Immediately Loaded Maxillary and Mandibular Dental Implants with Fixed CAD/CAM Prostheses Using a Flapless Surgical Approach: A Clinical Report Abhayjit Bedi, BDS, DMD, MS, FACP, 1, 2 Konstantinos X. Michalakis, DDS, MSc, PhD, FACP, 3, 4 Eugene J. Mariani Jr., DDS, MS, 5 & Despina Mato Zourdos, DMD 6 1 Clinical Associate Professor, Department of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston, MA 2 Private Practice limited to Prosthodontics, Auburn, MA 3 Adjunct Associate Professor, Division of Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA 4 Assistant Professor, Department of Removable Prosthodontics, Aristotle University of Thessaloniki and Private Practice limited to Prosthodontics, Thessaloniki, Greece 5 Private Practice limited to Oral Medicine and Periodontics, Worcester, MA 6 Private Practice, Millford, MA Keywords Immediate loading; teeth in an hour; virtual implant surgery; flapless implant surgery; accurate implant placement; CAD/CAM prostheses. Correspondence Konstantinos X. Michalakis, 3, Greg. Palama street, Thessaloniki 54622, Greece. E-mail: kmichalakis@the.forthnet.gr Accepted April 30, 2010 doi: 10.1111/j.1532-849X.2011.00689.x Abstract Immediate implant loading is a viable treatment method for selected cases. One of the greatest advantages of this method is the virtual surgery, which precedes the actual clinical treatment and eliminates any need for last minute decisions. The actual surgery time is decreased, since all steps are predetermined. Additionally, no flaps have to be elevated, resulting in preservation of periimplant soft tissues, vascularization of the underlying bone, fewer postoperative complications, and minimal patient discomfort. This article presents a clinical approach made possible due to the evolution of modern scanning techniques and appropriate software. Branemark’s original protocol required 4 to 6 months for im- plant osseointergration before placement of the definitive pros- thesis. 1-3 Although this approach gave very predictable results, it had certain drawbacks. The main disadvantages of this ap- proach were prolonged treatment time, two surgical procedures, placement of a removable prosthesis that required modifications during the course of treatment, and a greater number of ap- pointments. 4 Additionally, the original ad modum Branemark protocol required placement of five to six implants between the mental foramina and a fabrication of a bilateral cantilever of 15 to 20-mm long to provide posterior support and good mastication ability. 5,6 Newly acquired data from clinical studies modified these original protocols, both in the number of implants required for a fixed prosthesis and the time required for implant load- ing. 7 It has been reported that immediate implant loading has high survival rates. 8-11 Advances in implant topography have contributed to the success of immediate loading. Research has shown that roughened implant surfaces give more predictable results than machined surfaces. 12-15 The reported success rates for implants with roughened surfaces are 93% to 99.2% for the maxilla, and 93.2% to 100% for the mandible, for 1 to 5 years of follow-up. 16-19 Although micromovement of implants during the healing period has been a concern for osseointegra- tion, a limited amount (150 μm) does not seem to interfere with this process. 20 Micromotion can be limited by the use of a rigid prosthesis that splints implants together and by the use of expandable abutments. Patient report A 50-year-old woman presented with maxillary and mandibular complete dentures. She had been edentulous since she was 40 years old (Figs 1–3). The patient complained of the lack of stability and the esthetics of the present prostheses. She also stated that she never got psychologically accustomed to the removable prostheses and that she was interested in a fixed prosthetic rehabilitation. With the advent of the “Teeth in an Hour” concept, the patient was presented with the option of placing 7 to 8 implants in the maxilla and the mandible and immediately loading them. The patient’s medical and dental history and a panoramic radiographic survey were obtained. A comprehensive clinical Journal of Prosthodontics 20 (2011) 319–325 c  2011 by The American College of Prosthodontists 319