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Staged Full-Arch Rehabilitation With Tilted and Pterygoid Implants: A Pragmatic Hybrid Analog-Digital Workflow With
Francesco Liborio1, Fabio Massimo Sciarra1, Emanuele Di Vita1
1Dipartimento di Medicina di Precisione in Area Medica, Chirurgica e Critica Palermo, Universita degli Studi di Palermo, Palermo, Sicily, Italy.
Background And Aim:
Full-arch rehabilitation in patients with advanced maxillary atrophy has evolved considerably through the introduction of tilted and pterygoid implants combined with immediate loading protocols. At the same time, digital technologies have transformed prosthetic workflows. Nevertheless, fully digital procedures may still present limitations in edentulous arches because of scanning accuracy, equipment costs, and restricted accessibility in many clinical settings.
Case Report:
A 68-year-old male patient affected by terminal dentition and severe generalized periodontitis underwent staged implant-supported full-arch rehabilitation. The maxilla was treated first using immediate postextraction placement of six implants, including tilted posterior and pterygoid implants, followed by immediate loading. Six months later, the mandible was rehabilitated using the same treatment philosophy. Prosthetic rehabilitation was performed through a hybrid analog-digital workflow in which conventional implant impressions were integrated with digital scanning and CAD-CAM manufacturing.
Results:
All implants obtained adequate primary stability, allowing immediate loading. Clinical and radiographic examinations confirmed successful osseointegration, stable peri-implant tissues, and absence of biological or mechanical complications throughout the observation period. Definitive CAD-CAM prostheses demonstrated passive fit without requiring intraoral corrections. At 2 years, functional stability, aesthetic integration, and patient satisfaction remained excellent.
Conclusions:
This case illustrates that a hybrid analog-digital workflow can represent a practical and predictable alternative for full-arch rehabilitation in complex implant cases. By combining the precision of conventional impressions with the flexibility of digital prosthetic design, the proposed protocol achieved reliable clinical outcomes while remaining suitable for everyday clinical practice. Although further clinical studies are necessary, this approach may provide a practical and clinically applicable strategy that integrates conventional and fully digital rehabilitation protocols.
