Digital Full-Arch Excellence:
A Case Study Using the Panthera Fusion Bar and the Shining 3D Elite

With the ever-changing technological advancements in the dental industry, clinicians are constantly trying to keep up with the rapid advancements made in the industry. This “Dental Jungle” is a huge challenge for many clinicians, so many questions and unknowns. Fortunately, there are now solutions for clinicians to help them navigate this daunting road of the future.

This article highlights the clinical journey from patient assessment to the final prosthesis delivery, emphasizing the integration of digital technology and a multidisciplinary approach to achieve optimal results.

Based on 20 years of specialized research and development in high-precision 3D vision technology, photogrammetry has a ready been proven capable of achieving high accuracy for large-scale objects like airplanes, ships, and other significant structures.

SHINING 3D has taken a significant step further by innovatively applying its patented photogrammetry technology from high-end industrial applications to the dental field. This advancement delivers an extremely high-accuracy scanning experience, particularly beneficial for full-mouth edentulous dental implant applications.

It is called IPG – intraoral photogrammetry.

So, what makes IPG technology different compared to regular intraoral scanning?

Regular scanbody or scan flag scanning typically requires 360-degree scanning to capture its positions based on surface geometry features. This method often encounters issues due to insufficient features, particularly when scanning vibrating soft tissue between the scanbodies, or liquids such as blood or saliva, leading to a loss of scanbody positioning accuracy.

In contrast, IPG utilizes encoded patterns on scanbodies as accuracy control reference points for global optimization. This technology involves a comprehensive process of measuring and interpreting photographs to extract precise spatial information and creates highly accurate 3D data. One of the key advantages of IPG is that it requires significantly fewer perspectives to capture the scanbodies’ positions during the scanning process. This makes the scan workflow more efficient and avoids unnecessary accumulated errors.

The patient, a 73-year-old female, was referred for consultation regarding a full upper denture and a partial lower denture.

Key Findings

• Upper Arch: Periodontally compromised with a poor prognosis for all remaining teeth.
• Lower Arch: Retention of teeth 44, 43, 33, 34, and 37 was possible despite some pocketing.
• Primary Concern: The patient experienced significant discomfort and mobility in the upper anterior teeth, making chewing difficult.

Referring Clinician’s Suggestions

• Address both arches simultaneously for better occlusion.
• Consider interim and final prostheses.
• Coordinate surgical timing with denture readiness.

During my initial examination, the patient expressed strong opposition to a full upper denture with palatal coverage, citing concerns about taste alteration and discomfort. After reviewing all options, we decided on an implant-supported fixed solution (teeth-in-a-day) to address these concerns.

The patient was referred to Aspen Oral Surgery, where Dr. Martin Cloutier, a maxillofacial surgeon specializing in implant therapy, conducted a comprehensive evaluation and planned the following procedures:

1. Extractions: All maxillary teeth were extracted.
2. Implant Placement: Seven implants were immediately placed in the maxilla.
   1. Six implants achieved high primary stability, enabling immediate function.
   2. A seventh implant was placed for potential inclusion in the final prosthesis.

After surgery, I performed the chairside conversion of the All-on-X provisional prosthesis.

Steps

1. Provisional Prosthesis: Adapted to the implant positions and secured with Multi-Unit Abutments (MUAs) for immediate function.
2. Fit and Function: Adjustments were made to ensure proper fit, function, and esthetics.
3. Occlusal Verification: Undue stresses were minimized to protect the implants during healing.
4. Night Guard: A transitional night guard was provided to reduce stress on the implants and promote optimal healing.

The immediate solution restored function and esthetics, greatly improving the patient’s confidence and comfort during the healing phase.

Oral Surgeon Review and Final Torque Test: After six months, the patient returned to the oral surgeon for evaluation. Dr. Cloutier performed a final implant torque test to ensure implant integration and stability. The Multi-Unit Abutments (MUAs) were retorqued to their recommended specifications to confirm the implant stability before the fabrication of the final prosthesis.

On the same day, the patient returned to my office for the final prosthesis workflow.

Temporary Prosthesis Assessment: The temporary fixed provisional was evaluated for fit and function.

A comprehensive scan was performed to record all anatomical landmarks, including the palate, residual ridge, implant positions and opposing arch.

1. Before removing the temporary prosthesis, I captured a detailed pre-op scan. This step is important because the temporary acts as a guide for the final aesthetics and occlusion.

   I start by scanning the prosthesis in the patient’s mouth, moving systematically from the anterior teeth to the posterior region on one side, and then repeating the process on the other side. I ensure I capture all surfaces—the occlusal, buccal, and palatal. It is important to scan the soft tissue contours around the prosthesis.