Fully digital workflow for flapless post-GBR implant placement and immediate temporization with 3D printing
Dr. Giacomo Fabbri, Italy
“Achieving esthetic excellence in implant dentistry is one of the most demanding aspects of a treatment —especially when time and precision are critical. The combination of DTX Studio Clinic™, X-Guide®, and SprintRay Midas allows me to plan and execute with unmatched accuracy and immediacy. This workflow doesn’t just streamline the process; it empowers me to meet high esthetic expectations with confidence, even in complex cases”
Initial clinical situation
Frontal view – initial situation intra-orally (left).
Lateral view – initial situation intra-orally (right).
Palatal view – initial situation intra-orally.
3D bone evaluation shows the apical infection, the lack of bone on the buccal site, and also an inadequate bone quantity in the palatal aspect, which is not ideal for an immediate implant placement.
Maintenance of bone volume and stability
Autogenous bone chips harvested from the posterior mandible (left).
The socket was filled with 50% autogenous bone and 50% creos™ xenogain (right).
A creos xenoprotect resorbable membrane is used to cover the site (left).
A connective tissue graft is placed on the membrane to close the site (center).
The patient had an osseointegrated implant on #12 FDI. The temporary restoration is managed with a screw-retained bridge and a mesial cantilever (right).
Soft tissue healing after 30 days.
Soft tissue healing after 30 days.
Soft tissue healing after 60 days.
Data collection
CBCT scan.
DTX Studio™
CBCT file (DICOM) (left).
IOS file (STL) (center).
Clinical pictures (JPEG) (right).
Treatment planning
Implant planning
Sagittal view on implant planning of NobelActive® RP 4.3x13 mm prosthetically driven by a NobelProcera ASC abutment (left).
Frontal view on implant and abutment planning (center).
3D view (right).
Surgical procedure
Preparation of X-Guide and calibration
Situation after removal of the temporary mesial cantilever (left).
Positioning the X-Clip (center)
Calibration of the system before surgery (right).
Implant placement
Calibration of the drill (left).
X-Guide® screen and view during the drilling sequence (center).
Positioning of the implant NobelActive TiUltra RP 4.3 x 13mm (right).
Post-surgical impression
Intraoral scan with DEXIS IS 3800W
Scan body in place, ready for IOS (left).
Post surgical .STL file (right).
Immediate loading
Design of the provisional restoration on Universal Base CC RP 3mm. Ready to be printed with SprintRay Midas.
3D printing
Nesting in SprintRay software before 3D printing (left).
10 minutes of 3D printing with SprintRay Midas (right).
Curing and finishing of the temporary crown
3 minutes of curing with SprintRay NanoCure (left).
The temporary crown is cemented onto the Universal Base (center)
Glazing, make-up and polishing before placement (right).
Curing and finishing of the temporary crown
Placement of the printed crown (left).
The crown has been placed, and adjustments have been made (center).
Temporary smile (right).
Digital records & final restoration
IOS scan
.PLY file (left).
.STL file (right).
NobelProcera ASC Abutment Zirconia on Conical Connection RP and NP
A partial cut-back design was chosen to be able to add thin layer of porcelain for optimal esthetics (left).
NobelProcera ASC Abutments were chosen to respect biology and angulation, but also to offer a cement-free solution (center).
The screw channels were angulated to 19° degrees for optimal esthetic outcomes and to maintain strength in the occlusal area (right).
NobelProcera ASC Abutment Zirconia on Conical Connection RP and NP
Finalized abutments with veneering (left).
Finalized abutments placed on 3D-printed model (right).
Situation after removal of the temporary crowns (left).
NobelProcera ASC Abutment Zirconia on conical connection RP and NP before placement (right).
Finalized NobelProcera abutments in situ (left).
Final smile (right).
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creos™ xenogain3 methods of application to meet all your bone grafting needs.
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creos™ xenoprotectA membrane with outstanding handling that facilitates bone gain.
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NobelActive®An implant like no other
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X-Guide®Free-hand surgery with a real-time 3D guidance of your drill.
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DTX Studio™ ClinicExperience faster treatment planning.
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SprintRay 3D printingDeliver cutting-edge 3D printing solutions for implant dentistry.
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SprintRay MidasEffortlessly design and print restorations in minutes.
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