CAD-CAM surgically-guided oral implant site expansion and implant placement in severely atrophic maxilla

During the rehabilitation of patients with atrophic maxilla, an oral implantologist may face a challenge in achieving accurate implant placement. We present a 54-year-old man who is completely edentulous with a history of unretentive conventional complete dentures. The patient sought help for a fixed implant prosthesis and disagreed with the proposed plan to restore his missing teeth using a removable prosthesis. Clinical and radiographic examinations showed a severely resorbed maxilla with horizontal and vertical bone deficiency. A computer-guided surgical stent was used to place implants in the atrophic maxillary ridge. A double cone beam CT (CBCT) scan procedure was performed. The first scan of the patient's jaw was done using a radiographic scan appliance, and the second scan was done only with the scan appliance. This was followed by virtual implant planning, after which we designed and printed the CAD-CAM surgical stent. From the pilot drill to the final one, implant site preparation was done using a guide. Furthermore, ridge expansion and implant fixture placement were performed using a planned surgical guide to ensure accurate and precise implant placement. Next, a postoperative CBCT was done to determine the accuracy of the computer-guided stent using In2guide Pro Software. By superimposing the preoperative plane onto the postoperative scan, the postoperative CBCT was aligned on the same axis as the preoperative image. This case report shows that computer-guided stents for severely atrophic maxilla can potentially be used to facilitate both implant installation and bone expansion. However, in order to reach sound conclusions, further randomised control trials with large sample sizes should be carried out.