAM modified to accept titanium guide sleeves, creating a prosthesis integrated surgical guide; sleeve diameter and offsets followed manufacturer specifications. The guide prosthesis was fabricated via a validated workflow (additive or subtractive per software output) and sterilized according to manufacturer instructions [3].
Under local anesthesia, a flapless, fully guided protocol was used. After complete seating verification of the prosthesis guide, sequential guided osteotomies and implant placement were performed per the compatible guided kit [5]. Prior to initiating osteotomies, the seated prosthesis guide was used for intraoperative verification of key prosthetic parameters including phonetics (sibilants and fricatives), anterior–posterior position relative to the planned occlusal and esthetic planes, and arch form harmonization. Postoperative records including CBCT and periapical radiographs were registered to the preoperative plan to document entry, apex, and angular deviations, and clinical records captured primary stability and esthetic–phonetic acceptability. Methodological choices, including the use of flapless guidance and adherence to sleeve parameters, were based on evidence supporting accuracy and minimally invasive protocols [1–3,5].

Results: The prosthesis integrated surgical guide seated passively and remained stable throughout the procedure. Intraoperative checks with the seated prosthesis confirmed acceptable phonetics on sibilant and fricative sounds, anterior posterior positioning consistent with the planned occlusal and esthetic planes, and an arch form that harmonized with the planned contours; no adjustments to the planned osteotomy trajectories were required prior to drilling. All implants were placed flapless under full guidance as planned, without the need to raise a flap or place sutures. Immediate postoperative clinical assessment showed satisfactory esthetics and speech intelligibility, with minimal soft tissue morbidity. Postoperative cone beam imaging registered to the preoperative plan demonstrated implant positions within the prosthetically defined envelope, with entry, apex, and angular deviations within clinically acceptable thresholds reported for static guided surgery. No intraoperative complications or early postoperative adverse events were observed.

Conclusion: A prosthesis integrated surgical guide can serve a dual function by preserving the placement accuracy of static guidance while enabling intraoperative verification of speech, anterior posterior positioning, and arch form. Within the context of flapless, fully guided surgery, and supported by digital planning and DDS based prosthetic design, this concept advances prosthetically driven care beyond plan transfer alone [1–7]. Controlled studies are warranted to validate accuracy, efficiency, biologic and technical complication rates, and patient reported outcomes compared with conventional guide designs [1–5].

Articles: 1. Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29(suppl):25-42.
2. Gallardo YNR, da Silva-Olivio IRT, Mukai E, Morimoto S, Sesma N, Cordaro L. Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis. Clin Oral Implants Res. 2017;28(5):602-612. doi:10.1111/clr.12841
3. D’Haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer-guided implant surgery. Periodontol 2000. 2017;73(1):121-133. doi:10.1111/prd.12175
4. Papaspyridakos P, De Souza A, Kudara Y, et al. Screw-retained surgical guide for implant placement in terminal dentition patients with existing implants: technical report. J Prosthodont. 2022;31(7):639-643. doi:10.1111/jopr.13559
5. Romandini M, Ruales-Carrera E, Sadilina S, Hämmerle CHF, Sanz M. Minimal invasiveness at dental implant placement: a systematic review with meta-analyses on flapless fully guided surgery. Periodontol 2000. 2023;91(1):89-112. doi:10.1111/prd.12440
6. Chochlidakis KM, Romeo D, Ercoli C, Papaspyridakos P. Complete digital workflow for prosthesis prototype fabrication with the double digital scanning (DDS) technique: a prospective study on 16 edentulous maxillae. J Prosthodont. 2022;31(9):761-765. doi:10.1111/jopr.13569
7. Papaspyridakos P, Chochlidakis K, Kang K, Chen Y-W, Alghfeli A, Kudara Y, et al. Digital workflow for implant rehabilitation with double full-arch monolithic zirconia prostheses. J Prosthodont. 2020;29(6):460-465. doi:10.1111/jopr.13166

Books: N/A (all references are peer-reviewed journal publications)