Impact of number of maxillary fixation landmarks on the registration accuracy of an implant scanningworkflow.

Implant scanning workflow combining extraoral photogrammetry and the reverse scanning method for fabricating implant-supported prostheses.

The present study investigated the combined influence of four different scanning patterns and two intraoral scanning (IOS) technologies (Confocal Ultrafast Optical Sectioning vs. Active Triangulation with Structured Light) on the trueness and precision of both the intaglio and cameo surfaces of a maxillary reference denture. A maxillary complete arch reference denture was scanned using IOS technologies: Confocal Ultrafast Optical Sectioning (CUOS) and Active Triangulation with Structured Light (ATSL). Scanning was done 80 times with four strategies: APBOP (starting on the posterior intaglio surface), PABOP (beginning at the palatal aspect of the intaglio surface), BOPAP (starting on the cameo surface), and POBAP (beginning at the palatal cameo surface). Each strategy involved thorough scanning of various aspects, including occlusal surfaces, to capture the complete dentate arch. Distance-deviation values were calculated from comparisons with the STL reference model, and the data were analyzed using two-way ANOVA and Tukey's test. For the CUOS IOS technology, the POBAP scanning pattern exhibited the highest trueness (161 ± 6 μm) and precision (151 ± 7 μm), whereas the APBOP pattern showed the lowest trueness (183 ± 28 μm) and precision (171 ± 33 μm). For the ATSL IOS technology, the POBAP pattern also demonstrated the highest trueness (200 ± 32 μm) and precision (198 ± 32 μm), whereas the PABOP pattern showed the lowest trueness (241 ± 24 μm) and precision (239 ± 24 μm). The main effect of scanning technology was statistically significant (p < 0.001), with the estimated marginal mean (EMM) for CUOS being 171 μm, indicating greater trueness relative to ATSL (211 μm). A partial eta-squared value of 0.52 indicated that scanning technology explained approximately 52% of the total variation in trueness, representing a substantial effect size. CUOS consistently exhibited superior trueness across all scanning patterns compared with ATSL.

Clinical evaluation of retention and patient satisfaction of monolithic complete denture: A crossover controlled clinical trial.

This study aimed to investigate the biomechanical effects of different aligner thicknesses and expansion step sizes with the Invisalign Palatal Expander (IPE) on the midpalatal suture, teeth, and periodontal tissues during maxillary arch expansion using the finite element method (FEM), thereby facilitating its more precise and effective clinical application. Three-dimensional (3D) finite element models, including teeth, bilateral maxilla, midpalatal suture, periodontal ligament (PDL), aligner, and attachments, were constructed. Stress distribution and initial displacement of the midpalatal suture, teeth, and PDL were evaluated under three aligner thicknesses (0.5, 1.0, and 1.5mm) and different step sizes (0.1, 0.2, and 0.3mm). During expansion with the IPE, increased aligner thickness markedly enhanced the buccal displacement of posterior teeth, increased midpalatal suture initial displacement, and promoted bodily movement rather than tipping, albeit with increased PDL stress. A greater step size increased buccal displacement of the first molar but reduced that of the primary molars. Thicker aligners (≥ 1.0mm) combined with a larger step size directed mechanical effects posteriorly to a greater degree, promoting greater suture initial displacement in the posterior region. The thickness of the IPE aligner is the dominant factor regulating tooth movement patterns and midpalatal suture initial displacement, while step size modulates the magnitude and distribution of the mechanical response in the posterior maxillary arch. To promote greater posterior midpalatal suture displacement, we recommend using aligners with a thickness of at least 1.0mm in combination with an appropriately increased step size.

