Abstract
Objective: This study aims to present a fully digital protocol—Total Digital Concept (TDC®)—for immediate loading full-arch implant rehabilitation utilizing a prefabricated definitive prosthesis, thereby eliminating the need for provisional restorations and reducing treatment time.
Materials and Methods: A case series involving patients with terminal or edentulous dentition was treated using the TDC® workflow. The protocol integrates advanced digital technologies, including intraoral scanning, facial analysis, virtual diagnostic wax-up, and CAD/CAM manufacturing. Based on STL data from digital wax-ups aligned with 2D facial photography, implant planning was prosthetically driven. Surgical guides and final prostheses were fabricated preoperatively. Implants were placed using a fully guided approach, and definitive screw-retained prostheses were delivered within the same surgical session.
Results: The digital-to-clinical translation showed high accuracy, allowing immediate delivery of pre-fabricated definitive prostheses without modification. No intraoperative complications occurred, and postoperative follow-up at 1, 2, 6, and 12 months confirmed the stability of both implants and prostheses. Patient satisfaction was high due to minimal appointments and immediate functional and aesthetic outcomes.
Conclusions: The TDC® workflow demonstrates that full-arch implant rehabilitations with immediate loading and delivery of definitive prostheses are clinically feasible through a digital approach. This technique offers enhanced efficiency, precision, and patient satisfaction. However, despite its promising outcomes, current scientific evidence on fully digital full-arch workflows remains limited. Further clinical trials must validate its long-term predictability and broaden its applicability in routine implant practice.
References
Pera F, Pesce P, Menini M, Fanelli F, Kim BC, Zhurakivska K, et al. Immediate loading full-arch rehabilitation using transmucosal tissue-level implants with different variables associated: a one-year observational study. Minerva Dent Oral Sci. 2023;72(5):230-238.
Menini M, Pesce P, Bagnasco F, Carossa M, Mussano F, Pera F. Evaluation of internal and external hexagon connections in immediately loaded full-arch rehabilitations: A within-person randomised split-mouth controlled trial. Int J Oral Implantol (Berl). 2019;12(2):169-179.
Tealdo t, Menini M, Bevilacqua M, Pera F, Pesce P, Signori a, et al. immediate versus delayed loading of dental im- plants in edentulous patients’ maxillae: a 6-year prospective study. int J Prosthodont 2014;27:207–14.
Carossa M, Alovisi M, Crupi A, Ambrogio G, Pera F. Full-Arch Rehabilitation Using Trans-Mucosal Tissue-Level Implants with and without Implant-Abutment Units: A Case Report. Dent J (Basel). 2022 Jul 1;10(7):116. doi: 10.3390/dj10070116.
Pera P, Menini M, Pesce P, Bevilacqua M, Pera F, Tealdo t. immediate versus Delayed loading of Dental implants Supporting Fixed Full-arch Maxillary Prostheses: a 10-year Follow-up report. Int J Prosthodont 2019;32:27–31.
(6) Grandi T, Signorini L. Rehabilitation of the completely edentulous mandible by all-on-four treatment concept: a retrospective cohort study with up to 10 years follow-up.
Medicina 2022; 58:10-15
Cercadillo-Ibarguren I, Sánchez-Torres A, Figueiredo R, Valmaseda-Castellón E. Early Complications of Immediate Loading in Edentulous Full-Arch Restorations: A Retrospective Analysis of 88 Cases. Int J Oral Maxillofac Implants. 2017;32(5):1116–1122.
Carossa, M.; Scotti, N.; Alovisi, M.; Catapano, S.; Grande, F.; Corsalini, M.; et al. Management of a Malpractice Dental Implant Case in a Patient with History of Oral Bisphosphonates Intake: A Case Report and Narrative Review of Recent Findings. Prosthesis 2023;5:826-839.
Fung L, Brisebois P. Implementing Digital Dentistry into Your Esthetic Dental Practice. Dent Clin North Am. 2020;64(4):645-657.
