Complex Full-Arch Treatment with Zygomatic Implants, Fully Digital Protocol with Scan Flag Intraoral Scanning, and 3D-Printed Temporary Reconstructions in a Periodontal Patient-A Case Report.

Abstract

Background: The following case report presents the treatment of a patient with severe maxillary atrophy and failing residual dentition. The patient has been diagnosed with stage IV grade C periodontitis, making this case challenging from the very beginning. Methods: The treatment plan was based on collecting and merging digital data: CBCT, a face scan, and an intraoral scan. Due to the advancement of the periodontal disease, the treatment was divided into three stages. The entire process was conducted in a digital manner, based on the concept of prosthetically driven implantology. Additionally, all prosthetic temporaries were planned via digital smile design. Stage I included extracting the residual dentition, placing four implants in the mandible, and the delivery of a 3D-printed upper removable denture. Stage II included placing two zygomatic implants, two anchored piriform rims, and one midline implant. Both arches were immediately loaded with the intraoral welding of abutments screwed to multiunit abutments and 3D-printed shells. Subsequently, in stage III, two milled ceramic superstructures combined with a titanium milled bar were delivered as a final screw-retained restoration with the application of scan flags (horizontal scan bodies) for intraoral scanning. Results: The aforementioned technologies can all be implemented and merged into one complex treatment plan combining high predictability, successful esthetics, and a reliable and accurate end result. Even though the concept of scan flags is relatively new, this case shows its potential and merit. Conclusions: This case represents the power of the digital approach as a helpful tool in the recreation of functional and esthetic smiles in compromised conditions in periodontal patients.