This article highlights the critical role of digital technologies, particularly photogrammetry, in full-arch dental implant practices. By replacing traditional analog methods, digital tools enhance the precision of implant placement and prosthetic design, leading to better functional and esthetic outcomes. The seamless integration of photogrammetry with a computer-aided design /computer-aided manufacturing system not only streamlines the workflow but also improves patient satisfaction by reducing treatment times and increasing comfort. As technology advances, the importance of digital tools in implantology will continue to grow, offering clinicians more effective ways to deliver high-quality, predictable results.
Key points
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Digital Transformation : The shift from analog to digital records, particularly using 3-dimensional (3D) tools such as facial scanners, intraoral scanners, and photogrammetry has dramatically improved the accuracy and efficiency of full-arch dental implant procedures.
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Photogrammetry : Photogrammetry allows for highly accurate capture of implant positions, ensuring a passive fit of the prosthesis and reducing the risk of implant failure.
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Enhanced Patient Experience : The use of digital tools, including photogrammetry, shortens treatment times and improves patient comfort by minimizing the need for multiple appointments.
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Integration with computer-aided design (CAD)/computer-aided manufacturing (CAM) : Integration with a CAD/CAM system streamlines the design and fabrication process and enhances the overall workflow.
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Future Potential : As digital technologies continue to evolve, their role in implantology will expand, offering even greater precision and efficiency in treatment.
Introduction: a patient in need of full-arch dental implant treatment
A patient presents with failing upper dentition is requesting full-mouth dental extractions and implant treatment. What is the proper protocol to get the patient to the end of treatment ( Table 1 )?
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The need for proper records
Accurate facial and dental records are fundamental in planning All-on-X cases, as they directly impact the size, shape, position, and function of the final prosthesis. Preoperative records must encompass a detailed representation of facial features, including the interpupillary line, lip position to tooth display, and the relationship between dental and facial midlines, among others. Intraoperative records should include soft tissue form and position, implant position to the maxilla, implant positions to the mandible, and the jaw relationship between the maxilla and mandible. Postop records must encompass the final facial measurements and the dental measurements to ensure accuracy of your preoperative plan. Inaccuracies of records during any of these 3 phases of treatment can lead to poorly fitting prosthetics, compromised esthetics, and functional issues, ultimately diminishing patient satisfaction and confidence in the outcome. By employing a combination of records, measurements, and clinical evaluation, practitioners can ensure a precise alignment of facial and dental elements. This precision not only enhances the predictability of the procedure but also contributes to a more efficient workflow, better esthetic outcomes, and greater patient and doctor satisfaction. The integration of these records can be particularly challenging in cases where patients are edentulous or have minimal tooth display; however, overcoming these challenges with accurate records leads to superior results in both form and function. This article can help any practitioner understand the importance of proper, accurate records and how to employ the technological tools and instruments to finish complex, full-arch dental implant cases ( Figs. 1 and 2 ).
The ideal characteristics of records
The ideal characteristics of facial and dental records for completing All-on-X cases are rooted in their accuracy, comprehensiveness, and relevance to both functional and esthetic outcomes. First and foremost, these records must provide a precise and detailed representation of the patient’s facial anatomy and the patient’s dental anatomy and then accurately relate these 2 data sets together. This includes accurate measurements of the interpupillary line, which serves as a horizontal reference point, as well as the tooth-to-lip measurements both in repose and in a full smile. The frame of the lips around the teeth must be accurately captured to give the proper position of the teeth. Additionally, ideal records should capture the width of the nose from ala to ala to act as a guide to get proper width of the golden proportions of the teeth. These elements are critical for ensuring that the prosthesis aligns harmoniously with the patient’s facial features, enhancing both the natural appearance and the functional efficiency of the final result.
The accurate representation of the dentition of both the maxilla and mandible is crucial for determining the correct positioning and angulation of implants, which directly influences the stability and longevity of the prosthesis. Moreover, the records must include interocclusal records and an accurate depiction of the vertical dimension of occlusion, which are vital for achieving proper bite function and preventing issues such as temporomandibular joint (TMJ) disorders or uneven wear on the prosthesis.
The records should also detail the functional movements of the mandible, the curves of Spee, Wilson, and Monson, and the buccal corridors between the teeth and cheeks. These aspects are essential for ensuring that the prosthesis allows for natural and unrestricted mandibular movement, which is crucial for speech, chewing, and overall oral comfort. Furthermore, capturing the facial midline and horizontal occlusal cant is important for achieving symmetry and balance in the final esthetic outcome.
Equally important is the accurate representation of the natural shape and shade of the patient’s teeth. This ensures that the final prosthesis not only fits well but also blends seamlessly with any remaining natural teeth or in the case of a full arch, appears lifelike and aesthetically pleasing. The use of analog methods such as facebow transfers, static photos, and clinical facial measurements or the use of digital records such as facial scans, intraoral scans, or 3-dimensional (3D) photos helps to create a robust set of records that can be cross-referenced for accuracy and consistency.
The ideal records should be thorough, meticulously accurate, and capable of being integrated into a cohesive plan that addresses both the functional and esthetic needs of the patient. These records serve as the blueprint for successful implant placement and prosthesis fabrication, ensuring that the final prosthetic outcome is predictable, functional, and visually pleasing. When these characteristics are met, the likelihood of patient satisfaction and long-term success of the treatment increases significantly.
The full set of proper records
Preop Records
Health history and other significant medical records.
Scans
Cone beam computed tomography (CBCT), Pano, PA radiographs, 3D facial Photo with capture of dentition, Intraoral scans, 3D Jaw Movement Scan ( Figs. 3–6 ).
Dental and periodontal examination
Caries, missing teeth, periodontal condition, gingival type, amount of keratinized tissue, biotype, amount of bone quantity and quality, dental midlines of maxilla and mandible, Proclination of teeth, arch shape, occlusal plane angle, curve of Spee, curve of Wilson, curve of Monson, dental occlusal classification.
Facial examination
Midline, Horizontal Interpupillary line, Lip Frame, Tooth to lip in repose and full smile, Width of nose, buccal corridors, facial fifths, facial thirds, gingival show in full active smile, horizontal dental cant in relationship to face, TMJ range of motion, Lip support in the anterior-posterior (A-P) position, esthetic line (E-Line), skeletal classification.
Intra-op
Intraoral scan (IOS) of fiducial markers placed in relationship to preop anatomy, implant position in relationship to the other implants in the arch, implant position in relationship to the jaws of the maxilla and the mandible, Jaw relationship to each other with the new implants, immediate tissue levels in relationship to the implant abutments for the maxilla and the mandible ( Figs. 7–27 ).
