An individualized approach for a one-abutment one-time protocol using fully guided implant surgery: a 4-year follow-up case series.

Aim: The objective of the present case series was to evaluate the 4-year outcomes of implants placed in the esthetic area using static computer-assisted implant surgery (s-CAIS) and restored with a one-abutment one-time (OAOT) protocol using custom-made zirconia abutments and cemented provisional crowns manufactured prior to surgery. Materials and methods: Ten consecutive implants were placed in the esthetic area. Based on a digital implant and prosthodontic planning, surgical guides were ordered and used for the preparation of definitive custom-made zirconia abutments and polymethylmethacrylate provisional crowns. Implants were placed using the s-CAIS guide, and prosthetic components were placed immediately. Implant outcomes were evaluated at the time of surgery, after 4 months, and after 4 years.

Results: All implants were successfully placed with s-CAIS and restored with final abutments and provisional crowns. No major prosthetic adverse events were observed. After 4 years, the implant survival rate was 100%, minor peri-implant bleeding on probing was reported, and very stable peri-implant bone levels were observed. The pink esthetic score showed that the prosthetic components were well integrated, and the peri-implant soft tissue was stable.

Conclusions: Within the limitations of the present case series, these results suggest that emerging digital workflows allow the manufacture of final custom-made abutments and provisional crowns prior to surgery. This individualized OAOT procedure may reduce cement-related complications and improve esthetic outcomes by optimizing soft tissue healing with prosthetic components. However, such protocols have evolved toward fully digital workflows, and comparative clinical trials are needed.