Computer assisted implantology (CAI) was introduced more than 25 years ago and aimed to facilitate implant planning and to avoid intraoperative complications such as mandibular nerve damage, sinus perforations, fenestrations, or dehiscence [
1‐
4]. Based on a computerized tomography (CT) scan and a digitized tooth setup, the prosthetically ideal implant positions can be planned virtually with the help of a guided surgery software allowing for three dimensional visualization prior to implant surgery [
2,
5,
6]. Furthermore, the possibility to transfer the virtually planned implant position to the real clinical situation is provided by a stereolithographically fabricated surgical template [
3,
7]. While only few guided implant placement systems were available at the time, today, multiple CAI software are available on the market. Several in-vitro, cadaver and clinical studies have reported on the accuracy of guided implant placement [
8‐
10]. Although the current state of software and hardware technology has improved, inaccuracies in implant placement may occur and depend on different factors such as the template support (bone, mucosa, teeth, implants), intrinsic factors of the surgical guide (tolerance in diameter between the drill and the guide sleeve, fabrication accuracy of the guide) [
11,
12] and human related factors during the workflow of virtual planning and guided surgery [
7,
13]. The guided surgery approach is still controversially discussed [
14‐
16] even though the procedure may be performed in a safe and predictable way [
17,
18]. However, a systematic and concise approach performing the single steps in the treatment sequence may allow for more accurate implant positioning as type of guide and fixation have an important influence [
19,
20]. Additionally, the use of multiple templates with different supports, i.e. teeth and implant support combined in a sequenced order is believed to improve accuracy compared to a mucosa supported approach alone [
21].
While some patients wish to be informed in detail about the specific treatment steps, most of them want to know whether they would have to leave the dental office without teeth at some point of the treatment. In this context, immediate implant placement after tooth extraction and immediate implant loading with a fixed provisional reconstruction may help the patient as time after extractions and osseointegration is consolidated. In guided surgery protocols, minimally invasive placement and immediate loading has been a possible treatment step from the beginning [
3,
4]. Postoperative morbidity after flapless surgery is significantly reduced compared to the traditional open approach, especially in edentulous patients [
17,
22,
23]. Later during the treatment, reconstructions fabricated with the help of computer assisted design / computer assisted manufacturing (CAD/CAM) provide high quality and aesthetic materials. Although CAI and CAD/CAM procedures have facilitated towards a straight forward workflow in the rehabilitation of edentulous patients, immediate implant placement and immediate loading protocols combined are complex and required a high level of organization between the implantologist, the technician and the patient.
The aim of the present case report was to illustrate the feasibility of combined immediate implant placement and loading approach using CAI in the rehabilitation of a patient with a partially dentate mandible asking for a comprehensive treatment and, specifically, not accepting being edentulous all the while.