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All-on-six digital implantology for occlusion reconstruction

These days, digital implantology is becoming a trend worldwide. Compared with traditional implantology, digital implantology provides patients with more comfortable and satisfactory experience in terms of safety, degree of trauma, treatment period, and visualization with standard and efficient processes. Today’s case, from Dr. Abdelrahman Khalaf and Dr. Kirollos Hany of the Faculty of Dentistry Assiut University in Egypt (Fig 1), was a case of maxillary edentulous all-on-six digital implantation for occlusion reconstruction.   

Case background

Gender : Female 

Age : 61 years old 

Chief Complaint: Missing teeth in the upper jaw led to masticatory and esthetic problems, patients found it hard to adapt to the previous removable partial denture, and asked for a treatment to solve these problems. 

Make treatment plan

Two treatment plans were offered to the patient, either removable complete denture or an implant-supported fixed prosthesis. After discussing the pros & cons for each option, the patient chose to go for implants with fixed prosthesis. The details of the treatment plan were an all-on-six implantation on #16,#14,#12,#22,#24,and #26 with implant surgery guide. Used the Aoralscan 3 Intraoral scannerto capture every detail of the intraoral information to reconstruct the occlusion with fixed restorations. 

Design and make surgical guide 

Fig 2: Designed the surgical guide in exocad, the implant site, depth, angle were decided. 

After the surgical guide was designed, the dentist used AccuFab-D1s 3D printer to print the guide with resin SG01. AccuFab D1s is a 3D printer designed for dental use. With different kinds of resins, it can print models, surgical guides, temporary teeth, waxes and more.  

Scan

Fig 3: Emergence profile formation after implantation. It was good and plump. 

Fig 4: Scanned the implant scan bodies with Aoralscan 3 Intraoral scanner. 

In this case, the dentist obtained the upper jaw with Aoralscan 3 Intraoral scanner, removed the gingival data at implant sites, placed six scan bodies, then scanned again to capture detailed information. It was worth noting that the #26 was full of metal filling, Aoralscan 3 Intraoral scanner could obtain its morphology easily by activating metal scan function without spraying. 

DSD Design

In traditional treatment, the final tooth color, shape, arrangement is hard to be foreseen before the end of treatment, and there is no opportunity for patients to express their opinions. Now, with the help of DSD technology, patients can fully participate in the design process, share their opinions with the dentist to achieve “private customization” treatment and restorations. 

Fig5:In this case, the dentist determined the facial midline, dental midline, smile line and other parameters, designed the most suitable teeth with shape, length and width ratio, and finally completed the DSD design of maxillary implant long bridge #16~#24. 

Temporary teeth fixed

The temporary resin bridge was tried on the model to check whether the occlusal, edge, adjacency and overall shape of the prosthesis can meet the requirements (Fig 6). If the temporary teeth were not suitable, they can be adjusted at this step. Finally, the dentist placed the temporary teeth into patient’s mouth without much adjustment (Fig 7). 

Comments from dentists

Intraoral scanners simplify clinical procedures for us and allow better communication with the dental technician and with patients. Optical impressions reduce patient discomfort and are time efficient as they dramatically reduce the number of visits. Now we can deliver a full arch screw retained prosthesis in just 2 visits.

For us, the intraoral scanner is not just an impression tool but it also provides us with the final model on which we can make the final prosthesis and thus eliminating plaster models errors which is very technique sensitive. In these kinds of cases, thanks to the high accuracy of the intraoral scanner over conventional impressions, we can deliver these prostheses with very high satisfaction.  

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