Dr. Fabrizia Luongo
• Graduated in Dentistry at ‘Sacro Cuore’ University in Rome (2011)
• Periodontics Preceptorship Program at UCLA (2011–2012)
• Master of Science in Periodontics at the University of Rome ‘La Sapienza’ (2013–2014)
• Advanced Course of Implantology and Restorative Dentistry at the University of Guarulhos (2014)
• Since 2013, private practice in Rome and Verona mainly focused on Periodontology and Implantology
• Board member of the Digital Dentistry Society (DDS), active member since its foundation, and Ambassador of the DDS Italy between 2018 and 2022
• Author of the chapter, ‘The virtual diagnosis and treatment planning’ in the English, Italian and Chinese versions of the book ‘Digital Implantology’, edited by Quintessence International Member of the Editorial Board of the Journal of Dentistry
• Lecturer in different countries focusing on the aesthetic outcomes of implant therapy and digital technologies applied in dentistry
Dr. Giuseppe Luongo
Introduction
Introduction
Modern implant dentistry increasingly relies on digital technologies to enhance diagnostic accuracy, treatment predictability, and workflow efficiency. Among these technologies, artificial intelligence (AI) integrated into advanced imaging systems is rapidly transforming the clinician’s ability to detect pathologies, evaluate anatomical structures, and plan surgical procedures with greater confidence.
The integration of AI-based diagnostic support within dental imaging systems allows clinicians to identify lesions, assess bone quality, and streamline treatment planning while reducing the risk of diagnostic oversight. This clinical case demonstrates how an advanced imaging platform with integrated AI can support clinical decision-making from the initial diagnosis to surgical planning and final prosthetic rehabilitation.
Clinincal Case
Clinical Case
A patient presented to our clinic with multiple infiltrated prosthetic restorations in the maxillary arch. The clinical examination revealed compromised marginal integrity and signs of recurrent decay affecting several crowns and restorations (Fig 1).
An initial radiographic evaluation was performed using a panoramic radiograph (CS 9600; Carestream Dental LLC, 3625 Cumberland Blvd., Ste. 700, Atlanta, GA 30339). The image was analyzed with the support of AI-based diagnostic tools integrated into the imaging workflow. The AI-assisted interpretation highlighted apical lesions associated with teeth 11 and 27, indicating the need to extract both elements, and identified signs of marginal infiltration and secondary caries affecting multiple existing prosthetic restorations across the maxillary arch (Fig. 2).
This comprehensive AI-driven analysis was fundamental in redefining the restorative prognosis of the entire arch, supporting the decision to replace the existing prosthetic work rather than selectively treating individual units. In this way, the digital diagnostic phase enabled a shift from a problem-oriented, localized approach to a full-arch rehabilitative strategy (Fig. 3).
The early AI-assisted diagnostic phase, therefore, played a crucial role in improving lesion detection accuracy, identifying prosthetic failures that could otherwise have been underestimated, as well as guiding a more predictable and comprehensive treatment plan.
At this stage of comprehensive diagnosis, the patient expressed a desire to extend the rehabilitation to the mandibular arch. After a full clinical and radiographic evaluation, a global treatment plan was established, including a minimally invasive restorative approach for the lower arch with veneers, table tops where indicated, and a definitive crown on tooth 34. This decision allowed for a full-mouth rehabilitative strategy to be defined from the diagnostic phase onward.
“AI-based diagnostic support allows clinicians to streamline treatment planning while reducing the risk of diagnostic oversight.”
Digital Planning and Initial Treatment Phase
Digital Planning and Initial Treatment Phase
An intraoral scan was performed to digitally record the maxillary arch and to design the first provisional restoration in the anterior sector (teeth 12–22) and the crown on tooth n°27, to be replaced by an implant (Fig. 4). The digital workflow enabled the precise visualization of occlusal relationships and esthetic parameters before surgical treatment was initiated.
The clinical procedure began with the atraumatic extraction of teeth 11 and 27. A socket preservation procedure was performed at site 11 to maintain alveolar bone volume and support future implant placement. During the same appointment, teeth 12, 21, and 22 were prepared to support the provisional restoration (Fig. 5).
Following the initial healing phase, additional maxillary teeth were prepared, and a provisional restoration spanning teeth 16–13 and 23–26 was delivered. This staged approach enabled functional rehabilitation while maintaining optimal tissue-healing conditions at the extraction sites (Fig. 6).