Adenotonsillar hypertrophy (ATH) relates to airway obstruction and orofacial changes in children. Whether adenoid hypertrophy (AH), palatine tonsil hypertrophy (PTH), and combined ATH were associated with distinct patterns of hard palate morphology and tongue function in the early mixed dentition remains unclear. This cross-sectional study examined 420 schoolchildren aged 6-8 years in central Vietnam. AH was defined by the Fujioka adenoid-nasopharynx ratio (ANR > 0.6) and PTH by Brodsky grades 3-4; tongue strength was measured with the Iowa Oral Performance Instrument, and hard palate morphology by digital dental-cast analysis. Multivariable regression (adjusted for age, sex, BMI, lip-seal at rest, and school location) analyzed individual measures; modified Poisson regression analyzed a co-occurring phenotype (structural alteration plus low tongue strength). Univariable comparisons applied Benjamini-Hochberg false-discovery-rate (FDR) correction. Enlarged lymphoid tissue was present in 65.2% of children (AH only 19.3%, PTH only 32.6%, combined ATH 13.3%); tapered arch (31.0%), high-arch palate (20.0%), and low tongue strength (35.0%) were common. Nominally, AH was associated with a deeper, shorter palate, and PTH with a narrower tapered arch and lower tongue strength; but none survived FDR correction (smallest q = 0.16). In adjusted models, combined ATH was associated with a smaller anterior maxillary angle (β = -3.76°; 95% CI -6.22 to -1.29; p = 0.003) and palatal vault module (β = -0.54; -1.02 to -0.05; p = 0.032), each decreasing with adenotonsillar burden (both trends p ≤ 0.020). The co-occurring phenotype (77 children; 18.3%) became more common with burden (PTH only aPR 1.77, p = 0.040; combined ATH aPR 1.87, p = 0.048; trend aPR 1.38 per level, p = 0.020). Adenotonsillar hypertrophy was common in schoolchildren with mixed dentition. AH and PTH showed distinct patterns of palate and tongue alteration, although these did not survive FDR correction and remain exploratory. Combined ATH and greater adenotonsillar burden were consistently associated with maxillary arch narrowing; the co-occurrence alteration was also more frequent with higher burden. These findings support including palatal morphology and tongue function in orofacial screening during the mixed dentition, pending longitudinal confirmation.

To evaluate the invivo effect of varying experimental lighting conditions on the digital shade determination and scanning accuracy (trueness and precision) of two intraoral scanners (IOSs). The maxillary arches of 10 volunteers were scanned using two IOSs (Trios 4 wireless, 3Shape A/S [TR]; and Primescan, Dentsply Sirona [PR]). Scans were performed under four illuminance levels (0, 500, 1000, and 2500 lx) with scanner-specific color temperature (TR: 5500 K; PR: 4100 K). Digital shade selection was performed at the middle third of the right central incisor against visual consensus by three experts for Vita toothguide Classical (VC) and Vita toothguide 3D-Master (VM) shade guides. Scanning accuracy was assessed by superimposing IOS scans onto reference datasets obtained by digitizing conventional stone models with a laboratory scanner (InEos X5; Dentsply Sirona). Shade matching capability (accuracy and reliability) was also evaluated. Data were statistically analyzed using one-way ANOVA (α = 0.05). Ambient lighting significantly influenced digital shade matching and scanning trueness (p < 0.05). For shade matching accuracy, TR demonstrated the highest values at 1000 lx/5500 K (VC: 93.33% ± 14.05%; VM: 76.67% ± 22.50%), while PR performed best at 2500 lx/4100 K (VC: 96.67% ± 10.54%; VM: 50.00% ± 28.33%). TR produced significantly lower reliability results at the "no-light" (0 lx) condition (p < 0.05), whereas PR displayed no significant difference among groups (p > 0.05). For scanning trueness, TR exhibited the lowest deviation at 1000 lx/5500 K (104.04 ± 20.88 μm), while PR performed best at 2500 lx/4100 K (100.78 ± 19.36 μm). Ambient lighting conditions significantly affected IOS performance invivo. The optimal conditions were scanner-dependent: TR performed best under typical examination room lighting (1000 lx, 5500 K), while PR excelled under dental operatory lighting (2500 lx, 4100 K). To optimize digital impressions and esthetic shade matching, clinicians should adjust ambient lighting according to the specific requirements of the intraoral scanner being used.

