Strategic extraction protocol: Use of an image-fusion stereolithographic guide for immediate implant placement

Increasingly, patients are demanding a smooth transition from a hopeless dentition to a fixed implant-supported prosthesis without the use of an interim removable denture. This raises new challenges in adapting computer-aided design and computer-aided manufacturing (CAD-CAM) techniques to patients whose treatment plan includes immediate implant placement in fresh extraction sockets. To facilitate this conversion to a rehabilitated dentition, a strategic extraction protocol (SEP) can be applied. The SEP consists of selecting strategic, remaining, hopeless teeth as abutments to stabilize an image-fusion stereolithographic guide and to allow the immediate placement of sufficient implants to support an immediately loaded fixed prosthesis. The remaining supporting teeth are extracted in the same surgical session before the placement of the interim prosthesis.