Immediate Proto Co Ls and Guided Surgery Fo R Esthet Ic Success with Full- Mouth Implant Rehabilitat Ions

tive dental interventions is an optimal, longlasting outcome. Numerous techniques and technologies are available to increase the quality and predictability of dental treatment, even in severely compromised patients. These tools include immediate implant treatment protocols, minimally invasive surgical procedures, guided implant placement, and computer-aided design/computer-assisted manufacture (CAD/CAM)–fabricated all-ceramic implant components and restorations. There is now ample clinical evidence in support of immediate implant placement as a safe treatment option that preserves peri-implant bone and limits postsurgical resorption. However, in the presence of extensive periodontal or periapical lesions, a conventional multiple-step extraction and implant placement approach is still recommended. It is also evident that flapless implant placement limits chair time and postoperative complications and seems to prevent soft and hard tissue resorption. Flapless implant placement, however, requires sound knowledge of the individual bone morphology and fabrication of orientation guides to stay within these anatomic confines. Guided surgery allows proper implant selection and precise placement with a flapless approach. The exact implant dimensions, position, and angulation are planned on the computer, based on a computerized tomography (CT) scan, and transferred to a surgical template. The soft tissue collar around dental implants is very fragile, and repeated disconnection and connection of implant abutments disturbs this delicate environment and may lead to soft tissue recessions. Therefore, it is advisable to connect the Clinical Assistant Professor, Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA; Private Practice, San Sebastian, Spain. Professor and Chairman, Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.