The two widely used methods for orthodontic tooth movement with sliding mechanics are elastomeric power chains (EPC) and nickel-titanium closed-coil springs (NCCS). To compare the rate of extraction space closure during canine retraction, degree of root resorption, dental plaque accumulation and gingival health using NCCS versus EPC in subjects undergoing first premolar extractions. Single-centered, prospective, split-mouth randomized controlled trial. For canine retraction, NCCS and EPCs were randomly allocated to the right and left quadrants of both maxillary and mandibular arches in 46 subjects. Canine retraction, root resorption, plaque accumulation and gingival health were recorded at four points in time. Within groups, pairwise comparison and between-group comparisons were done using Wilcoxon signed rank test. Generalized Estimating Equation (GEE) analysis was employed to identify the factors significantly influencing the rate of extraction space closure during canine retraction and the extent of root resorption. The study investigators, patients recruited, and assessors were not blinded during the trial due to the visible nature of the orthodontic appliances used. NCCS exhibited faster rates in total canine retraction and during the T0-T1 (p = 0.039) and T2-T3 (p = 0.003) intervals. Root resorption exhibited non-significant differences. Whereas, NCCS demonstrated higher plaque retention at T1 (p = 0.013), T2 (p = 0.016) and T3 (p = 0.033). GI differed significantly between groups, with higher values with NCCS at T1 (p = 0.046) and EPC at T2 (p = 0.039). Extraction space closure rate displayed a significant difference between the T1-T2 and T2-T3 stages with NCCS (p = 0.025). GEE showed a significant positive association of age with root resorption (β = 0.939, CI = 0.312, 1.565, p = 0.003). NCCS demonstrated a significantly higher rate of extraction space closure and plaque accumulation compared to EPC. However, no statistically significant differences were observed between the two groups with respect to root resorption and gingival health. Furthermore, the degree of root resorption was found to increase significantly with the advancing age. Registered at clinicaltrials.gov under the identifier NCT06567730 on 23rd August 2024.

Ectodermal dysplasia (ED) is a hereditary condition stemming from genetic defects that disrupt the development of ectoderm-derived tissues, affecting structures such as hair, teeth, nails, and sweat glands. A rare manifestation of ED is anodontia, the complete congenital absence of both primary and permanent dentition. This absence leads to underdeveloped alveolar ridges, significantly complicating dental rehabilitation efforts. This case report details the management of a 27-year-old female patient with ED and anodontia who presented with a fragile zygomatic bone and a heightened risk of orbital complications associated with traditional, free-hand zygomatic implant placement. To address these challenges, a fully digital workflow was implemented, encompassing diagnosis, treatment planning, surgical procedures, and prosthetic fabrication. The maxillary arch was rehabilitated with four zygomatic implants placed using dynamic navigation. Immediate loading was achieved by delivering a provisional fixed prosthesis within 48h post-surgery. After a six-month healing period, the definitive restoration was fabricated using a Biocompatible High Performance Polymer (BioHPP) framework and Zirconia porcelain. Over a five-year follow-up period, all zygomatic and standard implants remained successful, with no evidence of inflammation, sinusitis, or bone loss. The final prosthetic rehabilitation significantly improved the patient's oral function and aesthetics, consequently enhancing quality of life and facilitating confident social integration and communication. The described protocol offers a feasible and predictable approach to managing severe atrophic edentulous cases, particularly in patients with ectodermal dysplasia.

Diprosopus (craniofacial duplication) is an exceedingly rare craniomaxillofacial dysmorphosis, considered a subgroup of conjoined twins, with phenotypes ranging from partial structural duplication to complete dicephalus. Its embryogenesis and molecular mechanisms remain poorly understood. This study describes a case of partial dentofacial duplication and reports novel genetic findings to explore potential etiology. A newborn Kazak male was referred for a prenatal-detected maxillary mass. Physical examination revealed left complete unilateral cleft lip and a 2.5 × 3.0cm soft tissue mass (accessory upper lip with a central sinus tract) originating from the ipsilateral upper lip. CT confirmed duplicated, translocated maxillary arches and widened nasal bone. The patient underwent two surgeries (at 11 months and 4 years of age) for cleft lip repair, duplicated maxilla excision, and bony contouring. Long-term follow-up showed unimpaired feeding and speech. Whole-exome sequencing (WES) of the patient and mother identified a shared heterozygous missense variant: PAX7 c.1033G > C (p.Ala345Pro, NM_001135254.1), classified as a variant of uncertain significance (VUS) per ACMG/AMP guidelines. This is the first report of a PAX7 VUS associated with craniofacial duplication. PAX7 plays critical roles in craniofacial development, and the conserved Ala345 residue suggests potential functional impact. While causality is not established, this finding links PAX7 to a rare duplication phenotype, providing a preliminary molecular basis for future prenatal screening and mechanistic studies. Additional functional validation and larger cohort studies are needed to confirm pathogenicity.

