GuidedSMILE Case Study: Upper Full Arch Rehabilitation

Background

A female patient in her early 70s presented with concerns regarding the appearance of her upper dentition. She was fit and well, with no significant medical history affecting treatment.

Approximately seven teeth remained in the upper arch. The anterior dentition was significantly proclined, with associated bone loss and gingival recession. The patient had been unhappy with the appearance of her smile for many years and was seeking a fixed treatment option.

Restoring the posterior spaces alone would not have addressed the position or prognosis of the remaining anterior teeth. Following clinical assessment and discussion of the available treatment options, an upper fixed full arch rehabilitation was selected.

The treatment plan involved extraction of the remaining upper teeth, implant placement and immediate delivery of a fixed provisional restoration, followed by a definitive zirconia restoration after healing.

Clinical Records

A complete set of records was collected before the case was submitted for GuidedSMILE planning.

These included:

• CBCT
• Intraoral scans
• Full smile photography
• Retracted photographs
• Occlusal photographs

The CBCT was reviewed with the patient as part of the treatment discussion, including the proposed implant positions and planned surgical approach.

Assessment of the available bone demonstrated favourable support within the anterior and premolar regions, allowing the implant distribution to be planned without extending further posteriorly.

The clinical records were then submitted to Quoris3D for digital planning.

Planning

The case was planned through the GuidedSMILE workflow before being returned to Dr Rajamani for clinical review and approval.

The planning process was prosthetically driven, with the proposed restorative outcome considered alongside the available bone, implant positions, restorative space and required bone reduction. The desired tooth position and prosthetic design were established first, allowing the implant positions to be optimised to provide appropriate support for the planned restoration.

Each implant position was assessed in relation to the available bone and surrounding anatomy, while also considering the required surgical access and the practical requirements of the guided procedure. Bone reduction was planned in conjunction with the implant positions and restorative requirements, ensuring that the surgical and prosthetic aspects of the case were considered as one coordinated plan.

This approach allowed the proposed implant positions, bone reduction and restorative outcome to be reviewed together before manufacture of the surgical components and provisional restoration. It also provided an opportunity to identify any potential limitations or considerations at the planning stage and address these before the patient reached surgery.

Following clinical review and approval of the plan by Dr Rajamani, the surgical guides, provisional prosthesis and components required for the conversion were prepared according to the approved design.

This structured approach helped create a more predictable transition from digital planning to guided surgery and immediate provisionalisation, with the surgical and restorative stages planned to work together from the outset.

Surgical Treatment

Treatment was carried out under local anaesthetic.

The degree of anterior tooth proclination presented an additional consideration at the beginning of surgery. A small number of teeth were initially extracted to allow the surgical guide to seat correctly.

A buccal flap was then raised, and the guide was positioned and secured. Stability of the guide was confirmed before the remaining teeth were extracted.

The fixed guide provided the reference for the planned bone reduction. The reduction was completed and verified against the planned restorative position before progressing to implant placement.

The osteotomy guide was then seated, and the implants were placed according to the approved digital plan.

Following implant placement, the multi-unit abutments and temporary cylinders were fitted and the provisional restoration was converted chairside.

The surgical sites were closed and the fixed provisional restoration was fitted on the day of surgery.

The immediate restoration allowed the patient to leave surgery with a fixed upper prosthesis.

Healing and Review

Postoperative care included medication to manage inflammation and discomfort, together with instructions to maintain a soft diet during the healing period.

The patient was contacted by the practice shortly after surgery and reviewed clinically. Some postoperative bruising was present, consistent with the extent of surgery, with no concerns identified regarding the initial healing.

Further reviews were completed at approximately two weeks and six weeks.

The provisional restoration remained in place throughout the healing period and the patient was advised to maintain a soft diet for approximately three months to minimise loading of the temporary prosthesis.

Following the three-month healing period, the case progressed to the definitive restorative stage.

Restorative Stage

At the restorative appointment, the provisional restoration was assessed clinically with the patient.

Tooth shape, appearance and colour were reviewed before progressing to the definitive restoration. The patient was satisfied with the provisional design and requested no aesthetic changes.

A second provisional prosthesis, produced at the time of the original surgery and retained by the practice, was used while the restorative records were completed.

The records included:

• Bite registration
• Clinical photographs
• Shade information
• Confirmation of the approved provisional design

These were returned to Quoris3D for manufacture of the definitive restoration.

As no changes to the provisional design were required, the case was able to progress to the final zirconia restoration without an additional aesthetic try-in.

Final Restoration

The definitive upper zirconia restoration was fitted following completion of the laboratory stage.

The approved provisional restoration had provided a clear reference for the final tooth position, shape, colour and occlusion, allowing the agreed design to be transferred into the definitive prosthesis.

The final restoration completed the patient's upper full arch rehabilitation following approximately three months of healing.

Outcome

The treatment replaced a compromised upper dentition with a fixed implant-supported restoration while addressing the patient's long-standing aesthetic concerns.

The patient reported a significant improvement in confidence following treatment and subsequently provided a video testimonial describing the impact the treatment had made.

From a clinical perspective, Dr Rajamani highlighted the value of having a clearly sequenced workflow and additional support during treatment planning.

The GuidedSMILE protocol provided defined stages from initial records and digital planning through bone reduction, implant placement, immediate provisionalisation and final restoration.

Each stage also provided a point at which the clinical result could be checked before progressing, helping to maintain consistency between the surgical plan and the intended restorative outcome.