Full-Arch Restoration: A Digital Workflow Success Story
Follow a complete full-arch implant case from initial scan to final prosthesis delivery. This case study demonstrates how digital workflow integration reduces appointments, improves accuracy, and delivers predictable outcomes.
Patient Presentation
Chief Complaint
64-year-old male with failing maxillary dentition, moderate bone loss, seeking fixed solution
Clinical Findings
- • Advanced periodontal disease
- • Multiple root fractures
- • Inadequate remaining bone for individual implants
- • Patient refused removable prosthesis
Treatment Plan
Full maxillary arch extraction, immediate placement of 6 implants with provisional restoration, followed by definitive zirconia hybrid prosthesis
Success Criteria
- ✓ Passive fit on all implants
- ✓ Proper occlusion and phonetics
- ✓ Natural aesthetics with gingival characterization
Phase 1: Digital Planning & Surgical Execution
Step 1: CBCT & Intraoral Scanning
Pre-operative data collection combining CBCT imaging with digital impressions of existing dentition:
- • CBCT scan performed with radiopaque markers for registration
- • iTero scan of maxillary and mandibular arches
- • Face-bow registration for mounting position
- • Smile photos showing lip line and tooth display
Step 2: Virtual Implant Planning
CBCT data merged with IOS files in implant planning software (Blue Sky Plan):
Implant Positioning
- • 6 implants (#2, #4, #6, #11, #13, #15 positions)
- • Angled distals to avoid sinus (30° angulation)
- • Minimum 3mm inter-implant distance
- • Platform positioned 3mm apical to CEJ
Prosthetic Design
- • Screw-retained design for retrievability
- • Titanium framework for passive fit
- • Hybrid design (gingival + teeth)
- • Proper emergence profile at screw access
Step 3: Surgical Guide & Provisional Fabrication
Lab fabricates surgical guide and provisional prosthesis prior to surgery:
Two-Week Timeline:
Day 1-3: Guide design approval, 3D printing initiated
Day 4-7: Surgical guide printed, sterilized, validated for fit
Day 8-14: Provisional milled from PMMA, multi-unit abutments attached
Day 15: Surgery day - guide and provisional delivered to surgeon
Surgery Day Workflow
8:00 AM: Extractions completed, guided surgery executed with zero deviations from plan
10:30 AM: Multi-unit abutments torqued to 35 Ncm, provisional seated and verified
11:00 AM: Occlusion adjusted, patient dismissed with immediate function
Phase 2: Definitive Prosthesis Fabrication
Step 4: Four-Month Healing & Final Impression
After osseointegration confirmation, scan bodies placed for definitive impression:
- • Provisional removed, multi-unit abutments remain in place
- • Scan bodies hand-tightened (10 Ncm)
- • iTero scan with scan body library registration
- • Opposing arch and bite registration captured
- • Provisional re-seated same day (no time without teeth)
Step 5: Digital Design & Try-In
Lab designs definitive prosthesis using scan data and provisional as reference:
Week 1
Framework design, metal try-in milled from titanium
Week 2
Passive fit verified, teeth setup wax-up for approval
Week 3
Final zirconia milling, layering, glazing, delivery
Metal Try-In Appointment
Critical verification step before completing prosthesis:
✓ Framework seated with no rocking or binding
✓ Single screw test performed (tighten one screw, all others remain passive)
✓ Vertical dimension and centric relation confirmed
✓ Tooth position and smile line approved by patient
Step 6: Final Delivery & Occlusal Refinement
Definitive prosthesis features monolithic zirconia with hand-layered gingival characterization:
Material Selection Rationale
Zirconia Hybrid Design: Titanium framework with overpressed pink and white zirconia
- • Superior strength vs acrylic (no fractures)
- • Stain-resistant surface (no coffee/wine discoloration)
- • Natural translucency in incisal third
- • Gingival characterization mimics tissue variation
Delivery Protocol
1. Torque all screws to 15 Ncm, wait 10 minutes, re-torque
2. Seal screw access holes with PTFE tape and composite
3. Refine occlusion in centric and excursions (no heavy contacts)
4. Polish any adjusted areas to high gloss
5. Home care instructions (Waterpik essential)
Outcome & Patient Satisfaction
Clinical Success Metrics
- ✓
Passive Fit Achieved
Single screw test passed on all 6 implants
- ✓
Proper Occlusion
Bilateral simultaneous contacts, canine guidance
- ✓
Natural Aesthetics
Proper tooth proportion, gingival zenith positions
Patient-Reported Outcomes
"I can't believe how natural these feel. I forget they're not my real teeth. The ability to eat anything without worry has changed my life."
— Patient testimonial, 6-month follow-up
Chewing efficiency: Restored to 85% of natural dentition
Phonetics: Normal speech within 2 weeks
Maintenance: Home care compliance excellent
Key Takeaways for Full-Arch Success
Digital Workflow Advantages
- • Predictable implant placement (zero surgical deviations)
- • Immediate provisional (patient never without teeth)
- • Reduced chair time (2 appointments vs 6+ traditional)
- • Superior fit accuracy (digital impression vs analog)
Critical Success Factors
- • Comprehensive treatment planning upfront
- • Lab-surgeon communication throughout
- • Material selection based on patient factors
- • Verification steps (try-ins, passive fit tests)
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