Accurate image registration is essential for successful digital dental implant planning. Surface-based registration, commonly used in clinical software, is sensitive to CBCT artifacts and relies on manual landmark selection, potentially reducing accuracy. Marker-based registration offers improved precision but is underused due to its technical complexity and time demands. The purpose of this ex-vivo study was to evaluate the accuracy of a novel marker-based registration method using limited-view CBCT reconstructions derived from two orthogonal projection images and to compare it with a conventional surface-based registration method. An ex-vivo model consisting of a maxillary arch with removable 3D-printed teeth and a radiographic guide containing radiographic markers was used to simulate five metal artifact conditions. Full-view CBCT scans were acquired for each condition. For the conventional method, three examiners independently performed dual-scan registrations using user-defined surface landmarks on full CBCT reconstructions. For the proposed method, examiners selected orthogonal projection images where markers were clearly visible and limited-view reconstructions were generated to identify marker centroids. Registration error was measured as the point-to-point distance between corresponding surface reference points, standardized to a common frame of reference. Inter-rater reliability was also assessed. Both methods maintained consistent performance across all artifact conditions. The proposed method demonstrated greater accuracy, with lower point-to-point registration errors and less spatial variation. Inter-rater reliability was excellent for the proposed method and good for the conventional approach. The proposed marker-based registration method using orthogonal projection images and limited-view CBCT reconstructions showed higher accuracy than conventional surface-based registration under controlled ex vivo conditions. Although the workflow currently requires additional examiner input, it may improve precision in dual-scan protocols for implant planning. Future clinical studies and software developments are required to support clinical implementation.

This study aimed to evaluate changes in the sagittal pharyngeal airway dimensions (SPAD) and the related mandibular position following maxillary levelling and alignment in late adolescent Class II division 2 (Class II/2) patients. Thirty Class II/2 patients (mean age 14.07 ± 1.21 years) were included. Pre-treatment orthodontic records were acquired, including panoramic and lateral cephalometric x-rays (T0), photographs, and study models, followed by the onset of levelling and alignment in the upper arch. Lateral cephalometric x-rays and photographs were repeated six months later at the termination of this stage (T1), and measurements were performed in comparison to T0. SPAD was assessed at the nasopharyngeal, oropharyngeal, and laryngopharyngeal levels. Mandibular position was evaluated using the Ba-Ar distance, while sagittal and vertical skeletal relationships were assessed using SNA°, SNB°, ANB°, and FMA°. Upper incisor inclination was accounted for using the U1-FH° measurement. Alignment of the maxillary arch in Class II/2 patients elicited a significant SPAD increase at the nasopharyngeal and the oropharyngeal levels (p < 0.001), with a non-significant change evoked at the laryngopharyngeal level (p = 0.42). Antero-posteriorly, a significant increase in the SNAº, SNBº, together with a significant decrease in the ANBº angle have been documented at T1. A significant increase in the Ba-Ar has been noted at T1 in contrast to T0, in addition to a significant reduction in the vertical dimension (FMAº). Dentally, a significant increase in the U1-FHº has been documented following the implemented treatment stage (p < 0.001). Results of this study may suggest that maxillary levelling and alignment in Class II/2 patients during the decelerating growth phase is associated with augmentation of the nasopharyngeal and oropharyngeal airways. These changes coincide with the significant labial tipping of the maxillary incisors and subsequent functional mandibular advancement, which collectively improve the intermaxillary relationship and reduce the vertical skeletal dimension. While natural growth cannot be entirely excluded, the rapid change suggests that these improvements are closely linked to the functional mandibular response. Maxillary alignment in Class II division 2 cases may enhance upper airway patency by triggering a forward functional mandibular response, highlighting a potential link between orthodontic correction and upper airway patency. Name of the Registry: ClinicalTrials.gov Trial Registration Number: NCT06602518 Date of Registration: 19/09/2024 "Retrospectively registered". URL: https://clinicaltrials.gov/study/NCT06602518?cond=nct06602518&rank=1.

ABSTRACT Background: Occlusal force differs between natural and rehabilitated dentition, affecting the load transferred to the bone. The concept of utilizing four implants to rehabilitate a maxillary arch using axial and tilted implants changed the perspective of implant-supported full arch rehabilitation. Occlusal load transmitted to the crestal bone is affected by the type of dentition or prosthesis opposing an arch. Currently, the dental literature lacks studies examining the relationship between crestal bone loss around all-on-four implants and varying opposing dentitions. Objective: To assess the impact of opposing dentition on the crestal bone changes around the peri implant region of Maxillary all-on-four implants. Methods: A retrospective case-control study of 24 maxillary all-on-four implant-supported prosthesis (ISP) samples was divided into 2 groups of 12 each: Group 1 opposing natural dentition and Group 2 opposing all-on-four ISP. Participants were rehabilitated with the same implant system and FP3 prosthesis, and were treated by a single clinician. Intra-oral periapical radiographs were taken with the paralleling cone technique to measure crestal bone loss. A Wilcoxon signed rank test was used within groups, and a Mann-Whitney U test between groups. Results: Crestal bone loss was observed in Group 1 tilted implants with a median of -0.64±0.52mm (P&lt;0.05), whereas crestal bone height increase was observed in Group 2 tilted implants with a median of 0.05±0.39mm. Comparison within group 2 showed a significant difference in the distal aspect of the tilted implants, with a mean bone loss of -0.48±0.38 mm in the mandibular arch (P&lt;0.05). In contrast, the mesial aspect of the mandibular implants showed bone gain. Conclusion: Maxillary all-on-four implants opposing natural dentition showed increased crestal bone loss compared to those opposing mandibular all-on-four implants. The bone changes around axial and tilted implants also varied, with more bone loss observed in maxillary tilted implants, opposing natural dentition.

