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Table of Contents
How Aoralscan Elite and MetiSmile Enable Predictable Full Arch Prosthetics
Introduction
Achieving a passive fit in full arch implant cases has traditionally required verification jigs — a time-consuming and often uncomfortable process for patients. But digital workflows are rapidly changing what’s possible.
In this case, I share how a full arch maxillary restoration was delivered with complete confidence, without needing a verification jig. Using the Aoralscan Elite for intraoral photogrammetry and the MetiSmile facial scanner for aesthetic planning, we were able to provide a highly accurate and natural-looking prosthesis for a patient whose implants had been placed during a complex immediate-load protocol.
The Clinical Case
The patient, a healthy 55-year-old woman, presented with a flexible denture and advanced periodontal disease affecting her remaining upper teeth. The remaining dentition was deemed unrestorable. She was highly motivated to move to a fixed solution that offered both function and aesthetics.
Treatment Approach
We planned a full arch implant-supported prosthesis using the OXY FIXO implant system — a one-piece implant with an integrated multi-unit abutment. Our surgical plan included:
– 4 anterior implants placed using a bone-supported guide
– 2 pterygoid implants, placed freehand to maximise AP spread without bone grafting
Immediate Loading Protocol
On the day of surgery:
– The implants at UR2 and UL2 were restored straight to fixture, without the need for abutments.
– At UR5 and UL5, temporary cylinders were used for a chairside pick-up technique.
– The pterygoid implants were left unloaded at this stage.
An immediate provisional bridge was fitted and torqued to specification. The patient left with a functional, fixed solution on day one — and was delighted.
Healing and Review
After a 10-week healing period, the patient returned for final prosthetic records. Soft tissues were healthy, and the bridge remained stable. At this point, we began our fully digital workflow to produce the definitive prosthesis.
The Scanning Protocol
Accurate data collection was key to achieving a passive fit — and we followed a structured, repeatable digital process using MetiSmile and Aoralscan Elite.
Step 1: MetiSmile Facial Scanning
We began with the MetiSmile facial scanner to guide smile design and facial harmony. This was used both pre-operatively and at the final prosthetic phase.
Each scan involved:
1. A natural smile scan (lips relaxed, full smile)
2. A retracted smile scan (with cheek retractors)
While scanning, the patient was asked to:
– Turn their head slightly to the left, then right
– Tilt their head slightly upward
These movements allow the system to capture full facial contours, midline alignment, incisal display, and lip support.
The two scans are then merged automatically, providing a 3D reference for designing tooth position, smile line, and overall symmetry — all tailored to the patient’s unique facial features.
Step 2: Aoralscan Elite – Intraoral & Photogrammetry Workflow
After facial scanning, we moved to intraoral data collection with Aoralscan Elite, following a structured three-phase protocol:
2.1 Provisional Bridge In Situ
We began by scanning the provisional bridge while still in place:
– This preserved the occlusal vertical dimension (OVD)
– Captured occlusion, incisal edge position, and tooth form
2.2 Soft Tissue Scan
After removing the bridge, a soft tissue scan was taken of the edentulous maxilla:
– This provides gingival contours for prosthetic emergence profile design
2.3 Domino Scan Flags – Photogrammetry
We then placed Domino scan flags on all multi-unit abutments — including the pterygoids. Each flag was carefully angled toward the midline of the palate to ensure the system could visualise and triangulate all markers effectively.
With Aoralscan Elite’s built-in photogrammetry module, we captured the 3D spatial relationship between all implants in a single scan, with sub-10µm accuracy. No physical impression materials or verification steps were needed.
Workflow Timing
This scanning workflow is not only accurate — it’s efficient:
– Single arch case: 30 minutes
– Dual arch case: 45 minutes
This includes the full scan process: facial scans, intraoral records, and photogrammetry capture.
Final Prosthesis Design
All the collected data — facial scans, provisional tooth form, occlusion, and implant positions — were merged digitally by our lab.
We designed a final titanium bar with a PMMA wrap, offering both strength and reparability. Because of the precision of the digital scan data, no verification jig or physical try-in was needed.
Fit and Delivery
The final prosthesis was delivered in a single appointment:
– The Sheffield test (single-screw test) confirmed passive fit
– Radiographs verified full seating on all abutments, including angled and pterygoid sites
– No adjustments were required
The prosthesis matched the patient’s facial features perfectly — thanks to the continuity between the MetiSmile-guided provisional and final designs.
Reflections
This case is a great example of what’s now possible when digital tools are used well. Even with freehand pterygoid implants and angled one-piece systems, we were able to deliver a passive-fitting, aesthetic full arch prosthesis with zero reliance on a verification jig.
The key to this success was the precision and efficiency of the scanning workflow:
– MetiSmile gave us facial confidence and helped the patient visualise her future smile
– Aoralscan Elite ensured implant data accuracy and passive fit on delivery
Conclusion
Verification jigs have long been a staple in full arch workflows — but this case shows they may no longer be necessary.
By combining high-resolution intraoral photogrammetry with facially driven design, we can now deliver full arch prosthetics that are:
Passive-fitting
Aesthetically predictable
Digitally planned from start to finish
Comfortable and fast for patients
For clinicians looking to modernise their approach, this workflow offers a reliable, repeatable path to excellent outcomes — and happier patients.