Radiographic Reassessment and Surgical Planning
Radiographic Reassessment and Surgical Planning
Approximately 45 days after the extractions, a cone beam computed tomography (CS 9600, Carestream Dental LLC, 3625 Cumberland Blvd., Ste. 700, Atlanta, GA 30339) scan was performed to evaluate the healing status of sites 11 and 27 in preparation for implant placement. The advanced imaging capabilities of the Carestream CS 9600 enabled a detailed three-dimensional assessment of bone morphology, density, and anatomical relationships (Fig. 7).
One of the key advantages of this workflow was the possibility to initiate the implant planning phase directly within the CBCT software environment. Immediately after image acquisition, the clinician virtually positioned the implants in sites 11 and 27 based on available bone volume and prosthetic requirements. The software enabled selection of the most appropriate implant geometry for each clinical situation, including the choice of implant diameter and length, thereby enabling an early prosthetically driven planning approach (Fig. 8A, B).
Following the initial planning phase in the CBCT software, the treatment plan was further refined using dedicated implant planning software. This second step enabled more detailed control over implant positioning and the digital design of a fully guided static surgical template.
A tooth-supported surgical guide was then digitally designed and manufactured based on the finalized virtual treatment plan. The ability to preview the surgical template in the planning software enabled the precise verification of implant positioning, significantly improving procedural predictability before the surgical intervention (Fig. 9).
Implant Placement and Prosthetic Workflow
Implant Placement and Prosthetic Workflow
The guided surgical procedure was performed using the previously fabricated tooth-supported surgical guide. Two implants were successfully placed at sites 11 and 27, per the digital treatment plan (Fig. 10).
A 3-month osseointegration period was observed, enabling stable bone healing around the implants. During this time, definitive restorations were delivered in the posterior sectors, restoring function and stability to the patient’s occlusion. In addition, a new provisional restoration was fabricated and delivered in the anterior region to maintain esthetics and soft tissue conditioning (Fig. 11).
After completion of the healing phase, a second-stage surgical procedure was performed to expose the implants. Scan bodies were placed, and an optical impression was acquired using an intraoral scanner to capture the precise 3D position of the implants (Fig. 12).
This fully digital workflow enabled accurate transfer of implant positioning data to the laboratory, ensuring high precision in the fabrication of the definitive restorations.
“This fully digital workflow enabled accurate transfer of implant positioning data to the lab, ensuring high precision in the fabrication of the definitive restorations.”
Final Prosthetic Rehabilitation
Final Prosthetic Rehabilitation
Following the digital impression and laboratory fabrication process, single crowns were delivered in the anterior sector (teeth 12–22). The final restorations achieved optimal functional integration, esthetic harmony, and long-term stability (Fig. 13).
In parallel, the mandibular rehabilitation was completed according to the pre-established global treatment plan, including veneers, table tops in selected posterior teeth, and a definitive crown on tooth 34.
This integrated full-mouth approach enabled harmonized functional and esthetic rehabilitation within a unified digital workflow (Fig. 14).
The digital workflow enabled precise control of emergence profiles, occlusal relationships, and soft-tissue support, resulting in predictable clinical outcomes and high patient satisfaction.
Discussion
Discussion
This clinical case highlights the expanding role of AI in modern dental diagnostics and treatment planning. AI-assisted imaging systems represent a significant advancement in the clinician’s ability to detect pathology, evaluate anatomical structures, and support evidence-based decision-making.
The integration of advanced imaging technology into daily clinical practice offers several advantages:
- Improved diagnostic accuracy through the automated detection of pathological findings
- Enhanced visualization of anatomical structures
- Streamlined treatment planning and communication
- Increased predictability in guided implant surgery
- Reduced risk of clinical errors
Furthermore, the combination of AI-supported imaging, digital planning software, guided surgery, and intraoral scanning enables a fully integrated digital workflow that improves efficiency while maintaining high clinical standards.
Conclusions
Conclusions
AI is rapidly becoming an essential component of digital dentistry. Its integration into advanced imaging systems enables clinicians to move beyond traditional radiographic interpretation toward a more data-driven, predictive approach to treatment planning.
The use of AI-assisted panoramic imaging in the diagnostic phase, followed by CBCT-based digital planning, supported accurate diagnostics, optimized implant positioning, and facilitated a predictable restorative outcome. As digital tools continue to evolve, the synergy between AI and clinician expertise will play an increasingly central role in delivering safe, efficient, and patient-centered care.
