Clinical case by Dr. Dmitry Dmitriyev . Prosthodontist
Introduction
In contemporary implant dentistry, the integration of a fully digital workflow is paramount for managing complex full-arch rehabilitations, particularly when immediate functional recovery is required. Intraoral Photogrammetry (IPG) provides highly precise, distortion-free impression capture for complex full-arch rehabilitations. This case presents a comprehensive maxillary and mandibular All-on-6 restoration. By integrating digital surgical planning with the SHINING 3D Aoralscan Elite scanner, the clinical team achieved predictable accuracy, excellent functional outcomes, and significantly reduced chairside time.
1. Case Profile & Initial Situation
A 41-year-old male patient presented with significant functional and aesthetic concerns, including tooth mobility, suppuration, gingival bleeding, halitosis, an inability to eat normally, and visible diastemas. His medical history noted high blood sugar levels and excessive alcohol consumption. Clinical evaluation confirmed severe chronic periodontitis with grade 3 mobility and multiple carious lesions, prompting a referral from another clinic specifically to discuss full-arch prosthetic options.
2.Treatment Objectives
The primary treatment objective was to achieve full social rehabilitation in the shortest possible time. The patient required a predictable solution to restore his ability to smile confidently and chew food comfortably without pain. To meet these functional and aesthetic demands, the clinical team decided on a total extraction protocol followed by a bimaxillary All-on-6 implant strategy.
3.Pre-operative Assessment & Planning
The primary treatment objective was to achieve full social rehabilitation in the shortest possible time. The patient required a predictable solution to restore his ability to smile confidently and chew food comfortably without pain. To meet these functional and aesthetic demands, the clinical team decided on a total extraction protocol followed by a bimaxillary All-on-6 implant strategyPrior to surgical planning, the patient underwent a one-month periodontal preparation phase, which included hygiene instruction and strict clinical monitoring.
Data collection for the digital workflow included:
CBCT scans.
Comprehensive photo and video protocols.
Intraoral scanning.
CBCT STL conversion for bone segmentation and virtual planning.
Virtual surgical planning was executed in EXOPLAN software to design stackable surgical guides. The plan utilized 6 Dentium implants per arch. To manage the anatomical limitations and ensure parallel prosthetic seating, X-gate D-type multi-unit abutments were planned for the upper jaw. For the lower jaw, X-gate V-type multi-unit abutments were selected to minimize angle divergence.
Maxillary
Mandibular
4. Surgical Phase & Immediate Provisionalization
The surgical interventions were staged to ensure optimal management of the compromised alveolar bone and soft tissues.
Maxillary (October 28, 2025):
Under sedation, full-arch extractions were performed on the upper jaw, followed by the precise placement of six Dentium implants. Due to identified deficits in both bone and soft tissues, concurrent grafting procedures were executed. To correct insertion angles and establish a common path of draw, X-gate D-type angled multi-units were utilized.
Mandibular (November 27, 2025)
Following the extractions on the lower jaw, six Dentium implants were placed. X-gate V-type angled multi-units were strategically selected to reduce angle divergence across the mandibular arch.
Immediate Provisionalization
An immediate loading protocol was implemented on the respective days of surgery for both arches. Following the installation of protective caps on the multi-units by the surgeon, the patient was transferred for provisional prosthetics. Provisionalization was achieved using a dry reline technique with reinforced PMMA on bases. A single set of provisional prostheses was utilized for the entire healing period, successfully restoring immediate masticatory function and aesthetics.
5.Final Digital Impression & Definitive Delivery
After the osseointegration and tissue healing phase, the final prosthetic phase commenced on April 30, 2026.
Intraoral data capture was performed using the SHINING 3D Aoralscan Elite. By leveraging its advanced IPG (photogrammetry) capability, the team effortlessly recorded the three-dimensional spatial relationships of the maxillary multi-units with micron-level accuracy, seamlessly completing the digital data acquisition for both arches.
Based on these highly accurate digital impressions, the definitive restorations—full-arch zirconia prostheses supported by FP1 titanium bars—were fabricated.
6.Clinical Outcomes
The IPG scanning accuracy translated directly into an exceptional clinical result. During delivery, intraoral evaluation confirmed a perfectly passive fit of the final frameworks across all implants. The restorations exhibited perfect marginal adaptation, ideal gingival contour for long-term soft tissue health, and appropriate occlusal contact distribution. The patient was highly satisfied, having regained both functional stability and a natural, aesthetic smile.
Conclusion
This complex bimaxillary rehabilitation highlights the predictability and efficiency of a fully digital All-on-6 workflow. While precise virtual planning and implant placement successfully resolved the patient's immediate functional and aesthetic collapse, the long-term success of the definitive phase relied on impeccable intraoral data capture. By utilizing the Aoralscan Elite in conjunction with dedicated scanbodies, the clinical team achieved ultra-high scanning accuracy and seamless spatial orientation of the multi-unit abutments. This critical digital foundation ensured a perfectly passive fit for the final zirconia-titanium frameworks, streamlining the restorative process, significantly minimizing chair time, and maximizing patient comfort.