Full Digital Workflow in Implant-Supported Fixed Complete Prostheses With Stereophotogrammetry

Objectives: To describes a full digital workflow with stereophotogrammetry combining intra-oral scanning and Cone Beam CT for the rehabilitation of a patient with failing dentition, restored with immediate-loaded transitional and subsequent definitive implant-supported fixed prostheses.
Methods: A digital facebow and axiograph (Modjaw; Villerburane, France), intra-oral scans (Triosâ 3; 3Shape), cone-beam computed tomography systems (CBCT), and photographs were acquired to record maxillo-mandibular relationship and mandibular movement. Based on a comprehensive clinical evaluation of esthetics and phonetics, including incisal edge position, anterior display, closest speaking space, and occlusal plane, a digital diagnostic wax-up was done using 3Shape software (DS 20.1.2). STL data from the intra-oral scans and diagnostic wax-up was superimposed and merged with the CBCT imaging for the surgical planning of 6 maxillary and 5 mandibular dental implants (Straumannâ; Basel, Switzerland). Following surgical procedures including teeth extractions and implant placement, abutments were inserted and a stereoscopic camera (PIC camera by Precise Implants Capture (PIC) dental; Madrid, Spain) was used to record the implant spatial relationship. Provisional fixed prostheses were digitally designed, milled, and delivered the day after surgery. After three months of healing, prototypes were fabricated incorporating changes to idealize esthetics and function. Definitive maxillary and mandibular monolithic Zirconia prostheses were milled and delivered utilizing the prototypes as a reference using CAD-CAM.
Results: Photogrammetry combining intra-oral scanning and CBCT allows digital treatment planning and full digital registration of multiple implants to restore a failing dentition with fixed complete prostheses in five clinical visits, providing an efficient and predictable workflow and improving patient's satisfaction.
Conclusions: Photogrammetry combining intra-oral scanning and CBCT provides a very promising full digital workflow to do treatment plan and restore failing dentition with implant-supported fixed complete prostheses in an efficient and predictable approach.