Full-arch restoration with immediate loading using Nobel Biocare’s 100% fully digital workflow and ICam photogrammetry for post-fabricated provisional technique
Dr. Renaud Noharet
France
“Nobel Biocare’s digital solutions significantly enhance the accuracy and predictability of full-arch treatments. These advanced tools improve patient experiences through their efficient and reliable performance.”
Patient: 79 years old, female, no systemic diseases, periodontal disease, presents with functional and esthetic complaints (visibility of roots in anterior area).
Clinical situation: Periodontal disease and mobile bridges on upper jaw (fracture of some roots coupled with bone loss).
Surgical solution: Extraction of remaining upper teeth, immediate placement with Nobel Biocare N1™ implant system using navigated surgery with X-Guide®. Immediate loading with IOS Dexis IS 3800 to record soft tissue, and photogrammetry with ICam to record implant's position.
Temporization: Immediate loading with 3D printed provisional directly screwed on Multi-unit Abutment.
Surgery date: October 6, 2023
Total treatment time: 6 months
Tooth position(s): Full arch rehabilitation in the maxillary region.
Initial situation (left).
Initial situation X-ray (right).
Intraoral clinical picture (left).
Intraoral clinical picture maxilla (right).
DICOM (left), PLY (center), clinical picture (right).
Merging DICOM & PLY (left), PLY (center), Cross sectional alignment between DICOM & PL (right).
PLY maxilla (top left), PLY mandible (bottom left).
Maxillary STL file (top right). Maxillary STL file merged with PLY file (bottom right).
Nobel Biocare N1 implant position planned according to the prosthetic wax up (left: frontal view, right: occlual view).
Fixing X-Guide tracker with EDX screws in the patient’s upper jaw to prepare for X-Mark™ protocol (left).
Calibration following X-Mark protocol, identification of clear reference points to calibrate accuracy of X-Guide (right).
Nobel Biocare N1 implant system placed. The visual on the top right displays the exact implant placement allowing for more accuracy and predictably.
Extraction, immediate implant placement with Nobel Biocare N1 implant system. Remaining teeth were conserved to use as reference points between preoperative and postoperative scans (step 8) (left).
Multi-Unit Abutment placement (right).
Post-operational intraoral scan, also called soft tissue scan using position locators on Nobel Biocare’s Multi-unit Abutment (left).
Post-operational photogrammetry scan using ICam specific position locators to accurately capture implant positions (right).
Post-operational STL intraoral file imported in IMETRIC3D software, for repositioning step with photogrammetry scan file (left).
Photogrammetry scan showing exact implant coordinates in IMETRIC3D software, for repositioning step with post-operational STL intraoral file (right).
Repositioning maxillary prosthetic wax up with exact implant coordinates previously matched in IMETRIC 3D software (step 12) (left).
Screw channel positions with exact implant positions in lab software (center).
Final maxillary prosthetic wax up, ready for printing (right).
Final prosthetic wax-up design in occlusion (left).
Smooth surface on the intaglio surface to adjust compression on soft tissue for FP1 restoration. No titanium base or Multi-unit temporary copings will be used (right).
Full-arch provisional printed using the SprintRay Pro 55s 3D printer, using OnX Tough resin.
Maxillary 3D printed provisional stained & glazed. Frontal view (left).
Maxillary 3D printed provisional stained & glazed, connection straight on Multi-unit Abutment (no titanium base as intermediate component) (right).
Maxillary 3D printed provisional with inserted analogs (fitting check). Frontal view (left).
Maxillary 3D printed provisional with inserted analogs (fitting check). Side view (right).
Provisional at 6 months follow up (left).
X-ray at 6 months follow up (right).
Patient’s smile at 6 months follow up.
Final NobelProcera® restoration delivered at 10 months.
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Nobel Biocare N1™ systemChange the way you treat patients.
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X-Guide®Free-hand surgery with a real-time 3D guidance of your drill.
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DEXIS™ IS intraoral scannersPut world-class scanning functions in your hands.
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ICamICam is the closest you'll ever come to a guaranteed passive fit.
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Multi-unit AbutmentKey to the original All-on-4® treatment concept.
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