Citation: Tallarico, M.; Galiffi, D.; Scrascia, R.; Gualandri, M.; Zadro ˙ zny, L.; Czajkowska, M.; Catapano, S.; Grande, F.; Baldoni, E.; Lumbau, A.I.; et al. Digital Workflow for Prosthetically Driven Implants Placement and Digital Cross Mounting: A Retrospective Case Series. Prosthesis 2022, 4, 353–368. https://doi.org/10.3390/ prosthesis4030029 Academic Editors: Andrea Scribante, Simone Gallo and Maurizio Pascadopoli Received: 13 June 2022 Accepted: 11 July 2022 Published: 18 July 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Case Report Digital Workflow for Prosthetically Driven Implants Placement and Digital Cross Mounting: A Retrospective Case Series Marco Tallarico 1, * , Davide Galiffi 1 , Roberto Scrascia 2 , Maurizio Gualandri 3 , Lukasz Zadro ˙ zny 4 , Marta Czajkowska 5 , Santo Catapano 6 , Francesco Grande 6 , Edoardo Baldoni 1 , Aurea Immacolata Lumbau 1 , Silvio Mario Meloni 1 and Milena Pisano 1 1 Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07021 Sassari, Italy; davidegaliffi@gmail.com (D.G.); baldoni@uniss.it (E.B.); alumbau@uniss.it (A.I.L.); melonisilviomario@yahoo.it (S.M.M.); milenapisano@yahoo.it (M.P.) 2 Independent Researcher, 74121 Taranto, Italy; roberto.scrascia@gmail.com 3 Independent Researcher, 00100 Rome, Italy; mauriziogualandri@gmail.com 4 Department of Dental Propaedeutics and Prophylaxis, Medical University of Warsaw, 02-006 Warsaw, Poland; lzadrozny@wum.edu.pl 5 Department of Laryngology, Medical University of Silesia, 40-027 Katowice, Poland; mrtczajkowska@gmail.com 6 Department of Prosthodontics, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; cts@unife.it (S.C.); francesco.grande90@gmail.com (F.G.) * Correspondence: me@studiomarcotallarico.it Abstract: Fully digital workflow in implant dentistry is ever increasing. Treatment of partial eden- tulous cases is well-documented; nevertheless, complete edentulous cases are still a challenge. To present several innovations in the treatment of complete edentulous patients using digital solutions, both for implant placement and restoration delivery, was the objective of this study. It was designed as a retrospective case series study, aimed to tune further research with larger sample size, and a longer follow-up. Patients requiring complete, implant-supported restoration were asked to participate in this study. Enrolled patients were treated with four implants, immediate loading and a definitive complete arch restoration. Patients were treated using computer-assisted, template-based surgery. Multi-piece surgical templates were used to accurately place the implants, to manage the bone if needed and to make immediate loading procedure quicker and easier. After osseointegration period, definitive, extra-oral, digital impressions were taken using newly developed scan analogs, connected in the patient mouth using temporary cylinders and stabilized by means of the low-shrinkage, flow- able, resin composite. Outcomes were implant and prosthesis survival rate, complications, accuracy, and patient satisfaction. Radiographic evaluation performed with a preliminary, radiopaque alu- minum try-in, was used to test the accuracy of the digital impressions. Overall, 20 implants were placed in five patients. All the implants osseointegrated without complications. One impression was taken a second time due to inaccuracy of the aluminum tray-in. Finally, all of the patients were completely satisfied with both surgical and prosthetic procedures. Within the limitations of this case series, multi-piece surgical templates showed promising results improving the clinician’s confidence in the case of bone reduction, post-extractive implants and immediate loading. The prosthetic template increased the trueness of the digital impression for complete edentulous patients. Finally, even if an impression was performed again, the scan-analog used for extra-oral chair-side digital impressions seemed to be a promising tool. Continuous improvements and further study are needed to confirm these preliminary results. Keywords: dental implants; digital workflow; guided surgery; prosthesis 1. Introduction Integrated treatment planning with dental implants is a well-established solution. Nevertheless, the achievement of the optimal implant position, based on the prosthetic Prosthesis 2022, 4, 353–368. https://doi.org/10.3390/prosthesis4030029 https://www.mdpi.com/journal/prosthesis