ENG
Full-arch immediate loading implant restoration has become an increasingly popular treatment option for edentulous patients, offering faster rehabilitation and improved patient comfort.
However, several clinical challenges remain, particularly in accurately capturing the positions of multiple implants and establishing the correct occlusal relationship. Precise implant position data is critical for achieving a passive fit of the prosthesis, minimizing stress on the implants, and ensuring long-term success. Inaccurate data can lead to misfit restorations, biological complications, and mechanical failures.
Another significant challenge lies in the accurate recording of the patient’s occlusal horizontal orientation and vertical dimension during the immediate loading phase. Soft tissue swelling, the instability of the pre-op occlusion, and changes in jaw relationship post-surgery further complicate the process.
Today’s case is provided by Dr. Yan Wenren，it shows how doctor used Aoralscan Elite to capture the implant position accurately, and used the Optimal Jaw relation to determine the most suitable jaw relationship for edentulous patients during the immediate loading implant cases.
Dr. Yan Wenren has been operating his own clinic for many years, with extensive expertise in immediate loading using All-on-X implant techniques, fixed and invisible orthodontics, microscopic endodontic therapy, digital aesthetic restorations, and early myofunctional treatment for children, etc.
Case Profile: jaw motion capture for edentulous patients
The female edentulous patient has been suffering from tooth loss for years. In the past, she has been using removable dentures. However, she now feels that the removable full denture is no longer sufficient to support her daily life, as it makes it difficult to eat certain hard foods. As a result, she visited the doctor seeking assistance.
Treatment Plan: All-on-X implant
Upon the patient’s arrival, the doctor gathered all the relevant information, including intraoral scan data, face scan data, CBCT, and so on. With these inputs, the doctor can perform a comprehensive analysis. After the initial evaluation and considering the patient’s preferences, the final treatment plan is to proceed with a restoration-driven All-on-X implant treatment.
Treatment Process
Intraoral scan data capture using Aoralscan Elite
After the implant surgery, the doctor used the Aoralscan Elite to capture intraoral scan data with IPG technology. First, the edentulous arch was scanned. Then, after installing the coded scanbody, the doctor captured the scanbody to capture the precise position of the implant. During this process, a cap scanbody was used to align the soft tissue with the coded scanbody, as the gingiva undergoes significant changes before and after surgery and is not stable enough.
Fig 1-4: all-on-X implant scan: upper jaw scanning
Fig 5-7: all-on-X implant scan: lower jaw scanning
Fig 8, 9: The completed scanned intraoral data.
Jaw movement trajectory capture using MetiSmile-MR
MetiSmile-MR is not just a face scanner, it also comes equipped with jaw motion features, including mandibular movement trajectory tracking, mandibular movement analysis, and optimal jaw relation. In this case, the doctor used the optimal jaw relation function to find the most suitable jaw position, as the original bite information was no longer optimal.
For this patient, who is undergoing All-on-X implant treatment, the doctor used a screw-retained bite fork to capture jaw movement, which helped in tracking markers during the scanning process.
Fig 10,11: the installation of the bite fork in the upper and lower jaw.
Fig 12,13: Scan the bite fork in the upper jaw
The 14,15: Scan the bite fork in the lower jaw
The 16,17: The scanning process and the final alignment of the bite fork.
Optimal jaw relationship determination process using MetiSmile-MR
The groundbreaking feature of the MetiSmile-MR is its integration of both face scan data capture and jaw motion functions. It is the world’s first face scanner to combine these two features.
In the Optimal jaw relation function, it records the static facial data, resting facial data and 30 times small, quick mouth opening movements. The software then identifies key landmarks, sets up a coordinate system based on these reference points. Doctors can adjust the vertical distance to find the optimal occlusal height. For the horizontal relation, the software calculates the intersection of the motion path with the horizontal plane, giving the centric relation and myofascial points for the doctor’s reference. Users can also easily check the occlusion with the four cross-sectional planes along the dental arch, and the software will show the interocclusal measurements.
Fig 18, 19: Order creation and marker making
Fig 20, 21: Static face data capture
Fig 22-25: face scan data and mouth open-close movement trajectory capture.
Fig 26, 27: coordinate system establishment and the optimal jaw relationship determination.
Design process
Once the new jaw relation is determined, it will be imported into exocad for the next stage of the design process.
Fig 28-33: The design process in exocad.
Printing with AccuFab-F1
AccuFab-F1 is Shining 3D’s latest printer, which deliver accuracy, speed, and reliability for the dental industry. It is tailored for All-on-X Prosthetics, with incredibly fast printing speeds, it ensures rapid production of durable and accurate restorations.
Fig 34,35: the printing process using AccuFab-F1.
Try in Process
The designed prosthesis is accurate with situation occlusion, do not need much adjustment during the try in process.
Fig 36-41: The try in process in patient’s mouth.
This is quite a complex case. The doctor performed implant surgery on both the upper and lower jaws simultaneously and delivered the temporary prosthesis on the same day. During the treatment, two key challenges had to be addressed. The first was accurately capturing the implant position immediately after surgery, despite the movable soft tissue. The second was determining the most suitable jaw relationship for the patient.
With Aoralscan Elite’s IPG workflow and MetiSmile-MR’s optimal jaw relationship feature, the doctor was empowered to overcome these challenges during the treatment. This approach not only allowed for greater accuracy of treatment results but also made the outcomes more predictable.