Traditional prosthetic workflow for implant rehabilitations with a reduced number of fixtures: proposal of a protocol.

The aim of this study was to describe a standardized protocol for the creation of a definitive prosthetic rehabilitation supported by a reduced number of implants, achievable with a limited number of an optimized appointments. The proposed protocol provides only for 4 appointments to finalize the set work. During the first appointment, definitive impressions are taken in order to obtain the master models and plaster bars. The second appointment is the most important: the aesthetic and functional evaluations of the provisional prostheses are carried out and the plaster bars tested. During the third appointment the teeth test is performed, with the corresponding phonetic and functional test. In the fourth appointment the definitive prostheses are delivered and screwed. The fundamental aspect of prosthetic finalization is the simplification and standardization of protocols to obtain better control of all different steps and to reduce the number of appointments with the patient. The realization of a correct definitive prosthesis is the key to long-term success in implant rehabilitation and can improve the patient's quality of life in various aspects. By optimising the time and standardising the procedures, it is possible to make definitive prostheses for rehabilitations with a reduced number of implants of excellent quality in only 4 appointments.

A simplified digital workflow for the prosthetic finishing of implant rehabilitations: a case report.

The aim of this article is to describe how, during the provisional and definitive prosthetic phases, using new digital technologies, it is possible to improve the ergonomics of the prosthetist's work and reduce the discomfort of patients, subjecting them to the fewest possible appointments at the dentist. The proposal of a full digital protocol, described by the following case report, for the realization of a definitive prosthetic rehabilitation supported by a reduced number of implants, in fact, allows to considerably reduce the number of appointments and reduce any bias. A 67-year-old male patient presents for the first visit to the Department of Dentistry of the San Raffaele Hospital, wearing a removable upper prosthesis and with the request to heal the aesthetic and functional situation through prosthetics fixed. An initial panoramic radiograph was performed, intra and extra oral photos were taken and also intraoral impressions. A stereo-lithographic models are obtained from intraoral scans, and two total prostheses, upper and lower, were packaged for the provisional post-surgical phase was performed. In accordance with the All-on-4 method 8 implant fixtures were placed. For the final prosthetic phase, the patient underwent only two operative sessions. In the first session, scans were taken with the provisionals in situ, of the patient's mucous membranes and with the Scan-abutments in place. In the second session using specific CADSoftware the matching of the STL files of the three scans were created, the opposing arches of the patient were related on a digital articulator, and the milled titanium bars were immediately constructed and finished with the resin. Finally, the definitive prostheses were delivered to the patient without any other test. Digital technology has allowed a clear reduction in working times and costs and has allowed the reduction of stress for patients who undergo invasive and extensive treatments to recover aesthetics and function, and for clinicians who must manage complex cases with fewer appointments possible.