# The First Biological Respect Protocol: A Biodigital Technique for Definitive Customized One-Time Abutments—A Case Report

## TL;DR

A new dental technique called the First Biological Respect protocol uses digital planning to create customized implant abutments, aiming to preserve bone and soft tissue around dental implants.

## Contribution

The paper introduces a novel digital technique for creating customized definitive abutments that reduce tissue damage during implant procedures.

## Key findings

- The FR protocol showed stable bone levels and maintained soft tissue volume at 6 months and 1 year.
- Soft tissue volume increased at 1 year, likely due to tissue maturation and customized prosthetics.
- The method allows single-stage implant placement without abutment disconnections, potentially improving tissue stability.

## Abstract

Background/Objectives: Dental implants represent a viable solution for replacing missing teeth; however, multiple disconnections and reconnections of intermediate abutments contribute to the apical displacement of the peri-implant connective tissue barrier, resulting in additional marginal bone loss. To the best of our knowledge, no definitive customized abutments currently exist that are specifically designed according to the morphology of the tooth to be replaced and its position within the dental arch, allowing for digital planning within the prosthetic implant design and insertion during the surgical procedure without subsequent disconnection. Methods: The First Biological Respect (FR) technique, described in this case report, enables the digital planning not only of the implant but also of the patented FR customized-shaped, definitive abutment and associated FR prosthetic components. The FR technique was applied to a case involving an immediate post-extraction implant in position 12. Results: With the limitations of a case report, the application of the FR protocol demonstrated stable crestal bone levels at the 1-year follow-up. Additionally, soft tissue volume was maintained at 6 months, reflecting the accuracy of the customized prosthetic components in supporting, guiding, and protecting peri-implant soft tissues. At the 1-year follow-up, an increase in soft tissue volume was observed, likely attributable to tissue maturation and the further customization of the definitive prosthetic elements. Conclusions: The FR technique represents a viable therapeutic alternative that, through its patented, fully customized components, allows for the digital planning of the implant, as well as the customized definitive abutment, coping, provisional, and final prosthetic framework. This facilitates a single-stage surgical and prosthetic approach. By eliminating the need for repeated abutment disconnections, this method supports the long-term stability of both hard and soft peri-implant tissues while also reducing overall treatment time for both clinician and patient. Further studies involving larger patient cohorts are necessary to validate this protocol.