CASE REPORT Computer-aided flapless implant surgery and immediate loading. A technical note Alfonso Baruffaldi 1 & Pier Paolo Poli 1 & Andrea Baruffaldi 2 & Lorenzo Giberti 3 & Maurizio Pigozzo 4 & Carlo Maiorana 1 Received: 4 May 2015 /Accepted: 21 March 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Purpose The aim of the present technical note was to describe a prosthetic technique developed to increase the predictability of immediately loaded implants supporting a fixed prosthesis after computer-aided template-guided flapless implant placement. Methods During a 2-year period, eight patients presenting partial edentulism underwent computer-aided template-guid- ed implant placement. The presented technique was used dur- ing the prosthetic procedures to directly transfer the data ob- tained with the facebow to the surgical environment, allowing for accurate repositioning of the temporary prosthesis on the implants as previously planned with the digital software. Results A total of 78 dental implants were immediately load- ed with an implant-supported fixed prosthesis after flapless template-guided implant placement. A survival and success rate of 100 % was reported after a mean follow-up of 1 year from the prosthetic loading. Neither major complications nor dropouts were observed during the healing time. From both clinical and radiological evaluations, implants appeared stable with no signs of soft tissue inflammation or infection and no evidence of pathological peri-implant bone resorption. Conclusions The proposed technique associated with computer-aided implant placement and immediate loading protocol provided a high implant and prosthetic survival and success rate. No complications were reported during the re- calls, suggesting predictability and reliability of the present technique over a short-term period. Keywords Computer-aided surgery . Dental implants . Fixed prosthesis . Immediate loading . Surgical template . Virtual planning Introduction With the development of flapless implant protocols, attention has been directed toward less invasive approaches [1]. Avoiding incisions and suturing allows for rapid mucosa healing, shallower gingival sulcus, less bone loss, and higher implant stability, which in turn generates less pain for the patient for a shorter timespan [2–5]. Accurate patient- specific planning of the implant rehabilitation is mandatory to obtain long-term successful results. Computer-guided sur- gery has been proposed to transfer the virtual plan to the sur- gical environment [6] by means of a static template produced with computer-aided design/computer-assisted manufacture (CAD/CAM) technologies, according to patient anatomy [6–9]. Despite the survival rate of implants placed with computer-aided procedures ranging between 89 and 100 % after 1 year, the corresponding prosthesis showed a survival rate of between 62 and 100 % [10]. Prosthesis fracture, screw loosening, misfit at the time of superstructure connection, and need for extensive occlusal adjustments after placement of the superstructures were the most reported postsurgical complica- tions [11]. A possible explanation might be related to difficul- ties in fixing the temporary prosthesis in the proper position * Pier Paolo Poli pierpaolo.poli@unimi.it 1 Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCSS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy 2 Piacenza, Italy 3 Bologna, Italy 4 Voghera, Italy Oral Maxillofac Surg DOI 10.1007/s10006-016-0554-5