Maxillary full-arch implant-supported rehabilitation with a digital workflow: Two-year follow-up

The following case report demonstrates the successful management of a 70-year-old patient experiencing masticatory difficulties. Through a maxillary full-arch implant-supported rehabilitation with six Straumann Bone Level Tapered (BLT) implants facilitated with a digital workflow, we improved her quality of life and fulfilled her expectations.

Initial situation

The healthy female patient with no medication, allergies or smoking habit came to our clinic seeking a resolution for her problems with chewing. Additionally, she reported a history of persistent dental and oral malodour. The patient expressed a desire to regain her ability to eat like before and recover her quality of life and confidence.

The extra-oral examination showed a low smile line, and the intra-oral examination found a removable bridge from tooth #13 to tooth #23 that was poorly adapted and showed signs of deterioration. The maxillary teeth, with the exception of tooth #18, were mobile. Generalised gingival inflammation, bleeding on probing and dental caries were also present (Fig. 1). The radiographic examination exposed severe bone loss in the posterior of the maxillary left quadrant, as well as caries and apical lesions on maxillary teeth (Fig. 2).

After conducting both radiographic and clinical assessments, the patient was categorised as having a complex condition according to both the surgical and prosthodontic SAC classifications. This classification system, developed by the International Team for Implantology, assists in evaluating the level of challenge and potential complications linked to implant-related restoration (Fig. 3).

Treatment planning

After an extensive conversation with the patient about the various treatment alternatives, a joint decision was reached that the chosen approach would involve a digital workflow, immediate implant placement and maxillary full-arch implant-supported restoration.

The treatment workflow involved:

1. digital implant placement planning using coDiagnostiX (Dental Wings);
2. design and printing of the bone reduction guide, surgical guide and resin models;
3. extraction of the hopeless teeth in the maxilla;
4. fixation of the surgical guide and immediate implant placement of six Straumann BLT implants in the maxilla;
5. filling of the gaps with Straumann XenoGraft;
6. delivery of the temporary screw-retained prosthesis;
7. delivery of the final screw-retained prosthesis 12 weeks after surgery; and
8. periodontal supportive therapy every three to four months.