Implementing 3D-printed indexing devices and contemporary scanning techniques for complete-arch implant-supported...

A sixty-eight-year-old male presented to the dental clinic seeking a complete mouth rehabilitation. He exhibited generalized dental caries, dental staining, cervical lesions, fremitus, and anterior wear. After declining tooth-retaining options, he elected full-mouth extractions with immediately loaded implant-supported prostheses. A hybrid workflow, incorporating both digital and conventional steps, was used to plan treatment. The cone-beam computed tomography-derived anatomical data were integrated with the articulated diagnostic casts using a custom three‑dimensional (3D)-printed hexagonal indexing device. The maxillary teeth were digitally removed to generate an edentulous cast, a cast of the maxilla generated from the segmented-CBCT data, and an artificial tooth arrangement. Subsequently, 3D-printed stackable surgical guides were fabricated to support extractions, osteotomy preparation, implant placement, and delivery of a milled polymethyl methacrylate interim prosthesis. A similar hybrid workflow was used for the mandibular arch, with an updated diagnostic maxillary arch compensating for occlusal changes introduced during the fabrication of the maxillary interim prosthesis. Implant positions were recorded using non-splinted and splinted intraoral scanning techniques, and verification casts were articulated to support fabrication of the definitive prostheses. The definitive, complete arch monolithic zirconia restorations demonstrated accurate fit, stable occlusion, and favorable soft-tissue contours. At the 1-year follow-up, radiographs showed stable peri-implant bone levels and clinically healthy peri-implant tissues, indicating favorable adaptation to the implant-supported prostheses.