Patient history: male, 56 years old, non-smoker, no significant concomitant diseases or medication.

Treatment planning was performed with ICXMagellan after DVT (CBCT) images in known double-scan technique (
Fig. 1
). Six implants were planned, some of which were to be placed at an angle according to the angulation possibilities of the abutments, taking into account the bone situation and bone quality. The necessary safety distances between the implants and the distances to the maxillary sinuses could be maintained.

For the fixation of the template, anchorage pins could already be placed virtually in addition to the palatal support to ensure the highest possible precision of implant placement and position.

In addition to the surgical guide, a 3D-printed model with inserted model analogs including the partially angulated abutments in the calculated gingival heights, as well as the fully coloured milled PMMA temporary restoration are delivered preoperatively. Fit and design can already be checked on the model (
Fig.


2

).

After insertion of the surgical template, the implantation is “fully guided” (
Fig.


3

). This means that all drilling steps as well as implant placement take place through the template. The position, axis and rotation of the implants are hereby specified and can be reliably achieved according to the planning (
Fig.


4

).

Of course, it is possible to realize all forms of flaring, but also a minimally invasive procedure by punch technique and to combine it with template-guided surgery. In this way, soft tissue preserving and reconstructive procedures can also be combined. It is also possible to include additional templates, such as a Reduction Guide for bone leveling, to create the desired starting situation for implant placement.

To complete the treatment, the prefabricated temporary ICX Smilebridge can now be placed in the passive-fit procedure (
Fig. 5
). This is bonded tension-free in the patient’s mouth and finished chairside in a few minutes. There is no need for time-consuming grinding, as data records from the radiological template, the wax-up or the old restoration are used to fabricate the temporary restoration.

For the patient this means that he keeps his usual bite and does not experience any negative changes. In the case shown here, it was possible to dispense with palatal support in this way, which significantly improved the patient’s quality of life in terms of taste perception and foreign body sensation. Where precision was previously lost in implantology – in the manual implementation of planning to treatment steps and the fabrication of prosthetic solutions, the use of the ICX-Imperial concept opens up a viable path.