This study evaluated and compared the accuracy of conventional alginate impressions and intraoral scans for orthodontic measurements and full-arch superimposition under clinical conditions with brackets and wires present. Intraoral scanners are increasingly used in orthodontics due to their advantages in efficiency, patient comfort, and digital workflow integration. However, concerns remain regarding their accuracy under clinical conditions, particularly in the presence of brackets and wires, which may introduce scanning artifacts. In vivo evidence evaluating their impact across sequential orthodontic stages remains limited. This in vivo study employed a within-subject comparative design, with conventional alginate models serving as the reference standard. Fifteen participants requiring orthodontic treatment were enrolled in this study. Five study models from each subject were obtained from (1) conventional alginate impression (Con), (2) intraoral scanning (Ios), (3) conventional alginate impression, (4) intraoral scanning after bonding with orthodontic brackets (ConBk and IosBk), and (5) intraoral scanning in subjects who were bonding with orthodontic brackets and wire insertion (IosBkW). The Con and ConBk models were poured and digitized using a laboratory scanner, while the intraoral scan data were exported as STL (Standard Tessellation Language) files. Linear measurements and superimposition analysis were performed in Ortho Analyzer software. Superimposition was performed using a landmark-guided registration protocol with standardized cross-sectional planes. Deviations were quantified as the maximum linear distance between corresponding cross-sectional profiles. Statistical comparisons were analyzed using Welch's analysis of variance and Games-Howell post hoc tests (p < 0.05). No statistically significant differences were observed in linear measurements between digital models obtained from intraoral scanners and conventional reference models across all orthodontic stages (p > 0.05). Intercanine and intermolar widths in both maxillary and mandibular arches showed high agreement with the conventional reference models, with minimal variations across conditions. For superimposition analysis, small but statistically significant deviations were detected in models with brackets and wires compared with the conventional reference (p < 0.001). However, these deviations were minor (-0.17 to -0.20 mm) and remained within clinically acceptable limits. Intraoral scanning can be confidently used throughout fixed-appliance therapy without removing brackets or wires when standardized scanning protocols are followed.

To analyze the compensatory characteristics and influencing factors of the maxillary arch curvature in the sagittal plane. A total of 537 pre-treatment cases with cone beam computed tomography (CBCT) and digital dental model were included. CBCT images and dental models were registered and fused to obtain landmark coordinates of the integrated models. On the midsagittal plane, maxillary arch was fitted separately on each side using clinical crown center points, indices reflecting maxillary arch morphology were measured. Generalized estimating equations (GEEs) and additional statistical analyses were employed to examine the relationship between maxillary arch curvature and its influencing factors. The gingival-directional intersection angle between the anterior and posterior segments of the maxillary arch in the sagittal plane (AC/PC) was smaller in adolescents (162.42° ± 6.38°) than adults (166.09° ± 6.93°). Differences were also observed among patients with varying degrees of crowding, overjet, and overbite. In GEE analyses accounting for within-subject clustering, age demonstrated a significant positive association with AC/PC (β = 1.781, P < 0.001), whereas the maxillomandibular plane angle (MP/PP) showed a significant negative association (β = -0.902, P < 0.001). With increasing age, the sagittal curvature of the maxillary arch tends to flatten, whereas greater curvature is associated with a larger maxillomandibular plane angle (MP/PP). Age and vertical skeletal relationships appear to play key roles in shaping sagittal maxillary arch morphology.

