Dr. Luca Comuzzi
• Oral Surgeon, Periodontist, Prosthetist
• Msc In Periodontology University of Nijmegen, The Netherlands on year 2000 EFP Certified General Practitioner
• 30 years of practice 17000 implant placed
• Specialized in the Use of Computer Assisted Navigated surgery with Navident
• Specialized in complex Biconometric rehabilitation with full arch and Navigation
• President of Revcon Academy
• Active member BBB Academy, DNS Society, and Lecturer of number of Italian and International Events.
• Lecturer for AAID in Las Vegas 2023
• Visiting Professor of Dynamic Implant Dentistry at Unicamillus Medical University in Rome in 2024
introduction
introduction
The case illustrates the use of a dynamic digital navigation for flapless implant insertion and a biconometry prosthetic solution.
Clinical case
Clinical case
A 35-year-old patient presented to the clinic with an infectious and esthetic problem at 12 and 22, 6 years after the placement of an internal hexagon implant (Fig. 1–2) and a cemented prosthesis (Fig. 3).
After careful examination and evaluation of the different possibilities, it was decided to plan the explantation of both implants on 12 and 22, using special BTI inserts for implant removal (Fig. 8).
Th extraction sites were regenerated using OsteoBiol® GTO®collagenated porcine bone covered with a 1-mm derma membrane above the graft (Fig. 4–7).
“Extraction sites were regenerated by means of OsteoBiol® GTO® Collagenated bone covered with 1mm thick derma membrane above the graft.”
The provisional phase for 12 and 22 (~5 months) involved Maryland-type prostheses fixed to adjacent teeth.
The X-ray after 3 months (Fig. 9–10) showed a good regenerative response, which was further consolidated after 6 months.
After ~ 6 months, implant planning was performed using Navident Software for Dynamic Guided Surgery (Fig. 11–12), and the Maryland bridges on 12 and 22 were removed.
Dynamic guided implant placement without flap elevation (Fig. 13–15) was performed in a precise, minimally invasive, and digitally predetermined manner, without the aid of static surgical guides.
RX at surgery confirmed good implant positioning (Fig. 16–17).
“Maryland bridges were removed for dynamic guided implant placement without flap elevation in a very precise, minimally invasive and digitally predetermined way, without the aid of static surgical guides.”
After 4 months, the Maryland bridges were removed again (Fig. 18), and conometric abutments were applied (Fig. 19).
An optical digital impression was taken to finalize the case with biconometric prostheses (Fig. 20-21).
Six months later, the results were checked and photographed (Fig. 22).
“There is excellent integration of implants with Cone-Morse connection in prosthetic biconometry inserted in regenerated bone.”
At 3 years (Fig. 23–25), the patient demonstrated excellent integration of implants with a Cone-Morse connection in prosthetic biconometry inserted into regenerated bone and good maintenance of gingival and bone volumes.
Notably, despite the presence of a gummy smile, the harmony of the gum profiles was preserved over time.
