Background: Alveolar ridge preservation (ARP) can successfully reduce volumetric ridge changes. However, there is still no consensus on what technique is the most advantageous for each specific clinical scenario. Hence, the aim of the present paper was to provide a treatment decision tree to guide the choice of predictable ARP procedures based on extraction socket buccal bone morphology and integrity. Material and Methods: Three socket types (ST) are proposed and discussed based on buccal bone morphology (intact, dehiscence or fenestration). Results: A decision tree for ARP was developed in order to merge ST classification with suitable treatment modalities. In the decision tree, the issue of when to allow unassisted healing or ARP was discussed. Described methods included bone grafting and collagen plug, and absorbable membrane or non-resorbable membrane, with or without flap elevation. Conclusion: A decision tree for ARP procedures was provided to guide clinicians towards the most conservative and predictable treatment approach based on remaining socket anatomical structures after extraction.

Background/Objectives: Thermal injury during implant osteotomy is a recognized complication of guided surgery, where closed guide architectures and metallic sleeves restrict coolant access to the drill-bone interface, reducing the effectiveness of conventional external irrigation. The objective of this study was to design, fabricate, and evaluate the clinical feasibility of a 3D-printed surgical guide system with integrated internal irrigation channels (the Liquid Guide System), capable of delivering saline directly to the osteotomy site within standard guided surgery workflows. Methods: The system was developed by integrating CBCT and IOS data in BlueSky Bio planning software; irrigation channel pathways were generated by CAD subtraction. Guides were fabricated by digital light processing (DLP) using biocompatible Asiga DentaGuide photopolymer resin, with metal 3D-printed auxiliary structures where required. Channel patency was confirmed by visual inspection after printing and after autoclave sterilization. The design was evaluated for compatibility with the BioHorizons Pro Surgical Guide Kit and the Ticare Fidelis Kit. Clinical feasibility was assessed in two cases: maxillary All-on-6 rehabilitation in a medically complex patient and an immediate implant placement in the esthetic zone. Results: Both guides were fabricated with confirmed patent irrigation channels. Seating accuracy was verified through occlusal fenestrations, and fixation was achieved with metal pins. Irrigation flow was unobstructed throughout all osteotomy steps and no intraoperative complications related to the guide or irrigation system were recorded. The system integrated into standard drilling protocols without modification for either platform. Conclusions: This proof-of-concept demonstrates technical feasibility across two implant systems and distinct clinical scenarios. Controlled in-vitro thermal studies and prospective clinical series required to establish efficacy.

Background/Objectives: Thermal injury during implant osteotomy is a recognized complication of guided surgery. Closed guide architectures and metallic sleeves restrict coolant access to the drill–bone interface, reducing the effectiveness of conventional external irrigation. This study aimed to describe the design and fabrication of a 3D-printed surgical guide system with integrated internal irrigation channels and to evaluate its technical and clinical feasibility in guided implant surgery. Methods: The system was developed by integrating CBCT and IOS data into BlueSky Bio planning software. Irrigation channels were generated by CAD subtraction. Guides were fabricated by additive manufacturing—digital light processing (DLP) in biocompatible Asiga DentaGuide resin and, in one case, selective laser melting (SLM) in Mediloy metal—with metal auxiliary components incorporated where required. Channel patency was confirmed by flow equivalence testing and visual inspection. The design was evaluated for compatibility with the BioHorizons Pro Surgical Guide Kit and the Ticare Fidelis Kit. Clinical feasibility was assessed in two cases: maxillary All-on-6 rehabilitation and immediate implant placement in the esthetic zone. Results: Both guides were successfully fabricated with confirmed patent irrigation channels. Guide seating was verified through occlusal fenestrations and secured with fixation pins. Irrigation flow remained unobstructed throughout all osteotomy steps, and no guide-related or irrigation-related complications were observed. The system was integrated into standard drilling protocols without modification for either implant platform. Conclusions: This proof-of-concept study demonstrates the technical feasibility of an internally irrigated surgical guide across two implant systems and distinct clinical scenarios. The proposed design was successfully integrated into standard guided surgery workflows and maintained functional irrigation. Further in vitro thermal studies and prospective clinical investigations are required to evaluate its effect on temperature control.