Maxillary Total Arch Distalization (MTAD) with interradicular mini-screws (MSs) in combination with Completely Customized Lingual Appliances (CCLAs) is an effective concept for Class II correction in adolescents and adults which does not require any additional supraconstructions. The aim of this study was to investigate the failure rates of MSs after strictly following a defined insertion protocol. From November 2015 to August 2025, a total of 958 interradicular MSs were inserted in the maxilla for MTAD in combination with a CCLA in one orthodontic specialist practice. The surgical procedures were performed by 8 different clinicians (6 orthodontist specialists/2 postgraduate students in orthodontics) on 283 patients (female: 199/male: 84) with an average age of 27.6 years, ±13.3. Premature loss was defined as any instance in which a MS required removal due to mobility or was lost spontaneously on a yes/no basis. Of the 958 interradicular mini-screws, 14 (1.5%) failed before schedule (palatal 13/buccal 1). No significant influence of the experience level of the clinicians (P = 0.394) on the mini-screw loss rate was observed. The highest loss rate was observed in the patients > 45 age group. One limitation is the retrospective study design, but no patient meeting the inclusion criteria was excluded for any reason. Interradicular mini-screws used as temporary anchorage devices for maxillary total arch distalization can exhibit comparably low failure rates (1.5%) to those placed in the anterior palate, provided that a well-established clinical protocol is strictly followed.

This study evaluated the longitudinal stability of transverse changes in patients treated with the Invisalign First system (IFS; Align Technology Inc, Tempe, Ariz) and hyrax expanders during the mixed dentition, followed through the permanent dentition. The objective was to determine whether expansion achieved during the mixed dentition was maintained through the transition to the permanent dentition. This retrospective longitudinal study included 119 patients: 44 patients treated with IFS, 36 patients treated with hyrax, and 39 untreated controls. Arch width changes at the canines, premolars, and first molars were measured on digital study models at 3 time points: pre-phase 1 treatment (T1), post-phase 1 treatment (T2), and pre-phase 2 evaluation (T3). Vertical skeletal changes were evaluated in a cephalogram subgroup. Statistical analyses included analysis of variance and linear mixed-effects models. Both IFS and hyrax groups showed greater maxillary arch width increases from T1 to T3 (IFS: 1.8-2.8 mm; hyrax: 2.2-3.7 mm) than controls (0.4-1.2 mm; P <0.0001). At T2, hyrax showed significantly greater interpremolar and intermolar expansion (4.1-4.8 mm) than IFS (1.9-2.8 mm), but more relapse from T2 to T3. The IFS group also showed increased mandibular arch width from T1 to T3 (1.9-2.9 mm) compared with controls (P <0.05). No significant vertical skeletal changes from T1 to T3 were observed. Both IFS and hyrax produced maxillary arch expansion that was maintained throughout the transition from mixed to permanent dentition. The IFS also showed stable mandibular arch expansion, supporting its use for mild crowding or transverse deficiencies without long-term vertical effects.

Inter-population variation in third molar agenesis and its effect on dental age estimation: Evidence from black and white South Africans.

Evaluation of presurgical infant orthopedics by the rhinoplasty appliance system with intraoral alveolar molding appliance in infants with bilateral cleft lip and palate: A preliminary study.

A sixty-eight-year-old male presented to the dental clinic seeking a complete mouth rehabilitation. He exhibited generalized dental caries, dental staining, cervical lesions, fremitus, and anterior wear. After declining tooth-retaining options, he elected full-mouth extractions with immediately loaded implant-supported prostheses. A hybrid workflow, incorporating both digital and conventional steps, was used to plan treatment. The cone-beam computed tomography-derived anatomical data were integrated with the articulated diagnostic casts using a custom three‑dimensional (3D)-printed hexagonal indexing device. The maxillary teeth were digitally removed to generate an edentulous cast, a cast of the maxilla generated from the segmented-CBCT data, and an artificial tooth arrangement. Subsequently, 3D-printed stackable surgical guides were fabricated to support extractions, osteotomy preparation, implant placement, and delivery of a milled polymethyl methacrylate interim prosthesis. A similar hybrid workflow was used for the mandibular arch, with an updated diagnostic maxillary arch compensating for occlusal changes introduced during the fabrication of the maxillary interim prosthesis. Implant positions were recorded using non-splinted and splinted intraoral scanning techniques, and verification casts were articulated to support fabrication of the definitive prostheses. The definitive, complete arch monolithic zirconia restorations demonstrated accurate fit, stable occlusion, and favorable soft-tissue contours. At the 1-year follow-up, radiographs showed stable peri-implant bone levels and clinically healthy peri-implant tissues, indicating favorable adaptation to the implant-supported prostheses.