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CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

Objectives: The use of digital devices is strongly influencing the dental rehabilitation workflow both for single-crown rehabilitation and for full-arch prosthetic treatments. Methods: In this study, trueness was analyzed by overlapping the scan dataset made with Medit I-500 (by using two different tips and two different scan strategies) with the scan dataset made with lab scanning, and the values of the (90°–10°)/2 method were reported. Precision was evaluated by using the same values of trueness coming from the intra-group overlapping (scan dataset made with an IOS overlapped and compared to each other). Moreover, two different software programs of overlapping were used to calculate accuracy values. Results: The mean difference of trueness was 26.61 ± 5.07 µm with the suggested strategy of intraoral scanning and using a new design of the tip, 37.99 ± 4.94 µm with the suggested strategy of intraoral scanning and using the old design of the tip, and 51.22 ± 6.57 µm with a new strategy of intraoral scanning and using the old design of the tip. The mean difference of precision was 23.57 ± 5.77 µm with the suggested strategy of intraoral scanning and using a new design of the tip, 38.34 ± 11.39 µm with the suggested strategy of intraoral scanning and using the old design of the tip, and 46.93 ± 7.15 µm with a new strategy of intraoral scanning and using the old design of the tip. No difference was found in the trueness and precision data extracted using the two different programs of superimposition Geomagic Control X and Medit Compare. Conclusions: The outcomes of this study showed that the latest version of I-Medit 500 with the use of a new tip seems to be promising in terms of accuracy when a full arch needs to be scanned. Moreover, Medit Compare, which is an application of Medit IOS software, can be used to calculate IOS accuracy.

A minimally invasive implant treatment approach for future full arch implant prosthetic rehabilitations of trophic jaws represents a challenge. An optimal implant planning is strongly related with an accurate merge of the prosthetic information and the radiographic data. To comply with that, most computer aided implantology (CAI) systems require additional steps, as radiographic stents or fiducial markers to overlap digital jaw scans to cone beam computed tomography (CBCT) data. Using dynamic CAI, residual teeth (up to three) make it possible for the merge to avoid new radiographic scans. An additional challenge is the treatment involving immediate implants compared with delayed implants placed into healed bone. As for other static CAI systems, the operator&rsquo, s experience and the quality of the CBCT data make the planning affordable and secure the entire implants placement procedure. The literature reports accuracies in terms of comparison between placed implants and planned implants, following a double CBCT approach, based on radiographic volume overlapping. Thirteen consecutive future totally edentulous patients (77 implants), divided into two groups (group A: 3&ndash, 4 teeth traced, group B: 5&ndash, 6 teeth traced) requiring a full arch implant prosthetic rehabilitation were included in the reported case series. A dynamic CAI was used to plan and to place all implants following all the recommended digital steps. The software used provided a tool (Trace and Place) that made the merge between X-ray views of the residual teeth and their own positions possible. This method definitely registered that teeth positions comply with the required accuracy live check. After implants placement, a post-operative CBCT was taken in order to evaluate the deviations of the achieved implants at coronal, apical, and depth level as well as angular deviations. Statistically significant radiological mean difference between the two groups was found in the coronal position of implants (0.26 mm, p &lt, 0.001), in the apical position of implants (0.29 mm, p &lt, 0.001), in the depth of implants (0.16 mm, p = 0.022), and in the angular deviation (0.7, p = 0.004). The use of the TaP technology for the treatment of the patients with at least three stable teeth that need to be removed for a totally implant prosthetic treatment is a promising technique. The performed accuracy analysis demonstrated that this digital protocol can be used without a loss of accuracy of the achieved implants compared to planned ones.

The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86&deg, as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.

Aim and objective The aim of the present case report is to describe the digital management of an implant prosthetic rehabilitation performed by the use of different digital technologies, which allowed to successfully perform in 1 day both the surgical and the prosthetical stages with a minimally invasive approach and a high standard of care. Background Coronavirus disease-2019 (COVID-19) pandemic is affecting dental everyday practice. Clinicians have to reduce the number of patients per day and the time they spend in the dental office. Minimally invasive and digital approaches, with less possible exposure and interaction, are suggested to reduce the risk of infection. Case description The failure of a short-span implant prosthetic rehabilitation combined with pain and mobility of the involved teeth was the main complaint reported by a 78-year-old male patient, who asked an urgent appointment to solve the problem. An intraoral scanner allowed the clinician to immediately take a preliminary digital impression of the arch to be treated. The resulting 3D files were sent by e-mail to the dental technician who provided a digital wax-up for the computerized workflow. Computer-aided implantology (CAI) performed using an in-office cone-beam computed tomography (CBCT) allowed clinician to guide the surgical approach in a prosthetic manner. Such an integration inside a well-defined workflow was the key for a successful and rapid treatment. Conclusion By using new innovative digital technology, the treatment was completed in 1 day, reducing the risk of COVID-19 by limiting the number of appointments and reducing contacts in confined environments like the dental office and public transportations. It also helped to reduce materials production and people movement in the treatment of dental emergency. Clinical significance The possibility of performing an effective treatment saving time by using efficient technology and a minimally invasive procedure highlights the importance of digital planning in order to optimize every single step of the treatment. Digital workflow reduces also the movement of potentially infected materials from the office to the dental laboratory. How to cite this article Stefanelli LV, Franchina A, Pagliarulo M, et al. Management of a Complex Case during COVID-19 Time Using One-day Digital Dentistry: A Case Report. J Contemp Dent Pract 2020;21(11):1284–1292.