Use of monolithic zirconia for graftless full-arch rehabilitations: a clinical case

OBJECTIVES The severe atrophic maxilla reha bilitation with dental implants can be an actual challenge for clini cians, both by surgical and pros thetic point of view. The constant evolution of digital technologies and the increasing improvement of graftless techniques and devic es (e.g., zygomatic, pterygoid, na sal and short implants, etc.) allow clinicians to treat complex cases with no need of extensive bone re generation procedures. The use of monolithic zirconia is improving the graftless im plant-prosthetic solutions for the following characteristics: high mechanical strength; high wear resistance; high aesthetic thanks to micro-stratifications; functional information maintenance; high biocompatibility. The aim of this work is to present the rehabilitation of a complex graftless case with a hybrid pros thetic solution, fabricated with a CAD/CAM procedure joining two materials: monolithic zirconia for the esthetic part and titanium for the underlying structure. MATERIALS AND METHODS We present the case report of a 62-years-old man with previous multiple implant-prosthetic reha bilitations failures. After the digital planning, we have removed the failed restorations and hopeless teeth, and placed 6 implants in mandible and 6 implants in max illa (4 zygomatic and 2 pterygoid implants). The fixed prosthetic re habilitations were made using the “zirconia on zirconia on titanium” protocol, a hybrid solution fabri cated with a CAD/CAM procedure by joining two materials: mono lithic zirconia for the anatomical part and a titanium structure. RESULTS AND CONCLUSIONS The key elements of full-arch re habilitations should be a multidis ciplinary approach, an accurate diagnostic process which allows a correct patients’ selection, the use of digital technologies for a fully guided surgery, and a predictable immediate-loading protocol. In the present case report after 2 years of follow-up, the im plant-prosthetic rehabilitation showed excellent functional and esthetic outcomes, and the pa tient was fully satisfied. CLINICAL SIGNIFICANCE Monolithic zirconia showed excel lent functional and esthetic prop erties for graftless implant-pros thetic rehabilitations. Moreover, the digital workflow allows clini cians to accurately plan the surgi cal procedures of implant place ment, making it simpler the fol lowing prosthetic procedures.