Abstract
Objective: To describe a digital workflow incorporating computer-aided design and computer-aided manufacturing (CAD-CAM) surgical guides and dynamic computer-assisted implant surgery (CAIS) for implant planning and placement in a mandibular immediate complete denture (ICD) and implant-retained overdenture (IOD). Methods: The clinical procedures were divided into four phases: (1) trial denture fabrication and data acquisition, (2) surgical guide fabrication, (3) intraoral surgery and ICD delivery, and (4) IOD delivery. Data acquisition involved intraoral scanning of maxillary and mandibular stone casts, both with and without the trial denture, and a cone beam computed topography (CBCT) scan taken with the patients wearing the trial denture in occlusion using putty silicone for maxilla-mandibular separation. Four-piece 3D printed surgical guide was fabricated, comprising: (1) bone reduction guide with posterior support, (2) guide for mandibular anterior teeth, (3) anterior bite plane, and (4) implant surgical guide. Results: The four-piece CAD-CAM surgical guide enabled flapless extractions, avoided the need for bone grafting, and allowed for immediate implant placement with controlled bone reduction. The bone reduction guide established adequate vertical space for prosthesis thickness and prevented visible transition zones between the denture flange and residual ridge. The guide also facilitated accurate implant positioning in accordance with prosthetic planning. Conclusions: This digital protocol demonstrates the integration of CAD-CAM and CAIS technologies for immediate implant placement in ICD and IOD treatment. The four-piece surgical guide supports precise implant positioning, optimal bone reduction, and improved esthetic outcomes, while reducing the healing duration prior to definitive prosthesis delivery.