Full-Arch Implant-Supported Rehabilitation Using Reverse Scan Technique: A Case Report
This was a case report successfully employing the reverse scan technique. A 72-year-old male patient desired to restore his teeth in both jaws. Clinical examination revealed the presence of several remaining teeth with poor prognosis due to significant bone loss and mobility. The treatment plan involved extracting these teeth, placing 4 implants in the maxilla and mandible, and fitting an interim immediate loading prosthesis. Full-thickness flaps were raised during surgery, and the remaining teeth were extracted. Implants and multiunit abutments were placed, followed by impressions and the recording of the interjaw relationship using index dentures. After 6 months of osseointegration, the reverse scan technique was employed, using light silicone, reverse scan bodies, and extraoral scanning to capture implant positions, soft tissue profiles, and prosthesis shapes. Titanium frames were machined for the final prostheses—monolithic zirconia for the maxilla and zirconia crowns with composite gingiva for the mandible. These were delivered after confirming the fit, aesthetics, and occlusion. The technique enhanced patient comfort, minimized chair time, and ensured the quality of the prosthetic outcome.
(a) Intraoral photographs. (b, c) Occlusal surface photographs of the maxillary and mandible. (d) Pretreatment radiographies. Clinical examination and radiographies revealed a loss of vertical dimension and poor prognosis of the remaining teeth.
(a) Taking impressions with silicone. (b) Recording occlusal relation using 2 index dentures. (c) Interim prosthesis after delivery in the mouth. (d) Patient’s smile after interim prosthesis delivery. Following implant placement and multiunit abutment installation, impression copings related to pattern resin were made, and silicone impressions were taken. The interjaw relationship was immediately recorded using an index denture. The laboratory fabricated interim acrylic prostheses delivered to the patient after 2 days.
(a) Records of soft tissue profile. (b) Attachments of reverse scan body to the interim prosthesis. (c) Extraoral scan files. (d) Records of occlusal relation. (e) Fully recorded information. Once the silicone was cured, the soft tissue profile was recorded. Secondly, reverse scan bodies were screwed into the interim prosthesis, and an extraoral scan was performed to capture implant position, soft tissue profile, and prosthesis shape, excluding the occlusal relationship. Thirdly, the interim prosthesis was reattached to the mouth, and the patient was asked to bite to record the occlusal relationship. Fourthly, the extraoral prosthesis scan file and the occlusion scan file were merged to provide comprehensive information.
(a) Passive fit testing. (b) CAD-CAM titanium frames. (c) Fit testing of frames. (d) The frames from the occlusal surface. A jig was designed and printed from the digital information to ensure a passive fit. The Sheffield test, observed with magnifying loupes, confirmed passive fit. Titanium frames were machined using CAD-CAM, with a monolithic zirconia prosthesis planned for the maxilla and zirconia crowns with composite gingiva for the mandible. At the subsequent appointment, the frames were clinically checked and found to have a passive fit and closely fitted the soft tissue.
(a, b, c). Final prostheses. (d) Posttreatment patient’s smiling. Once the frames met requirements, the final prostheses were entirely manufactured by the laboratory, consisting of monolithic zirconia for the maxilla and zirconia crowns with composite gingiva for the mandible. The final prostheses were delivered to the patient, ensuring passive fit, aesthetics, and occlusion.
Contributor Notes
Phuc Ngoc Nguyen https://orcid.org/0009-0002-8987-227X.