Using postoperative CBCT to enhance preoperative planning integration in complete arch implant rehabilitation

Abstract

In biorestoratively driven implant treatment planning, the initial prosthetic design is determined before implant placement. However, in patients with a terminal dentition, the loss of vertical dimension after tooth extraction and the absence of reference teeth complicate the alignment of the prosthetic design with the postextraction clinical situation, as well as precise occlusal registration and optimal tooth positioning. This article introduces a novel workflow that employs an additional cone beam computed tomography (CBCT) scan after implant placement to enhance data alignment, prosthetic rehabilitation, and occlusal registration for complete arch immediate loading of dental implants. By integrating preoperative and postoperative CBCT scans and utilizing stable bony landmarks as reference structures, this method effectively transfers preoperative planning into the postoperative intraoral environment. Unlike removable appliances or fiduciary markers, which are prone to misalignment, this technique ensures accurate prosthesis insertion with minimal adjustments, is adaptable to various workflows, including freehand implant placement, and provides a reliable and versatile solution to optimizing the outcomes of implant-supported prostheses.