Monolithic Zirconia Full-Arch Rehabilitation Using Digital Technology

Menoufia University

Status: Completed

Conditions: Edentulous Jaw

Treatments: Device: Motion-Integrated, Fully Digital Full-Arch Implant Rehabilitation Combining Maxillary M-4 and Mandibular All-on-4 Protocols with Monolithic Zirconia Prostheses

Study type: Interventional

Funder types: Other

Identifiers

NCT07369583

ADMNF-0050

Details and patient eligibility

About

20 edentulous patients presented for full-arch rehabilitation and was managed using a motion-integrated, fully digital workflow that combined the M-4 protocol in the maxilla with the All-on-4 concept in the mandible. Dual-scan CBCT and facial scans enabled prosthetically driven planning, while stackable and mucosa-supported surgical guides facilitated precise implant placement. Real-time jaw-motion data were incorporated into the design process to individualize occlusion, and definitive monolithic zirconia prostheses were fabricated and delivered on titanium multi-unit abutments using Rosen screws.

Full description

20 edentulous patients sought comprehensive full-arch rehabilitation to improve function, esthetics, and overall oral comfort. Management was performed using a fully digital, motion-integrated workflow that strategically combined two established implant protocols: the M-4 technique in the maxilla to maximize anterior anchorage in areas of limited bone volume, and the All-on-4 concept in the mandible to provide stable posterior support with tilted distal implants. Treatment planning began with dual-scan CBCT imaging and high-resolution facial scans, allowing accurate alignment of skeletal, dental, and soft-tissue datasets for prosthetically driven virtual design. A stackable guide system was employed in the maxilla to sequentially guide fixation, osteotomy preparation, and implant placement, whereas a mucosa-supported guide was used in the mandible to ensure stable positioning on the residual ridge. During the prosthetic phase, real-time mandibular motion was recorded and integrated into the CAD software to refine occlusal morphology according to the patient's functional movements. Definitive monolithic zirconia full-arch prostheses were then digitally fabricated and secured to titanium multi-unit abutments using Rosen screws, providing a rigid, precise, and metal-free restorative solution. This coordinated workflow addressed both functional and esthetic demands, enabling an efficient, patient-specific approach to immediate full-arch rehabilitation.

Enrollment: 20 patients

Sex: All

Ages: 40 months to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Adults aged 40-65 years with edentulism in one or both arches.
• Adequate bone volume in the anterior maxilla for M-4 protocol and mandible for All-on-4 placement.
• Willingness to undergo full-arch implant rehabilitation using a digital workflow.
• Ability to provide informed consent and comply with study procedures.

Exclusion criteria

• Systemic conditions contraindicating implant surgery (e.g., uncontrolled diabetes, immunosuppression).
• Active oral infections or untreated periodontal disease.
• Heavy smokers (>10 cigarettes/day) or substance abuse.
• History of head and neck radiation therapy or bisphosphonate use.
• Pregnancy or breastfeeding.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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20 participants in 1 patient group

Motion-integrated digital full-arch rehabilitation (M-4 maxilla / All-on-4 mandible)

Experimental group

Description:

A fully digital, motion-integrated implant rehabilitation protocol combining the M-4 concept in the maxilla and the All-on-4 concept in the mandible. The arm included prosthetically driven planning using CBCT, intraoral and facial scanning, stackable and mucosa-supported surgical guides, immediate loading, jaw-motion tracking-guided occlusal design, and definitive monolithic zirconia full-arch prostheses connected to titanium multi-unit abutments.

Treatment:

Device: Motion-Integrated, Fully Digital Full-Arch Implant Rehabilitation Combining Maxillary M-4 and Mandibular All-on-4 Protocols with Monolithic Zirconia Prostheses