Total maxillary rehabilitation using a digital protocol: A clinical case study

Background. Current advances in digital dentistry enhance the efficiency of rehabilitation for patients with missing teeth, while gradually replacing analog methods. The combination of cone beam computed tomography with intraoral scan data allows for precise virtual planning of surgical procedures thus minimizing deviations during implant placement. Furthermore, high precision in the placement of prosthetic structures is ensured. In this article, a clinical case study is presented to demonstrate a full digital protocol, which is becoming increasingly relevant in dental practice.

Clinical case description. This clinical case study reports on the total rehabilitation of a patient’s maxillary teeth. The cause of tooth loss was chronic periodontitis and its complications. After examination, the patient was diagnosed with ICD-10: K08.1: Loss of teeth due to accident, extraction, or local periodontal disease; K05.3: Chronic periodontitis. Tooth 1.3 was extracted, six implants were placed using a navigation template, superstructures (multi-unit abutments) were installed, followed by intraoral scanning of the jaws to make a temporary prosthetic structure. On Day 3 after surgery, a temporary structure was fixed in the oral cavity. After six months, a repeat intraoral scan was performed; a permanent screw-fixed prosthesis made of zirconium dioxide (without titanium bases) was prepared.

Conclusion. The clinical case described demonstrates a well-established approach to total maxillary rehabilitation using dental implants and a fully digital protocol. Digital technologies contribute to improving the effectiveness of implant treatment for patients, reducing the risk of complications, increasing patient comfort, and facilitating communication between the dentist and dental technician.

1. Bratos M, Ramos V Jr, He W, Zhang H. An integrated digital workflow for long-term interim combined fixed and removable prostheses. J Prosthet Dent. 2024:S0022-3913(24)00135-5. https://doi.org/10.1016/j.prosdent.2024.01.038

2. Cappare P, Sannino G, Minoli M, Montemezzi P, Ferrini F. Conventional versus Digital Impressions for Full Arch Screw-Retained Maxillary Rehabilitations: A Randomized Clinical Trial. Int J Environ Res Public Health. 2019;16(5):829. https://doi.org/10.3390/ijerph16050829

3. Ashurko I, Trofimov A, Tarasenko S, Mekhtieva S. Full-Mouth Screw-Retained Implant-Supported Rehabilitation with Multiunit Abutments Using Virtual Guided Surgery and Digital Prosthetics Protocol. Case Rep Dent. 2020;2020:3585169. https://doi.org/10.1155/2020/3585169

4. Garcia E, Tung TW, Jaramillo S, Gutierrez A, Alvear J, Tinajero M. Full-Arch Rehabilitation With Mucosa-Supported Prostheses Utilizing a Digital Workflow: A Case Report. Cureus. 2024;16(7):e64941. https://doi.org/10.7759/cureus.64941

5. Tealdo T, Bevilacqua M, Scaglione L, Alberti C, Montagna P, Gelpi F, Gelpi F. A fully digital planning and manufacturing of an aesthetically conceived and guided full-arch implant-supported rehabilitation. European Journal of Musculoskeletal Diseases. 2024;13:2.

6. Nowicki A, Osypko K. Digital Workflow in Full Mouth Rehabilitation with Immediate Loading, Intraoral Welding and 3D-Printed Reconstructions in a Periodontal Patient: A Case Report. Reports (MDPI). 2023;6(4):52. https://doi.org/10.3390/reports6040052

7. Cattoni F, Chirico L, Merlone A, Manacorda M, Vinci R, Gherlone EF. Digital Smile Designed Computer-Aided Surgery versus Traditional Workflow in “All on Four” Rehabilitations: A Randomized Clinical Trial with 4-Years Follow-Up. Int J Environ Res Public Health. 2021;18(7):3449. https://doi.org/10.3390/ijerph18073449

8. Franchina A, Stefanelli LV, Gorini S, Fedi S, Lizio G, Pellegrino G. Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols. Methods Protoc. 2020;3(4):84. https://doi.org/10.3390/mps3040084

9. La Monaca G, Pranno N, Annibali S, Di Carlo S, Pompa G, Cristalli MP. Immediate flapless full-arch rehabilitation of edentulous jaws on 4 or 6 implants according to the prosthetic-driven planning and guided implant surgery: A retrospective study on clinical and radiographic outcomes up to 10 years of follow-up. Clin Implant Dent Relat Res. 2022;24(6):831–844. https://doi.org/10.1111/cid.13134

10. Papaspyridakos P, De Souza A, Bathija A, Kang K, Chochlidakis K. Complete Digital Workflow for Mandibular Full-Arch Implant Rehabilitation in 3 Appointments. J Prosthodont. 2021;30(6):548–552. https://doi.org/10.1111/jopr.13356

11. Creagh J, Bohner L, Sesma N, Coachman C. Integrating a Facially Driven Treatment Planning to the Digital Workflow for Rehabilitation of Edentulous Arches: A Case Report. J Contemp Dent Pract. 2020;21(12):1393–1397.

12. Gracher AHP, de Moura MB, da Silva Peres P, Thomé G, Padovan LEM, Trojan LC. Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review. Int J Implant Dent. 2021;7(1):17. https://doi.org/10.1186/s40729-021-00297-z

13. Meloni S, Spano G, Ceruso FM, Gargari M, Lumbau A, Baldoni E, Massarelli O, Pisano M, Tallarico M. Upper jaw implant restoration on six implants with flapless guided template surgery and immediate loadings: 5 years results of prospective case series. Oral & Implantology. 2019;12(2):28. https://doi.org/10.1111/clr.45_13508

14. Wulfman C, Naveau A, Rignon-Bret C. Digital scanning for complete-arch implant-supported restorations: A systematic review. J Prosthet Dent. 2020;124(2):161–167. https://doi.org/10.1016/j.prosdent.2019.06.014

15. Azevedo M, Correia F, Faria Almeida R. Accuracy of Implant Guided Surgery in Fully Edentulous Patients: Prediction vs. Actual Outcome-Systematic Review. J Clin Med. 2024;13(17):5178. https://doi.org/10.3390/jcm13175178

16. Pesce P, Pera F, Setti P, Menini M. Precision and Accuracy of a Digital Impression Scanner in Full-Arch Implant Rehabilitation. Int J Prosthodont. 2018;31(2):171–175. https://doi.org/10.11607/ijp.5535

17. Pesce P, Bagnasco F, Pancini N, Colombo M, Canullo L, Pera F, Bressan E, Annunziata M, Menini M. Trueness of Intraoral Scanners in Implant-Supported Rehabilitations: An In Vitro Analysis on the Effect of Operators’ Experience and Implant Number. J Clin Med. 2021;10(24):5917. https://doi.org/10.3390/jcm10245917

18. Kim W, Li XC, Bidra AS. Clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures: A systematic review. J Prosthodont. 2023;32(2):102–107. https://doi.org/10.1111/jopr.13575

19. Bidra AS, Rungruanganunt P, Gauthier M. Clinical outcomes of full arch fixed implant-supported zirconia prostheses: A systematic review. Eur J Oral Implantol. 2017;10 Suppl 1:35–45.