Siqueira R, Galli M, Chen Z, Mendonça G, Meirelles L, Wang HL, et al. Intraoral scanning reduces procedure time and improves patient comfort in fixed prosthodontics and implant dentistry: a systematic review. Clin Oral Investig. 2021;25(12):6517-6531.
Yogui FC, Verri FR, de Luna Gomes JM, Lemos CAA, Cruz RS, Pellizzer EP. Comparison between computer-guided and freehand dental implant placement surgery: A systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2021;50(2):242-250.
Bohner L, Gamba DD, Hanisch M, Marcio BS, Tortamano Neto P, Laganá DC, et al. Accuracy of digital technologies for the scanning of facial, skeletal, and intraoral tissues: A systematic review. J Prosthet Dent. 2019;121(2):246-251.
Carossa M, Cavagnetto D, Ceruti P, Mussano F, Carossa S. Individual mandibular movement registration and reproduction using an optoelectronic jaw movement analyzer and a dedicated robot: a dental technique. BMC Oral Health. 2020;20(1):271.
Abdullah, A.; Muhammed, F.; Zheng, B.; Liu, Y. An overview of computer-aided design/computer-aided manufacturing
(CAD/CAM) in restorative dentistry. J Dent Mater Tech 2018;7:1–10.
Joda T, Zarone F, Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review. BMC Oral Health. 2017;17(1):124.
Stanley M, Paz AG, Miguel I, Coachman C. Fully digital workflow, integrating dental scan, smile design and CAD-CAM: case report. BMC Oral Health. 2018;18(1):134.
Papaspyridakos P, Chochlidakis K, Kang K, et al. Digital workflow for implant rehabilitation with double full-arch monolithic zirconia prostheses. J Prosthodont 2020;29:460-465.
Papaspyridakos P, Chen YW, Gonzalez-Gusmao I, et al. Complete digital workflow in prosthesis prototype fabrication
for complete-arch implant rehabilitation: a technique. J Prosthet Dent 2019;122:189-192
Hassan B, Gimenez Gonzalez B, Tahmaseb A, Greven M, Wismeijer D. A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: A pilot clinical study. J Prosthet Dent. 2017;117(4):486-492.
Pera F, Pesce P, Bagnasco F, Pancini N, Carossa M, Baldelli L, et al. Comparison of Milled Full-Arch Implant-Supported Frameworks Realised with a Full Digital Workflow or from Conventional Impression: A Clinical Study. Materials (Basel). 2023;16(2):833.
Amin SA, Hann S, Elsheikh AK, Boltchi F, Zandinejad A. A complete digital approach for facially generated entire arch diagnostic wax-up, guided surgery, and implant-supported interim prosthesis by integrating 3D facial scanning, intraoral scan, and CBCT. J Prosthodont. 2023;32(1):90-93.
Coachman C, Calamita MA, Coachman FG, Coachman RG, Sesma N. Facially generated and cephalometric guided 3D digital design for complete mouth implant rehabilitation: A clinical report. J Prosthet Dent. 2017;117(5):577-586.
Wang J, Wu YL, Ma J, Wu F, Li DH. A novel implant-supported fixed complete rehabilitation technique based on a dynamic virtual patient. J Dent. 2023;137:104649.
Harris BT, Montero D, Grant GT, Morton D, Llop DR, Lin WS. Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: A clinical report. J Prosthet Dent. 2017;117(2):197-204.
Papaspyridakos P, De Souza A, Bathija A, Kang K, Chochlidakis K. Complete Digital Workflow for Mandibular Full-Arch Implant Rehabilitation in 3 Appointments. J Prosthodont. 2021;30(6):548-552.
Makarov N, Pompa G, Papi P. Computer-assisted implant placement and full-arch immediate loading with digitally prefabricated provisional prostheses without cast: a prospective pilot cohort study. Int J Implant Dent. 2021;7(1):80.
Chen C, Lai H, Zhu H, Gu X. Digitally prefabricated versus conventionally fabricated implant-supported full-arch provisional prosthesis: a retrospective cohort study. BMC Oral Health. 2022;22(1):335.
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